RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 1

TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501040 ARM SLING L 00432 1796-13-10 3.72 EA=1EA .00 1 00000000 65.00
ARM SLING L 37.16 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000615 1 X 2 5/8 WHITE LABLES 816 00499 UNV80201 9.99 PK=1PK .00 1 00000000 .00
1 X 2 5/8 WHI 9.99 PK=1PK/PK 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000614 1"X 2 5/8 CLEAR LABELS 866 00499 AVE8660 23.99 PK=1PK .00 1 00000000 .00
1"X 2 5/8 CLE 23.99 PK=1PK/PK 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000739 1.2 GAL CAP ROOM HUMIDIFIE 01304 4714100HF 31.91 EA=1EA .00 1 00000000 93.00
1.2 GAL CAP R 31.91 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000754 100FT ROLL-SEG 6"-COR TUB 01304 301150 11.70 EA=1EA .00 1 00000000 69.00
100FT ROLL-SE 11.70 RL=1EA/RL 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500512 2WAY CATH 12FR. FOLEY 5CC 00249 S512 4.3092 EA=1EA .00 1 00000000 44.00
2WAY CATH 12F 51.71 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500513 2WAY CATH 14FR 5CC BALLON 00249 DYND11501 4.3092 EA=1EA .00 1 00000000 44.00
2WAY CATH 14F 51.71 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500514 2WAY CATH 16FR 5CC BALLON 00249 DYND11502 4.3092 EA=1EA .00 1 00000000 44.00
2WAY CATH 16F 51.71 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 2
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500499 2WAY CATH 16FR FOLEY 30CC 00249 S186 4.91 EA=1EA .00 1 00000000 35.00
2WAY CATH 16F 58.89 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500515 2WAY CATH 18FR 5CC BALLON 00249 DYND11503 4.3092 EA=1EA .00 1 00000000 44.00
2WAY CATH 18F 51.71 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500500 2WAY CATH 18FR FOLEY 30CC 00249 S618 4.91 EA=1EA .00 1 00000000 35.00
2WAY CATH 18F 58.89 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500516 2WAY CATH 20FR 5CC BALLON 00249 S520 1.31 EA=1EA .00 1 00000000 44.00
2WAY CATH 20F 15.66 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500501 2WAY CATH 20FR FOLEY 30CC 00249 S620 4.91 EA=1EA .00 1 00000000 35.00
2WAY CATH 20F 58.89 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500517 2WAY CATH 22FR 5CC BALLON 00249 DYND11504 4.3092 EA=1EA .00 1 00000000 44.00
2WAY CATH 22F 51.71 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500502 2WAY CATH 22FR FOLEY 30CC 00249 S622 1.18 EA=1EA .00 1 00000000 35.00
2WAY CATH 22F 14.13 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500518 2WAY CATH 24FR 5CC BALLON 00249 S524 1.31 EA=1EA .00 1 00000000 44.00
2WAY CATH 24F 15.66 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 3
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500503 2WAY CATH 24FR FOLEY 30CC 00249 S624 1.18 EA=1EA .00 1 00000000 35.00
2WAY CATH 24F 14.13 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500519 2WAY CATH 26FR 5CC BALLON 00249 S526 1.31 EA=1EA .00 1 00000000 44.00
2WAY CATH 26F 15.66 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500520 2WAY CATH 28FR 5CC BALLON 00249 S528 .28 EA=1EA .00 1 00000000 44.00
2WAY CATH 28F 3.40 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500504 2WAY CATH 28FR FOLEY 30CC 00249 S628 .28 EA=1EA .00 1 00000000 35.00
2WAY CATH 28F 3.40 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500521 2WAY CATH 30FR 5CC BALLON 00249 265730 .28 EA=1EA .00 1 00000000 44.00
2WAY CATH 30F 3.40 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500505 2WAY CATH 30FR FOLEY 30CC 00249 S630 1.21 EA=1EA .00 1 00000000 35.00
2WAY CATH 30F 14.49 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001016 3-0 VICRYL J416H 00257 23000J416H 44.995 BX=1BX .00 1 00000000 .00
3-0 VICRYL J4 44.995 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000759 340 ML HUMIDIFIER W/ ADAPT 01304 36-003-40 1.01 EA=1EA .00 1 00000000 12.00
340 ML HUMIDI 20.12 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 4
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500506 3WAY CATH 16FR 30CC 00249 DYND11572 7.3233 EA=1EA .00 1 00000000 63.00
3WAY CATH 16F 87.88 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500507 3WAY CATH 18FR 30CC 00249 DYND11573 7.3233 EA=1EA .00 1 00000000 63.00
3WAY CATH 18F 87.88 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500508 3WAY CATH 20FR 00249 PS720 3.70 EA=1EA .00 1 00000000 63.00
3WAY CATH 20F 44.37 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500509 3WAY CATH 22FR 30CC 00249 DYND11575 7.3233 EA=1EA .00 1 00000000 63.00
3WAY CATH 22F 87.88 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500510 3WAY CATH 24FR 00249 06200167L24 8.82 EA=1EA .00 1 00000000 63.00
3WAY CATH 24F 105.78 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500511 3WAY CATH 26FR 00249 2D2655 2.85 EA=1EA .00 1 00000000 63.00
3WAY CATH 26F 34.20 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000764 760ML NEB W/ADAPTER (HUMI 01304 04-3D0808 3.29 EA=1EA .00 1 00000000 78.00
760ML NEB W/ 39.51 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500471 ABDOMIBAL BINDER 60-75 IN 00249 1821000818 22.06 EA=1EA .00 1 00000000 166.00
ABDOMIBAL BIN 22.06 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 5
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500468 ABDOMINAL BINDER 12" 00249 MDS169028 17.66 EA=1EA .00 1 00000000 166.00
ABDOMINAL BIN 17.66 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500470 ABDOMINAL BINDER 58-442 00249 58442 11.90 EA=1EA .00 1 00000000 166.00
ABDOMINAL BIN 11.90 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500467 ABDOMINAL BINDER 9" 00249 MDS169022 12.69 EA=1EA .00 1 00000000 166.00
ABDOMINAL BIN 12.69 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500469 ABDOMNIAL BINDER 9"58432 00249 58432 9.52 EA=1EA .00 1 00000000 166.00
ABDOMNIAL BIN 9.52 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501141 ABDUCTION PILLOW 00249 17.09 EA=1EA .00 1 00000000 185.00
ABDUCTION PIL 102.52 CS=6EA/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500985 ACUDYNE SWABSTICKS 00249 MDS093901ZZ .2044 EA=1EA .00 1 00000000 .00
ACUDYNE SWABS 10.22 BX=50/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501001 ADAPTIC 3X3 00249 CUR250330Z .2074 EA=1EA .00 1 00000000 8.00
ADAPTIC 3X3 10.37 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501002 ADAPTIC 3X8 00249 CUR250381Z .5342 EA=1EA .00 1 00000000 32.00
ADAPTIC 3X8 12.82 BX=24EA/BX 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:Y MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 6
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000326 ADHERENT DRAPE 92-0500 2.22 EA=1EA .00 1 00000000 .00
ADHERENT DRAP 55.51 BX=25EA/BX 25 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001228 ADHESIVE MEDICAL SPRAY 00257 3158007730 11.41 EA=1EA .00 1 00000000 .00
ADHESIVE MEDI 45.62 BX=4EA/BX 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2800006 ADJACENT TISSUE TRANSFER OR REARRANG .00 EA= .00 1 00000000 1467.00
ADJACENT TISS .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 14000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800011 ADJACENT TISSUE TRANSFER OR REARRANG .00 EA= .00 1 00000000 1211.00
ADJACENT TISS .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 14000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
80001003 ADMISSION KIT 00249 DYKD2002A 2.4525 EA=1EA .00 1 00000000 .00
ADMISSION KIT 29.43 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000762 ADULT AEROSOL MASK 00396 301-170EA .4968 EA=1EA .00 1 00031110 49.00
ADULT AEROSOL 00249 HCS4630B 24.84 CS=50EA/CS 50 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2504032 ADULT BP CUFF 00249 MDS9913HP 2.954 EA=1EA .00 1 00000000 .00
ADULT BP CUFF 14.77 PK=5EA/PK 5 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 2.954 1 .00 3 00000000 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 7
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90000763 ADULT NASAL CANNULA 7’ 00396 301-100EA .4694 EA=1EA .00 1 00031110 35.00
ADULT NASAL C 00249 HCS4514 23.47 CS=50EA/CS 50 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000760 ADULT NON-REBREATHER 01304 301181 .7226 EA=1EA .00 1 00031110 69.00
ADULT NON-REB 36.13 CS=50EA/CS 50 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501339 ADULT SLIPPERS XXL 00249 MDT211218XXLI 1.0215 EA=1EA .00 1 00031110 7.50
ADULT SLIPPER 00304 6239LG 49.03 CS=48EA/CS 48 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500039 ADULT WIPES 00249 MSC263810 1.5171 EA=1EA .00 1 00031110 16.00
ADULT WIPES 00062 10-710 36.41 CS=24EA/CS 24 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001537 AERO CHAMBERS 01304 317-621-210 101.46 CS=1CS .00 1 00031110 150.00
AERO CHAMBERS 101.46 CS=1CS 1 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501021 AIRCAST LEFT 00123 02BLK 25.41 EA=1EA .00 1 00000000 425.00
AIRCAST LEFT 00249 ARC02BLK 25.41 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501022 AIRCAST RIGHT 00123 02BRK 31.46 EA=1EA .00 1 00000000 425.00
AIRCAST RIGHT 00249 ARC02BRK 31.46 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500142 AIRWAY 100MM 00249 DYND60425 .2267 EA=1EA .00 1 00031110 32.00
AIRWAY 100MM 2.72 BX=12EA/BX 12 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 8
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500143 AIRWAY 110MM 0249 5568122006 .3233 EA=1EA .00 1 00031110 14.00
AIRWAY 110MM 3.88 BX=12EA/BX 12 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500137 AIRWAY 40MM 00249 6697-002041 .18 EA=1EA .00 1 00031110 14.00
AIRWAY 40MM 2.21 BX=12EA/BX 12 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500138 AIRWAY 60MM 00249 DYND60410 .2267 EA=1EA .00 1 00031110 14.00
AIRWAY 60MM 2.72 BX=12EA/BX 12 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500139 AIRWAY 70MM 00249 6697412071 .21 EA=1EA .00 1 00031110 14.00
AIRWAY 70MM 2.52 BX=12EA/BX 12 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500140 AIRWAY 80MM 00249 DYND60415 .2267 EA=1EA .00 1 00031110 14.00
AIRWAY 80MM 2.72 BX=12EA/BX 12 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500141 AIRWAY 90MM 00249 6697412091 .21 EA=1EA .00 1 00031110 14.00
AIRWAY 90MM 2.52 BX=12EA/BX 12 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000209 ALCOHOL 00249 MDS098003Z .9875 EA=1EA .00 1 00000000 .00
ALCOHOL 11.85 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000001 ALCOHOL PREP 00249 KDL5750 1.0175 BX=1BX .00 1 00000000 .00
ALCOHOL PREP 00074 KC5033 20.35 CS=20BX/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 9
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001276 ALLEN WRIST SPLINT LG. 00123 79-71047 18.20 EA=1EA .00 1 00000000 41.00
ALLEN WRIST S 00249 ORT33600L 18.20 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001275 ALLEN WRIST SPLINT SM. 00249 SDJ7971043 9.74 EA=1EA .00 1 00000000 41.00
ALLEN WRIST S 9.74 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000367 ALLERGIC TO LABEL 00783 59704578 48.06 BX=1BX .00 1 00000000 .00
ALLERGIC TO L 48.06 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501526 ALOE VESTA BODY WASH &SHAM 00249 MSC095348 .3583 EA=1EA .00 1 00000000 .00
ALOE VESTA BO 00062 82-0994 17.20 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001499 AMBU BAG ADULT 00396 520-612-000 13.28 EA=1EA .00 1 00031110 65.00
AMBU BAG ADUL 00249 CPRM1116 79.68 CS=6EA/CS 6 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001432 AMPLATZ WIRE 00058 46-525 40.654 EA=1EA .00 1 00000000 102.00
AMPLATZ WIRE 203.27 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500374 ANKLE BRACE LG 00420 176705 15.18 EA=1EA .00 1 00000000 161.00
ANKLE BRACE L 15.18 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500373 ANKLE BRACE MED 00420 176704 15.66 EA=1EA .00 1 00000000 161.00
ANKLE BRACE M 15.66 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 10
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500372 ANKLE BRACE SM 00420 176703 13.50 EA=1EA .00 1 00000000 161.00
ANKLE BRACE S 13.50 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1444950 APPENDECTOMY .00 EA= .00 1 00000000 2221.00
APPENDECTOMY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44950 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444960 APPENDECTOMY RUPTURED OPEN .00 EA= .00 1 00000000 2776.00
APPENDECTOMY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44960 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
90001185 AQUACEL AG 4X4 00257 1638177902 10.39 EA=1EA .00 1 00000000 14.00
AQUACEL AG 4X 103.86 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500069 ARM BOARD INFANT 00249 NON24288H .60 EA=1EA .00 1 00000000 20.00
ARM BOARD INF .60 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501038 ARM SLING CHILD 00249 ORT11400SD 5.86 BX=1BX .00 1 00000000 65.00
ARM SLING S 23.44 BX=4EA/BX 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500071 ARMBOARD 18" 00249 NON24291H 1.42 EA=1EA .00 1 00000000 20.00
ARMBOARD 18" 1.42 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 11
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500070 ARMBOARD 9" 00249 5189450010 .39 EA=1EA .00 1 00000000 20.00
ARMBOARD 9" 39.00 CS=100EA/CS 100 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500038 ART LINE ARM BD 00249 18686010 6.00 EA=1EA .00 1 00000000 45.00
ART LINE ARM 120.06 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000736 ASMAPLANT STAND PEAK FLOW 01304 26111300 10.00 EA=1EA .00 1 00000000 48.00
ASMAPLANT STA 100.00 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001028 ATRAC-TAIN CREAM 5OZ TUBE 00249 COL1814 5.1238 EA=1EA .00 1 00000000 25.00
ATRAC-TAIN CR 61.485 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500404 BANDAGE ACE 2" 00249 MDS046002 .2944 EA=1EA .00 1 00000000 5.00
BANDAGE ACE 2 14.72 BX=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500405 BANDAGE ACE 3" 00249 MDS046003 .3758 EA=1EA .00 1 00000000 7.00
BANDAGE ACE 3 18.79 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500406 BANDAGE ACE 4" 00249 MDS087004LF .4236 EA=1EA .00 1 00000000 9.00
BANDAGE ACE 4 21.18 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500407 BANDAGE ACE 6" 00249 MDS046006 .7446 EA=1EA .00 1 00000000 14.00
BANDAGE ACE 6 37.23 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 12
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001277 BANDAID 1" 00249 NON25600 1.10 BX=1BX .00 1 00000000 .00
BANDAID 1" 13.20 CS=12BX/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001678 BANDAID 2" 00249 NON25504 2.3242 BX=1BX .00 1 00000000 .00
BANDAID 2" 27.89 CS=12BX/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001176 BARALYME 00299 32-55-001-0006 94.75 CS=1CS .00 1 00000000 .00
BARALYME 94.75 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001179 BARRIER WIPES 00257 1638037439 5.79 BX=1BX .00 1 00000000 .00
BARRIER WIPES 5.79 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500150 BASIN 7QT 00249 DYND80347 .2964 EA=1EA .00 1 00000000 14.00
BASIN 7QT 00062 93-H36210 14.82 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001093 BATTERY 9V 00249 DRCPC1604Z .6988 EA=1EA .00 1 00000000 .00
BATTERY 9V 00361 810694 8.386 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001092 BATTERY AAA 00249 DRCPC2400Z .1982 EA=1EA .00 1 00000000 .00
BATTERY AAA 4.756 BX=24EA/BX 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001309 BATTERY C 00249 DRCPC1400Z .4588 EA=1EA .00 1 00000000 .00
BATTERY C 5.505 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 13
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001310 BATTERY D 00249 DRCPC1300Z .605 EA=1EA .00 1 00000000 .00
BATTERY D 7.26 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001020 BATTERY-AA 00249 DRCPC1500 .1963 EA=1EA .00 1 00000000 .00
BATTERY-AA 00052 EVEE91SBP36H 28.26 CS=144EA/CS 144 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
4111334 BB TRANSFUSE BLOOD PRODUCT .00 EA= 1.00 1 00000000 1063.00
TRANSFUSE BLD .00 .00 2 00000000 .00
....P..... 6B(0391) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36430 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2500003 BEDPAN 00249 DYND80245 .4694 EA=1EA .00 1 00000000 36.00
BEDPAN 00062 541-5072-0000 23.47 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500004 BEDPAN FRACTURE 00249 DYNC8521 .5696 EA=1EA .00 1 00000000 39.00
BEDPAN FRACTU 13.67 CS=24EA/CS 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500556 BENSON WIRE 180CM 00104 G01431 11.50 EA=1EA .00 1 00000000 128.00
BENSON WIRE 1 00058 49-147 11.50 EA=1EA/EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000072 BIO-HAZ BAG 6X9 00249 DYND30261 4.715 PK=1PK .00 1 00000000 .00
BIO-HAZ BAG 6 00084 SB69BZ 47.15 CS=10PK/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 14
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500472 BIO-PATCH DRESSING 00249 J-J4150Z 7.50 EA=1EA .00 1 00000000 115.00
BIO-PATCH DRE 75.00 BX=10EA/BX 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000339 BIOHAZARD BAG 17X17 00249 NON151717 56.12 CS=1CS .00 1 00000000 .00
BIOHAZARD BAG 56.12 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000340 BIOHAZARD BAG 40X46 00249 HTBA8046ZR 55.20 CS=1CS .00 1 00000000 .00
BIOHAZARD BAG 00146 14-828-89 55.20 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001332 BIOHAZARD BAGS 24X33 00249 NON122433 5.748 RL=1RL .00 1 00000000 .00
BIOHAZARD BAG 57.48 CS=10RL/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2800015 BIOPSY OR EXCISION OF LYMPH NODE OPE .00 EA= .00 1 00000000 617.00
BIO EXC LYMPH .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 38500 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
90001345 BIOPSY SKIN PUNCH 2MM 00285 DD-2MM 25.00 BX=1BX .00 1 00000000 20.00
BIOPSY SKIN P 25.00 BX=1BX 1 .00 2 00000000 .00
.......... 44(0272) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001344 BIOPSY SKIN PUNCH 4MM 00285 DD-4MM 25.00 BX=1BX .00 1 00000000 20.00
BIOPSY SKIN P 25.00 BX=1BX 1 .00 2 00000000 .00
.......... 44(0272) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 15
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499415 BIOPSY SOFT TISSUE OF NECK OR THORAX .00 EA= .00 1 00000000 382.00
BIOPSY SOFT T .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 21550 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800012 BIOPSY SOFT TISSUE OF THIGH OR KNEE .00 EA= .00 1 00000000 430.00
BIOPSY SOFT O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 27323 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
90001404 BLOOD GAS CARTRIDGE 00316 945-713 807.84 EA=1EA .00 1 00000000 .00
BLOOD GAS CAR 807.84 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001459 BLUNT FILL NEEDLE 00249 B-D305180 6.601 BX=1BX .00 1 00000000 .00
BLUNT FILL NE 66.01 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001638 BLUNT FILTER NEEDLE 00249 B-D305211Z 19.90 BX=1BX .00 1 00000000 .00
BLUNT FILTER 19.90 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500073 BONE MARROW NEEDLE 00249 0707DIN1515X 11.03 EA=1EA .00 1 00000000 135.00
BONE MARROW N 110.30 CS=10EA/CS 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001503 BP CUFF ISOLATION 00328 39203 3.82 EA=1EA .00 1 00000000 .00
BP CUFF ISOLA 76.32 BX=20EA/BX 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 16
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500033 BUTTERFLY 19GA X7/8 00249 45900101 .54 EA=1EA .00 1 00000000 16.00
BUTTERFLY 19G 26.95 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500034 BUTTERFLY 25GA X1/2 00249 B-D367298Z .5814 EA=1EA .00 1 00000000 36.00
BUTTERFLY 25G 29.07 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501518 BUTTERFLY SETS 21GA. 00249 723367296 .59 EA=1EA .00 1 00000000 16.00
BUTTERFLY SET 29.67 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2146226 C-QUR/TACSHIELD MESH 4X6 00249 BAR9001C0212 .00 EA=1EA .00 1 00000000 2325.00
CQURTASMESH4X 00043 9001C0212 .00 BX=10EA/BX 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: C1781 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
80000653 CALCULATOR TAPE-2 1/4 00499 UNV35715 .9992 EA=1EA .00 1 00000000 .00
CALCULATOR TA 11.99 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500056 CARRA-KLENZ 00249 CRR102060 2.7892 EA=1EA .00 1 00000000 144.00
CARRA-KLENZ 33.47 CS=12EA/CS 12 .00 2 00000000 .00
.......... 78(0250) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500408 CAST PADDING 2" 00420 889002 .60 EA=1EA .00 1 00000000 9.00
CAST PADDING 12.00 BG=20EA/BG 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 17
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500409 CAST PADDING 3" 00249 MDS067003Z 1.5917 BG=1BG .00 1 00000000 12.00
CAST PADDING 19.10 BG=12/BG 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500410 CAST PADDING 4" 00249 MDS067004Z 1.8808 EA=1EA .00 1 00000000 20.00
CAST PADDING 22.57 BG=12EA/BG 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500411 CAST PADDING 5" 00420 889005 3.29 EA=1EA .00 1 00000000 24.00
CAST PADDING 65.79 BG=20EA/BG 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000974 CASTILE SOAP 00249 MDS001005H .76 EA=1EA. .00 1 00000000 .00
CASTILE SOAP .76 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501223 CATH 10FR PED 00249 DYND11710 3.65 EA=1EA .00 1 00031110 44.00
CATH 10FR PED 43.77 BX=12EA/BX 12 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500531 CATH 16FR 5CC COUDE 00249 DYND11216 4.2158 EA=1EA .00 1 00000000 49.00
CATH 16FR 5CC 50.59 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: C1758 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2500529 CATH 22FR 30CC TELFON 3WA 00249 0167V22S 12.77 EA=1EA .00 1 00000000 44.00
CATH 22FR 30 153.20 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 18
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500532 CATH 22FR 5CC COUDE 00249 0168L22 1.22 EA=1EA .00 1 00000000 49.00
CATH 22FR 5CC 14.69 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: C1758 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2500530 CATH 24FR 30CC TEFLON 3WAY 00249 0167V24 12.77 EA=1EA .00 1 00000000 63.00
CATH 24FR 30C 153.20 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501222 CATH 8FR PED 00249 DYND11708 3.18 EA=1EA .00 1 00031110 44.00
CATH 8FR PED 38.14 BX=12EA/BX 12 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501014 CATH FOLEY 2WAY 26 FR 00249 5626 1.21 EA=1EA .00 1 00000000 35.00
CATH FOLEY 2W 14.49 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500526 CATH FOLEY 2WAY 30FR 30CC 00249 0166SI30 10.65 EA=1EA .00 1 00000000 35.00
CATH FOLEY 2W 127.80 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500522 CATH FOLEY 30CC 16FR SILVE 00249 06200166S116 11.22 EA=1EA .00 1 00000000 35.00
CATH FOLEY 30 134.61 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500523 CATH FOLEY 30CC 18FR SILVE 00249 06200166S118 11.22 EA=1EA .00 1 00000000 35.00
CATH FOLEY 30 134.61 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 19
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500524 CATH FOLEY 30CC 20FR SILVE 00249 06200166S120 11.22 EA=1EA .00 1 00000000 35.00
CATH FOLEY 30 134.61 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500525 CATH FOLEY 30CC 22FR SILVE 00249 06200166S122 11.51 EA=1EA .00 1 00000000 35.00
CATH FOLEY 30 138.07 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500528 CATH FOLEY 30CC 30FR SILVE 00249 016SS128 10.65 EA=1EA .00 1 00000000 44.00
CATH FOLEY 30 127.80 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500527 CATH FOLEY 5CC 28FR SILVER 00249 01655I30 10.65 EA=1EA .00 1 00000000 44.00
CATH FOLEY 5C 127.80 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500095 CATH MALE LG TEXAS 00249 RCH33304 .816 EA=1EA .00 1 00000000 39.00
CATH MALE LG 24.48 BX=30EA/BX 30 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500094 CATH MALE MED TEXAS 00249 DYND12302 .6288 EA=1EA .00 1 00000000 39.00
CATH MALE MED 15.72 CS=25EA/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500976 CATH PLUG 00249 76 .32 EA=1EA .00 1 00000000 6.00
CATH PLUG 80.24 CS=250EA/CS 250 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000977 CATH STRIP 00249 DERCS50Z 1.4352 EA=1EA .00 1 00000000 .00
CATH STRIP 71.76 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 20
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500996 CATH TRAY ADD-A FOLEY 00249 DYND11020 8.696 EA=1EA .00 1 00000000 288.00
CATH TRAY ADD 86.96 CS=10EA/CS 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501114 CATH. PED. 6FR. 00249 DYND11706 3.18 EA=1EA .00 1 00000000 44.00
CATH. PED. 6F 38.14 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001523 CAVICIDE 00249 MAP131150 5.5956 EA=1EA .00 1 00000000 .00
CAVICIDE 67.1466 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500050 CENTRAL VENOUS SET 00310 CS04300 21.50 EA=1EA .00 1 00000000 232.00
CENTRAL VENOU 107.48 CS=5EA/CS 5 .00 2 00000000 .00
.......... 50(0278) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: C1751 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2501227 CERVICAL RIGID COLLAR PED. 00420 167601 11.88 EA=1EA .00 1 00000000 183.00
CERVICAL RIGI 11.88 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501225 CERVICAL RIGID COLLAR TALL 00432 167605 14.10 EA=1EA .00 1 00000000 183.00
CERVICAL RIGI 14.10 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501226 CERVICAL RIGID REGULAR 00432 1676-04-00 14.10 EA=1EA .00 1 00000000 412.00
CERVICAL RIGI 14.10 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 21
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1443760 CHANGE OF GASTOSTOMY TUBE PERCUTANIO .00 EA= .00 1 00000000 392.00
CHANGE OF GAS .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43760 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2504034 CHILD BP CUFF 00249 MDS9911HP 3.558 EA=1EA .00 1 00000000 .00
CHILD BP CUFF 17.79 PK=5EA/PK 5 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 3.558 1 .00 3 00000000 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000689 CHINSTRAP FOR BIPSP/CPSP 01304 73302175 18.90 EA=1EA .00 1 00000000 59.00
CHINSTRAP FOR 18.90 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501423 CHLORAPREP 26ML. 00249 MDF260815 5.6012 EA=1EA .00 1 00000000 122.00
CHLORAPREP 26 140.03 CS=25EA/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001493 CHLORASCRUB SWABS 00249 NPKB10800z 10.43 BX=1BX .00 1 00000000 .00
CHLORASCRUB S 10.43 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1447562 CHOLECYSTECTOMY LAPARASCOPIC .00 EA= .00 1 00000000 3123.00
CHOLECYSTECTO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 47562 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1447600 CHOLECYSTECTOMY OPEN .00 EA= .00 1 00000000 3123.00
CHOLECYSTECTO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 47600 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 22
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500426 CLAVICAL SPL. S 00420 73512 6.03 BX=1BX .00 1 00000000 49.00
CLAVICAL SPL. 6.03 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500428 CLAVICLE SPL.LG 00249 SDJ7985007 6.18 BX=1BX .00 1 00000000 49.00
CLAVICLE SPL. 6.18 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500427 CLAVICLE SPL.MD 00420 73513 6.60 BX=1BX .00 1 00000000 49.00
CLAVICLE SPL. 6.60 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500429 CLAVICLE SPL.XL 00420 73515 8.27 BX=1BX .00 1 00000000 49.00
CLAVICLE SPL. 8.27 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001603 CLIPPER CHARGER 00257 4509009662 32.70 EA=1EA .00 1 00000000 .00
CLIPPER CHARG 32.70 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001602 CLIPPER SURGICAL 00241 MMM9661 31.96 EA=1EA .00 1 00000000 .00
CLIPPER SURGI 31.96 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000767 COACH INCENTIVE SPIROMETER 00249 DHD221200 4.8017 EA=1EA .00 1 00000000 30.00
COACH INCENTI 57.62 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL=41115017 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500393 COBAN 1" 00249 4509001581 .51 EA=1EA .00 1 00031110 12.00
COBAN 1" 3.04 CS=6EA/CS 6 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 23
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501420 COBAN 2 COMPRESSION SYSTEM 00249 4509002094 13.00 BX=1BX .00 1 00000000 40.00
COBAN 2 COMPR 104.02 CS=8BX/CS 8 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501585 COBAN 2" 00249 MDS089002 1.3964 EA=1EA .00 1 00000000 35.00
COBAN 2" 50.27 CS=36EA/CS 36 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:Y MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500395 COBAN 3" 00249 MDS089003 1.8392 EA=1EA .00 1 00031110 59.00
COBAN 3" 44.14 CS=24EA/CS 24 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:Y MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500396 COBAN 4" 00249 MDS089004 2.3061 EA=1EA .00 1 00031110 79.00
COBAN 4" 41.51 CS=18EA/CS 18 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:Y MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500886 COBAN STERILE 4" 00249 MMM1584S 1.6194 EA=1EA .00 1 00000000 35.00
COBAN STERILE 29.15 CS=18EA/CS 18 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1444140 COLECTOMY PARTIAL .00 EA= .00 1 00000000 4413.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44140 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444204 COLECTOMY PARTIAL W/ ANASTOMOSIS .00 EA= .00 1 00000000 4877.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44204 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 24
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1444207 COLECTOMY PARTIAL W/ ANASTOMOSIS W/ .00 EA= .00 1 00000000 6037.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44207 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444208 COLECTOMY PARTIAL W/ ANASTOMOSIS W/ .00 EA= .00 1 00000000 6271.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44208 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444146 COLECTOMY PARTIAL W/ COLOPROCTOSTOMY .00 EA= .00 1 00000000 6921.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44146 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444143 COLECTOMY PARTIAL W/ END COLOSTOMY A .00 EA= .00 1 00000000 4503.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44143 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444160 COLECTOMY PARTIAL W/ REMOVAL OF TERM .00 EA= .00 1 00000000 4181.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44160 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444205 COLECTOMY PARTIAL W/REMOVAL TERMINAL .00 EA= .00 1 00000000 4645.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44205 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444211 COLECTOMY TOTAL ABDOMINAL W/ PROCTEC .00 EA= .00 1 00000000 8129.00
COLECTOMY TOT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44211 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 25
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500423 COLLAR LG 00249 ORT13100L 3.45 BX=1BX .00 1 00000000 99.00
COLLAR LG 3.45 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500422 COLLAR MD 00249 ORT13100M 2.58 BX=1BX .00 1 00000000 223.00
COLLAR MD 2.58 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500421 COLLAR SM 00249 ORT13100S 3.22 BX=1BX .00 1 00000000 99.00
COLLAR SM 3.22 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500424 COLLAR UNIVERSAL 00420 73705 3.50 BX=1BX .00 1 00000000 99.00
COLLAR UNIVER 3.50 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500425 COLLAR X-LONG 00420 73706 3.50 BX=1BX .00 1 00000000 99.00
COLLAR X-LONG 3.50 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001280 COLLES FOREARM L LG. 00249 ORT33300LL 7.05 EA=1EA .00 1 00000000 18.00
COLLES FOREAR 7.05 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001278 COLLES FOREARM L MD. 00249 ORT33300LM 6.81 EA=1EA .00 1 00000000 18.00
COLLES FOREAR 6.81 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001279 COLLES FOREARM R LG. 00249 ORT33300RL 7.20 EA=1EA .00 1 00000000 18.00
COLLES FOREAR 7.20 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 26
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001277 COLLES FOREARM RIGHT MD. 00249 ORT33300RM 6.81 EA=1EA .00 1 00000000 18.00
COLLES FOREAR 6.81 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001362 COLLES FOREARM SMALL LEFT 00249 ORT33300LS 6.06 EA=1EA .00 1 00000000 18.00
COLLES FOREAR 6.06 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1445378 COLONOSCOPY .00 EA= .00 1 00000000 1049.00
COLONOSCOPY .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
------------------------------------------------------------------------------------------------------------------------------------
1445383 COLONOSCOPY FLEXIBLE TO SPLENIC FLEX .00 EA= .00 1 00000000 1424.00
COLONOSCOPY F .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 45383 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445382 COLONOSCOPY FLEXIBLE W/ CONTROL OF B .00 EA= .00 1 00000000 1340.00
COLONOSCOPY F .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 45382 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1413132 COLONOSCOPY W/ BIOPSY .00 EA= .00 1 00000000 1591.00
COLONOSCOPY W .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 13132 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445380 COLONOSCOPY W/ BIOPSY .00 EA= .00 1 00000000 1154.00
COLONOSCOPY W .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 45380 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 27
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1445386 COLONOSCOPY W/ DILATION BY BALLOON 1 .00 EA= .00 1 00000000 1165.00
COLONOSCOPY W .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 45386 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445381 COLONOSCOPY W/ DIRECTED SUBMUCOSAL I .00 EA= .00 1 00000000 1300.00
COLONOSCOPY W .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 45381 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445384 COLONOSCOPY W/BIOPSY BY HOT BIOSPY F .00 EA= .00 1 00000000 1486.00
COLONOSCOPY W .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 45384 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445385 COLONOSCOPY W/BIOPSY SNARE .00 EA= .00 1 00000000 1486.00
COLONOSCOPY W .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 45385 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2500158 COMBINE DRESSING SURGIPAD 00249 NON21453 .083 EA=1EA .00 1 00000000 2.00
COMBINE DRESS 19.92 CS=240EA/CS 240 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2330513 COMPLEX PROCEDURE .00 EA= .00 1 00000000 985.00
COMPLEX PROCE .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001521 COMPLY 3983MM 00249 3983MM 106.71 BX=1BX .00 1 00000000 .00
COMPLY 3983M 106.71 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 28
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000352 COPY PAPER 00118 4COPY 3.45 RM=1RM .00 1 00000000 .00
COPY PAPER 00361 135848 34.50 CS=10RM/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000569 COPY PAPER-14" 00499 HAM10329-01 12.99 RM=1RM .00 1 00000000 .00
COPY PAPER-14 12.99 RM=1RM/RM 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000573 COPY PAPER-BLUE 00052 UNV11202 12.99 RM=1RM .00 1 00000000 .00
COPY PAPER-BL 12.99 RM=1RM/RM 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000570 COPY PAPER-GOLDENROD 00499 UNV11205 5.44 RM=1RM .00 1 00000000 .00
COPY PAPER-GO 5.44 RM=1RM/RM 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000575 COPY PAPER-GREEN 00499 UNV11203 10.49 RM=1RM .00 1 00000000 .00
COPY PAPER-GR 10.49 RM=1RM/RM 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000576 COPY PAPER-PINK 00499 UNV11204 4.03 RM=1RM .00 1 00000000 .00
COPY PAPER-PI 4.03 RM=1RM/RM 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000572 COPY PAPER-YELLOW 00499 UNV11201 12.99 RM=1RM .00 1 00000000 .00
COPY PAPER-YE 12.99 RM=1RM/RM 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000571 COPY PAPRER-BUFF 00499 UNV11206 5.27 RM=1RM .00 1 00000000 .00
COPY PAPRER-B 5.27 RM=1RM/RM 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 29
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001076 CORRECTION TAPE 00118 BICWOETP21 3.145 EA=1EA .00 1 00000000 .00
CORRECTION TA 6.29 EA=2EA/EA 2 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000975 COTTON TIP 6" STERILE 00249 MDS202000 1.666 BX=1BX .00 1 00000000 .00
COTTON TIP 6" 16.66 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000007 COTTONBALLS 00249 MDS21461 1.0015 BG=1BG .00 1 00000000 .00
COTTONBALLS 00062 13-3170 20.03 CS=20BG/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001705 COVIDIEN PROBE COVER 00249 KDL500500 .6408 BX=1B .00 1 00000000 .00
COVIDIEN PROB 16.02 BX=25/BX 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .6408 1 .00 3 00000000 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500459 CRADLE BOOT 00249 5.95551E+11 17.89 EA=1EA .00 1 00000000 49.00
CRADLE BOOT 17.89 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1499292 CRITICAL CARE EVAL/MGT EA ADDITIONAL .00 EA= .00 1 00031110 302.00
CRITICAL CARE .00 .00 2 00031220 .00
SERVICE .......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99292 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499291 CRITICAL CARE EVAL/MGT FIRST 30-74 M .00 EA= .00 1 00031110 604.00
CRITICAL CARE .00 .00 2 00031220 .00
SERVICE .......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99291 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 30
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001023 CRITIKON PAPER ER 00760 E9050JC 25.00 BX=1BX .00 1 00000000 .00
CRITIKON PAPE 25.00 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001140 CRITIKON PAPER OR 00760 E9050K 25.00 BX=1BX .00 1 00000000 .00
CRITIKON PAPE 25.00 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000705 CROUP TENT CANOPIES(CAM3MI 01304 81THS5522 8.60 EA=1EA .00 1 00000000 33.00
CROUP TENT CA 51.60 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500480 CRUTCHES ADULT 5’10"-6’6" 00249 MDSV80534 12.5617 EA=1EA .00 1 00000000 75.00
CRUTCHES ADUL 75.37 CS=6EA/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500481 CRUTCHES ADULT 5’2"TO 5’10 00249 MDSV80535 9.4213 EA=1EA .00 1 00000000 169.00
CRUTCHES ADUL 75.37 CS=8EA/CS 8 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500479 CRUTCHES XLONG 6’6"-7 2" 00249 9.84 EA=1EA .00 1 00000000 75.00
CRUTCHES XLON 59.03 CS=6EA/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500482 CRUTCHES YOUTH 4’6"TO 5’2" 00249 MDSV80536 9.9063 EA=1EA .00 1 00000000 75.00
CRUTCHES YOUT 79.25 CS=8EA/CS 8 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001550 CUFF 1 TUBE L ADULT LG.972 00328 99872 5.21 EA=1EA .00 1 00000000 .00
CUFF 1 TUBE L 104.20 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 31
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001627 CUFF ADULT SINGLE MDS9723D 00249 MDS9723DM 5.01 EA=1EA .00 1 00000000 .00
CUFF ADULT SI 25.07 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001626 CUFF CHILD SINGLE MDS9721D 00249 MDS9911HP 3.554 EA=1EA .00 1 00000000 .00
CUFF CHILD SI 17.77 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001552 CUFF DUAL ADULT LONG 3929 00328 39294 3.75 EA=1EA .00 1 00000000 .00
CUFF DUAL ADU 75.00 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001621 CUFF DUAL ADULT MDS9713DM 00249 MDS9713DM 3.82 EA=1EA .00 1 00000000 .00
CUFF DUAL ADU 19.08 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001581 CUFF DUAL ADULT MDS9713HP 00328 99593 5.52 EA=1EA .00 1 00000000 .00
CUFF DUAL ADU 110.48 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001554 CUFF DUAL CHILD 39296 00328 39296 4.14 EA=1EA .00 1 00000000 .00
CUFF DUAL CHI 82.80 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001624 CUFF DUAL CHILD MDS9711CM 00249 MDS9711DM 3.75 EA=1EA .00 1 00000000 .00
CUFF DUAL CHI 18.76 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001623 CUFF DUAL INFANT MDS9710DM 00249 MDS9710DM 3.23 EA=1EA .00 1 00000000 .00
CUFF DUAL INF 16.15 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 32
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001553 CUFF DUAL L.ADULT MDS9714H 00328 39291 5.05 EA=1EA .00 1 00000000 .00
CUFF DUAL L.A 101.04 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001622 CUFF DUAL LG ADULT MDS9714 00249 MDS9714DM 4.11 EA=1EA .00 1 00000000 .00
CUFF DUAL LG 20.53 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001625 CUFF INFANT SINGLE MDS9720 00249 MDS9720DM 4.83 EA=1EA .00 1 00000000 .00
CUFF INFANT S 24.17 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001628 CUFF LG.ADULT SING.MDS9724 00249 MDS9724DM 5.53 EA=1EA .00 1 00000000 .00
CUFF LG.ADULT 27.65 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001551 CUFF S.ADULT LONG MDS9723H 00249 MDS9723HPL 5.108 EA=1EA .00 1 00000000 .00
CUFF S.ADULT 25.54 PK=5EA/PK 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001546 CUFF SINGLE ADULT MDS9913HP 00249 MDS9913HP 2.954 EA=1EA .00 1 00000000 .00
CUFF SINGLE A 14.77 PK=5EA/PK 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001548 CUFF SINGLE CHILD MDS9911HP 00249 MDS9911HP 3.558 EA=1EA .00 1 00000000 .00
CUFF SINGLE C 17.79 PK=5EA/PK 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001549 CUFF SINGLE INFANT MDS9720 00249 MDS9720HP 3.23 EA=1EA .00 1 00000000 .00
CUFF SINGLE I 16.15 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 33
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001545 CUFF SINGLE L.ADULT MDS9914HP 00249 MDS9914HP 4.272 EA=1EA .00 1 00000000 .00
CUFF SINGLE L 21.36 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001547 CUFF SINGLE SM.ADULT MDS9912HP 00249 MDS9912HP 3.904 EA=1EA .00 1 00000000 .00
CUFF SINGLE S 19.52 CS=5EA/CS 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500002 CULTURE SWAB 00249 B-D220109 1.1872 EA=1EA .00 1 00031110 18.00
CULTURE SWAB 00146 220109 59.36 BG=50EA/BG 50 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001341 CUP 16OZ. 00692 2373 40.77 CS=1CS .00 1 00000000 .00
CUP 16OZ. 40.77 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000343 CUP SOUFFLE 00249 NON024220 1.53 PK=1PK .00 1 00000000 .00
CUP SOUFFLE 30.60 CS=20PK/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000345 CUPS 5OZ 00249 NON03005 1.9224 PK=1PK .00 1 00000000 .00
CUPS 5OZ 00062 63-0351 48.06 CS=25PK/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000344 CUPS MED PLASTIC 00249 DYND80000 .523 PK=1PK .00 1 00000000 .00
CUPS MED PLAS 26.15 CS=50PK/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000187 CURAD CLOTH TAPE 2" 00249 1538-2 5.40 BX=1BX .00 1 00000000 .00
DURAPORE TAPE 64.79 CS=12BX/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 34
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001707 CUROS CAP 00249 MMMCFJ1270Z 79.30 BX=1BX .00 1 00000000 .00
CUROS CAP 79.30 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 79.30 1 .00 3 00000000 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001424 CUSTOM CD 00089 XX 1.05 BX=1BX .00 1 00000000 .00
CUSTOM CD 1.05 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001487 CUSTOM HOLTER KITS 00111 S0A2R5ABKW 4.35 EA=1EA .00 1 00000000 .00
CUSTOM HOLTER 4.35 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501403 CVP DRESSING TRAY 00249 DYND75223 2.7213 EA=1EA .00 1 00000000 169.00
CVP DRESSING 108.85 CS=40EA/CS 40 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 31300025 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000100 CYSTO BLADDER 00249 07062C4040 3.31 EA=1EA .00 1 00000000 .00
CYSTO BLADDER 159.05 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501575 CYTOLOGY BRUSH 00756 158R 11.50 EA=1EA .00 1 00000000 79.00
CYTOLOGY BRUS 230.00 BX=20BX/BX 20 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1411044 DEBRIDEMENT BONE FIRS 20 SQ CM OR LE .00 EA= .00 1 00000000 828.00
DEBRIDEMENT B .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 11044 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 35
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1411043 DEBRIDEMENT MUSCLE AND/OR FASCIA FIR .00 EA= .00 1 00000000 497.00
DEBRIDEMENT M .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 11043 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411000 DEBRIDEMENT OF EXTENSIVE EZCEMATOUS .00 EA= .00 1 00000000 200.00
DEBRIDEMENT O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 11000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411040 DEBRIDEMENT SKIN-PARTIAL THICKNESS .00 EA= .00 1 00000000 150.00
DEBRIDEMENT S .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 11040 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411042 DEBRIDEMENT SUBCUTANEOUS TISSUE FIRS .00 EA= .00 1 00000000 232.00
DEBRIDEMENT S .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 11042 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
80000101 DEFIB PAD 00249 4509-02346N 4.00 EA=1EA .00 1 00000000 .00
DEFIB PAD 39.95 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001261 DEFOAMER 00522 3238 13.99 BT=1BT .00 1 00000000 .00
DEFOAMER 13.99 BT=1BT 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000979 DENTIPS 00249 MDS096502 32.75 BX=1BX .00 1 00000000 .00
DENTIPS 65.50 CS=2BX/CS 2 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 36
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000181 DENTURE CUPS 00249 DYND70293 .9024 PK=1PK .00 1 00000000 .00
DENTURE CUPS 22.56 CS=25PK/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501202 DEODRANT 00249 MSC095010 .2293 EA=1EA .00 1 00000000 .00
DEODRANT 00062 D82-752 22.01 CS=96EA/CS 96 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500494 DERMABOND 00249 ETHDHVM12 15.6108 EA=1EA .00 1 00000000 103.00
DERMABOND 00202 DHVM12 187.33 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001096 DESK CALENDAR PD/WALL BK 00499 7.99 EA=1EA .00 1 00000000 .00
DESK CALENDAR 7.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000630 DESK STAPLER 00118 UNV43119 5.99 EA=1EA .00 1 00000000 .00
DESK STAPLER 5.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500009 DIAPER ADULT 00249 FITULTRALG 7.175 BG=1BG .00 1 00000000 70.00
DIAPER ADULT 00062 10-VB013 28.70 CS=4PK/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500010 DIAPER ADULTXL 00249 FITPLUSXLG 7.6875 PK=1PK .00 1 00000000 31.00
DIAPER ADULTX 30.75 CS=4PK/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501395 DIAPERS PULL-UP LG. 00249 MSC23505 6.2775 PK=1PK .00 1 00000000 31.00
DIAPERS PULL- 25.11 CS=4PK/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 37
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501394 DIAPERS PULL-UP MED 00249 MSC23005 6.2775 PK=1PK .00 1 00000000 31.00
DIAPERS PULL 25.11 CS=4PK/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501396 DIAPERS PULL-UP XL 00249 MSC23600 6.2775 PK=1PK .00 1 00000000 31.00
DIAPERS PULL- 25.11 CS=4PK/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001405 DIGITAL THERMOMETER 00257 3596916814 4.72 EA=1EA .00 1 00000000 .00
DIGITAL THERM 113.28 CS=24EA/CS 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1443450 DILATION OF ESOPHAGUS BY UNGUIDED SO .00 EA= .00 1 00000000 284.00
DILATION OF E .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43450 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
80000461 DINAMAP PAPER 00257 8156 24.00 BX=1BX .00 1 00000000 .00
DINAMAP PAPER 24.00 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000695 DISP CUFFLESS FENE TRACH 8 00394 8DCFN 38.00 EA=1EA .00 1 00000000 175.00
DISP CUFFLESS 38.00 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000699 DISP INNER CANN FENE 4 00394 4DICFEN 3.60 EA=1EA .00 1 00000000 12.00
DISP INNER CA 36.00 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 38
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90000700 DISP INNER CANN FENE 6 00394 6DICFEN 3.60 EA=1EA .00 1 00000000 12.00
DISP INNER CA 36.00 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000701 DISP INNER CANN FENE 8 00394 8DICFEN 3.60 EA=1EA .00 1 00000000 12.00
DISP INNER CA 36.00 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500250 DISP. VAGINAL SPECULUM 00249 W-A59001Z 1.4058 EA=1EA .00 1 00000000 81.00
DISP. VAGINAL 33.74 BX=24EA/BX 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000718 DISPOSABLE CUFFED TRACH 10 00394 10DCT 38.00 EA=1EA .00 1 00000000 175.00
DISPOSABLE CU 38.00 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000715 DISPOSABLE CUFFED TRACH 4 00394 4DCT 67.12 EA=1EA .00 1 00000000 175.00
DISPOSABLE CU 67.12 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000716 DISPOSABLE CUFFED TRACH 6 00394 6DCT 67.12 EA=1EA .00 1 00000000 175.00
DISPOSABLE CU 67.12 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000717 DISPOSABLE CUFFED TRACH 8 00394 8DCT 67.12 EA=1EA .00 1 00000000 175.00
DISPOSABLE CU 67.12 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000719 DISPOSABLE FENE TRACH 6 00394 6DFEN 38.00 EA=1EA .00 1 00000000 175.00
DISPOSABLE FE 38.00 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 39
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90000694 DISPOSABLE FENE TRACH 8 00394 8DFEN 38.00 EA=1EA .00 1 00000000 175.00
DISPOSABLE FE 38.00 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000688 DISPOSABLE HEADSTRAP FOR B 01304 73312106 4.78 EA=1EA .00 1 00000000 59.00
DISPOSABLE HE 47.80 PK=10EA/PK 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000697 DISPOSABLE INNER CANNULA 4 00394 4DIC 3.60 EA=1EA .00 1 00000000 12.00
DISPOSABLE IN 36.00 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000698 DISPOSABLE INNER CANNULA 8 00394 8DIC 3.60 EA=1EA .00 1 00000000 12.00
DISPOSABLE IN 36.00 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000696 DISPOSABLE INNNER CANNULA 00394 6DIC 3.60 EA=1EA .00 1 00000000 12.00
DISPOSABLE IN 36.00 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500251 DONUT CUSHION 00249 2867-351819 1.34 EA=1EA .00 1 00000000 59.00
DONUT CUSHION 1.34 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500258 DRAIN BAG 1.50 00249 401933 1.16 EA=1EA .00 1 00000000 18.00
DRAIN BAG 1.5 11.62 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500260 DRAIN BAG 2.25 00249 SQU401935 .651 EA=1EA .00 1 00000000 18.00
DRAIN BAG 2.2 00072 401513 6.51 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 40
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500261 DRAIN BAG 2.75 00249 SQU401936 .651 EA=1EA .00 1 00000000 18.00
DRAIN BAG 2.7 00072 401936 6.51 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500098 DRAINAGE BAG 00249 DYND15205 2.3995 EA=1EA .00 1 00000000 30.00
DRAINAGE BAG 47.99 CS=20EA/CS 20 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1499419 DRAINAGE OF PERITIONEAL ABSCESS OR L .00 EA= .00 1 00000000 3897.00
DRAINAGE OF P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 49020 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2500259 DRAINBAG 1.75 00249 SQU401512 .523 EA=1EA .00 1 00000000 18.00
DRAINBAG 1.7 5.23 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500257 DRAINBAG 1.25 00249 401510 1.65 EA=1EA .00 1 00000000 18.00
DRAINBAG 1.25 16.49 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501030 DRAPE LOWER EXTREMITY 00249 DYNJP8002 4.93 EA=1EA .00 1 00000000 46.00
DRAPE LOWER E 59.16 CS=12EA/CS 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500299 DRAPE SHEET 00249 DYNJP2419 1.96 EA=1EA .00 1 00000000 45.00
DRAPE SHEET 23.52 CS=12EA/CS 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 41
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501069 DRAPE UNDER BUTTOCK 00249 1259001229 .99 EA=1EA .00 1 00000000 110.00
DRAPE UNDER B 53.43 CS=54EA/CS 54 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2800008 DRESSINGS AND OR DEBRIEDEMENT OR PAR .00 EA= .00 1 00000000 192.00
DRESSINGS AND .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 16020 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
80001451 DUAL LUER LOCK M/FEM. 00249 BHL2C6250 .1788 EA=1EA .00 1 00000000 .00
DUAL LUER LOC 90.13 CS=504EA/CS 504 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500283 DUODERM 4X4 00249 SQU187660 1.912 EA=1EA .00 1 00000000 14.00
DUODERM 4X4 9.56 BX=5EA/BX 5 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500284 DUODERM 8X8 00249 1638187662 10.19 EA=1EA .00 1 00000000 49.00
DUODERM 8X8 50.93 BX=5EA/BX 5 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000186 DURAPORE TAPE 1" 00249 MMM15382 6.394 BX=1BX .00 1 00000000 .00
DURAPORE TAPE 63.94 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501059 DURAPREP 00249 4509008630 5.297 EA=1EA .00 1 00000000 30.00
DURAPREP 105.94 CS=20EA/CS 20 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 42
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501267 DYNA-HEX4 4OZ. 00249 MDS098710 1.7058 EA=1EA .00 1 00031110 25.00
DYNA-HEX4 4 81.88 CS=48EA/CS 48 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500124 E TRACH TUBE UNCUFFED 4.5 00277 4130-86226 1.04 EA=1EA .00 1 00031110 25.00
E TRACH TUBE 10.39 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500129 E,TRACH TUBE 6.0 00249 4130-086109 1.58 EA=1EA .00 1 00031110 25.00
E,TRACH TUBE 15.84 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001316 E-TRAP 00372 711099 11.00 EA=1EA .00 1 00000000 .00
E-TRAP 00414 711099 275.00 CS=25EA/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500134 E. TRACH TUBE 8.0 00249 4130086113 2.16 EA=1EA .00 1 00031110 25.00
E. TRACH TUBE 21.56 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500136 E. TRACH TUBE CUFF 10.0 00249 4130-086117 4.01 EA=1EA .00 1 00031110 35.00
E. TRACH TUBE 40.11 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500132 E. TRACH TUBE CUFF 7.5 00249 4130-086112 1.026 EA=1EA .00 1 00031110 25.00
E. TRACH TUBE 10.26 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500128 E.TRACH TUBE 5.5 00249 4130-086108 3.42 EA=1EA .00 1 00031110 35.00
E.TRACH TUBE 34.22 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 43
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500127 E.TRACH TUBE CUFF 5.0 00249 4130-86107 1.92 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 19.16 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500130 E.TRACH TUBE CUFF 6.5 00249 DYND43065 1.568 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 15.68 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500131 E.TRACH TUBE CUFF 7.0 00249 DYND43070 2.21 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 22.10 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500133 E.TRACH TUBE CUFF 8.5 00249 4130-086114 4.01 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 40.11 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500135 E.TRACH TUBE CUFF 9.0 00249 4130-086115 2.68 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 26.76 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500120 E.TRACH TUBE UNCUFF 2.5 00249 4130-086222 1.33 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 13.27 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500121 E.TRACH TUBE UNCUFFED 3.0 00249 4130-086223 1.04 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 10.39 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500122 E.TRACH TUBE UNCUFFED 3.5 00249 4130-86224 1.04 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 10.39 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 44
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500123 E.TRACH TUBE UNCUFFED 4.0 00249 4130-86225 1.04 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 10.39 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500126 E.TRACH TUBE UNCUFFED 5.5 00249 4130-86228 1.04 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 10.39 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001229 EAKIN SEAL COHESIVE 00257 1638839001 3.82 EA=1EA .00 1 00000000 .00
EAKIN SEAL CO 38.24 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001599 EAR CURETTES BLUE 00257 819004888 36.69 BX=1BX .00 1 00000000 .00
EAR CURETTES 36.69 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001600 EAR CURETTES GREEN 00257 819001222 36.69 BX=1BX .00 1 00000000 .00
EAR CURETTES 36.69 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001601 EAR CURETTES WHITE 00257 819009555 36.69 BX=1BX .00 1 00000000 .00
EAR CURETTES 36.69 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1443235 EGD UPPER GASTROINESTINAL EDOSCOPY D .00 EA= .00 1 00000000 779.00
EGD UPPER GAS .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43235 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 45
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1443244 EGD WITH BAND LIGATION OF ESOPHAGEAL .00 EA= .00 1 00000000 1156.00
EGD WITH BAND .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43244 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443239 EGD WITH BIOPSY UPPER GASTROINTESTIN .00 EA= .00 1 00000000 903.00
EGD WITH BIOP .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43239 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443255 EGD WITH CONTROL OF BLEEDING ANY MET .00 EA= .00 1 00000000 1190.00
EGD WITH CONT .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43255 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443246 EGD WITH PEG TUBE PLACEMENT .00 EA= .00 1 00000000 1558.00
EGD WITH PEG .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43246 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2500988 EGG CRATE 00249 NON081962H 29.66 EA=1EA .00 1 00000000 200.00
EGG CRATE 29.66 EA=IEA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001133 EKG RECORDING PAPER 00929 9402-024 48.34 EA=1EA .00 1 00000000 .00
EKG RECORDING 48.34 CS=1EA/CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001134 EKG RECORDING TABS 00929 120 49.00 EA=1EA .00 1 00000000 .00
EKG RECORDING 49.00 CS=1EA/CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 46
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001120 ELASTIC NET 2" 00249 NONNET02 10.13 BX=1BX .00 1 00000000 .00
ELASTIC NET 2 10.13 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001121 ELASTIC NET 3" 00257 4304058440 6.15 BX=1BX .00 1 00000000 .00
ELASTIC NET 3 6.15 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001236 ELASTIC NET 4 00249 NONNET04 12.41 BX=1BX .00 1 00000000 .00
ELASTIC NET 4 12.41 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001237 ELASTIC NET 6 00249 NONNET06 17.09 BX=1BX .00 1 00000000 .00
ELASTIC NET 6 17.09 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000401 ELASTIC NET 7" 00249 NONNET07 19.78 BX=1BX .00 1 00000000 .00
ELASTIC NET 7 19.78 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000116 ELECTRODE ADULT 00249 MMM2560 5.785 PK=1PK .00 1 00000000 .00
ELECTRODE ADU 115.70 CS=20PK/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001102 ELECTRODE EMPI 2" 00551 198928-001 .53 EA=1EA .00 1 00000000 39.00
ELECTRODE EMP .52 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000115 ELECTRODE INFANT 00249 MDS611303AH 1.31 PK=1PK .00 1 00000000 .00
ELECTRODE INF 1.31 PK=1EA/PK 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 47
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500180 EMESIS BASIN 00249 DYND80321 .061 EA=1EA .00 1 00000000 5.00
EMESIS BASIN 15.24 CS=250EA/CS 250 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001126 EMPI ELECTRODES 6000 SERIE 00551 199485-001 16.15 EA=1EA .00 1 00000000 59.00
EMPI ELECTROD 16.15 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2504020 EMPI FLEECE PADS 00249 4509001581 .51 EA=1EA .00 1 00031110 214.00
EMPI FLEEC PA 3.04 CS=6EA/CS 6 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501137 ENDO POUCH 10MM 00249 ETHPOUCH 52.15 EA=1EA .00 1 00000000 .00
ENDO POUCH 10 00202 POUCH 312.90 BX=6EA/BX 6 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500005 ENEMA SET 00249 DYND-70100 .766 EA=1EA .00 1 00000000 68.00
ENEMA SET 36.77 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2800003 ENTERECTOMY, RESECTION OR SMALL INTE .00 EA= .00 1 00000000 4204.00
ENTERECTOMY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 44120 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499409 ENTEROLYSIS FREEING OF INTESTINAL AD .00 EA= .00 1 00000000 2681.00
ENTEROLYSIS .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44005 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 48
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001157 ENVELOPES W/O WINDOWS CCH 00393 123 17.99 BX=1BX .00 1 00000000 .00
ENVELOPES W/ 17.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001194 ENVELOPES WINDOW CCH 00393 1234 52.99 BX=1BX .00 1 00000000 .00
ENVELOPES WIN 52.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000679 ENVELOPES-#10 PAYROLL 00107 8003 49.00 BX=1BX .00 1 00000000 .00
ENVELOPES-#10 49.00 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000581 ENVELOPES-BROWN CLASP 10X1 00052 UNV35267 23.99 BX=1BX .00 1 00000000 .00
ENVELOPES-BRO 23.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000580 ENVELOPES-BROWN CLASP 9X12 00052 UNV35264 19.99 BX=1BX .00 1 00000000 .00
ENVELOPES-BRO 00361 187021 19.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001385 EPIDURAL TRAY 00530 332256 16.05 EA=1EA .00 1 00000000 .00
EPIDURAL TRAY 160.47 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501333 EPISTAT NASAL CATH KIT 00251 15-27030 71.92 EA=1EA .00 1 00000000 503.00
EPISTAT NASAL 71.92 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500990 ER LACERATION TRAY 00249 DYNJ03000 3.5338 EA=1EA .00 1 00000000 133.00
ER LACERATION 00062 11-4523 56.54 CS=16EA/CS 16 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 49
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2800007 ESCHAROTOMY INITAL INCISION .00 EA= .00 1 00000000 494.00
ESCHOROTOMY I .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 16035 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2500866 ESMARK BANDAGE 4X9 00249 5868055514 2.58 EA=1EA .00 1 00000000 35.00
ESMARK BANDAG 51.55 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000119 ESOPH. STETH 18FR 00249 DTXM1024215 4.4488 EA=1EA .00 1 00000000 .00
ESOPH. STETH 111.22 BX=25EA/BX 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500125 ETRACH TUBE UNCUFFED 5.0 00249 4130-86227 1.04 EA=1EA .00 1 00031110 25.00
ETRACH TUBE U 10.39 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000205 EXAM GLOVE NITRILE LG. 00249 T-X925030 3.254 BX=1BX .00 1 00000000 .00
EXAM GLOVE NI 00062 11-2523 32.54 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000204 EXAM GLOVE NITRILE MED. 00249 T-X925020 3.254 BX=1BX .00 1 00000000 .00
EXAM GLOVE NI 00062 11-2522 32.54 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000203 EXAM GLOVE NITRILE SM. 00249 T-X925010 3.254 BX=1BX .00 1 00000000 .00
EXAM GLOVE NI 00062 11-2521 32.54 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 50
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000332 EXAM GLOVES LG S 00249 MDS194136Z .2234 EA=1EA .00 1 00000000 .00
EXAM GLOVES L 22.34 BX=100EA/BX 100 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001615 EXAM PAPER 00249 NON23322 1.8092 RL=1RL .00 1 00000000 .00
EXAM PAPER 21.71 CS=12RL/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1499416 EXCISION BENIGN LESION INCLUDING MAR .00 EA= .00 1 00000000 266.00
EXCISION BENI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 11421 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800005 EXCISION MALIGNANT LESION INCLUDING .00 EA= .00 1 00000000 423.00
EXCISION MALI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11640 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499412 EXCISION OF LESION OF TENDON SHEATH .00 EA= .00 1 00000000 892.00
EXCISION OF L .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 27630 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800010 EXCISION OF SKIN AND SUBCUTANEOUS TI .00 EA= .00 1 00000000 679.00
EXCISION OF S .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11470 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446320 EXCISION OF THROMBOSED HEMORRHOID EX .00 EA= .00 1 00000000 455.00
EXCISION OF T .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 46320 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 51
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499417 EXCISION OR DESTRUCTION OPEN INTRA A .00 EA= .00 1 00000000 2936.00
EXCISION OR D .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 49203 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1421930 EXCISION TUMOR SOFT TISSU OF BACK .00 EA= .00 1 00000000 1595.00
EXC TUM BACK .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 21930 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800014 EXCISION TUMOR SOFT TISSUE OF FACE S .00 EA= .00 1 00000000 1268.00
EXC TUM 2MM .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 21014 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499414 EXCISION TUMOR SOFT TISSUE OF PELVIS .00 EA= .00 1 00000000 1480.00
EXCISION TUMO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 27048 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800009 EXCISION TUMOR SOFT TISSUE OF SHOULD .00 EA= .00 1 00000000 1013.00
EXCISION TUMO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 23071 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1424075 EXCISION TUMOR SOFT TISSUE OF UPPER .00 EA= .00 1 00000000 1759.00
EXC TUM UP AR .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 24075 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800004 EXPLORATORY LAPAROTOMY EXPLORATORY C .00 EA= .00 1 00000000 2640.00
EXPLORATORY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 49000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 52
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2504004 EXUDERM 2X2 00249 MSC5522 .765 EA=1EA .00 1 00000000 18.00
EXUDERM 2X2 7.65 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501139 EXUDERM 4X4 00249 MSC5544 1.504 EA=1EA .00 1 00000000 26.00
EXUDERM 4X4 15.04 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500173 EYE PAD SMALL 00249 NON21600Z .0632 EA=1EA .00 1 00000000 11.00
EYE PAD SMALL 3.16 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001595 EZ STABILIZER 00053 9066 4.00 EA=1EA .00 1 00000000 36.00
EZ STABILIZER 4.00 EA=1EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000737 EZPAP THERAPY SYS PRESS PO 01304 26230747 15.00 EA=1EA .00 1 00031110 100.00
EZPAP THERAPY 150.00 CS=10EA/CS 10 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500216 FACIAL TISSUE 00249 NON243275 .1347 BX=1BX .00 1 00031110 5.00
FACIAL TISSUE 00062 13-200 26.94 CS=200BX/CS 200 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501510 FALL RISK KIT LARGE 00249 6238Y 3.69 EA=1EA .00 1 00000000 146.00
FALL RISK KIT 00304 6237Y 3.69 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501509 FALL RISK KIT REGULAR 00249 6236Y 19.37 EA=1EA .00 1 00000000 146.00
FALL RISK KIT 19.37 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 53
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501511 FALL RISK SLIPPERS LARGE 00249 516306250L 5.08 EA=1EA .00 1 00000000 38.00
FALL RISK SLI 5.08 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501512 FALL RISK SLIPPERS MEDIUM 00249 516306250M 4.93 EA=1EA .00 1 00000000 86.00
FALL RISK SLI 4.93 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501514 FALL RISK SLIPPERS SMALL 00249 516306250S 5.17 EA=1EA .00 1 00000000 86.00
FALL RISK SLI 124.08 CS=24EA/CS 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501508 FALL RISK SOCKS STANDARD 00249 MDTPS4B03FPY .96 EA=1EA .00 1 00000000 .00
FALL RISK SOC 00304 6239Y 46.08 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501507 FALL RISK SOCKS LARGE 00249 MDTPS4B04FPY .9906 EA=1EA .00 1 00031110 10.00
FALL RISK SOC 00304 6239LY 47.55 CS=48EA/CS 48 .00 2 00031111 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000656 FASTENERS-2" 00499 UNV81002 2.69 EA=1EA .00 1 00000000 .00
FASTENERS-2" 2.69 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000666 FASTENERS-SELF ADHESIVE 00361 SMD68220 17.99 BX=1BX .00 1 00000000 .00
FASTENERS-SEL 00118 SMD68220 17.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001258 FAX CART.TN430 00052 IVRTN430 49.99 EA=1EA .00 1 00000000 .00
FAX CART.TN43 00361 IVRTN430 49.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 54
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000623 FAX CARTRIDGE TN420 00361 IVRTN420 47.99 EA=1EA .00 1 00000000 .00
BRTTN420 47.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500293 FECAL INCONT.COLLECTION 00249 9822 5.06 EA=1EA .00 1 00000000 30.00
FECAL INCONT. 50.62 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500105 FEEDING TUBE 8FR 00249 BRD0036410H .56 EA=1EA .00 1 00000000 16.00
FEEDING TUBE .56 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500146 FEEDING TUBE INFANT 5FR‘ 00249 BRD0036400H .57 EA=1EA .00 1 00000000 16.00
FEEDING TUBE .57 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501231 FEMALE CATH KIT 00249 DYND10805 1.5424 EA=1EA .00 1 00000000 23.00
FEMALE CATH K 38.56 CS=25EA/CS 25 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001382 FEMORAL LEG SPLINT 25" 00585 79-72295 36.39 EA=1EA .00 1 00000000 311.00
FEMORAL LEG S 36.39 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500333 FENESTRATED TOWEL 00249 DYA4409Z .2098 EA=1EA .00 1 00000000 5.00
FENESTRATED T 10.49 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000585 FILE FOLDER STANDARD 00052 UNV12113 8.29 BX=1BX .00 1 00000000 .00
FILE FOLDER S 00361 744100 8.29 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 55
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001635 FILTER NEEDLE 18GA.X11/2 00257 3.58381E+11 22.50 BX=1BX .00 1 00000000 .00
FILTER NEEDLE 22.50 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001204 FINGER SPLINT 00249 ZIM254801700 1.9183 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 23.02 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001205 FINGER SPLINT 00420 66-0025-002-00 2.41 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 28.93 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001206 FINGER SPLINT 00420 66-0017-001-00 1.17 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 13.98 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001207 FINGER SPLINT 00249 ZIM254801500 3.1617 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 18.97 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001208 FINGER SPLINT 00420 00-2548-016-00 .88 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 5.28 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001209 FINGER SPLINT 00420 00-2548-017-00 .94 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 5.63 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001210 FINGER SPLINT PLASTALUME 00420 00-2548-015-00 .97 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 5.82 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 56
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001211 FINGER SPLINT PLASTALUME 00420 00-2548-018-00 1.02 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 6.09 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1446200 FISSURECTOMY INCLUDING SPHINCTEROTOM .00 EA= .00 1 00000000 1275.00
FISSURECTOMY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 46200 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2500292 FLATUS BAG 00249 3583145524 1.20 EA=1EA .00 1 00000000 23.00
FLATUS BAG 59.81 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500106 FLEXIFLO 8FR 00249 5520-000473 14.69 EA=1EA .00 1 00000000 158.00
FLEXIFLO 8FR 146.90 CS=10EA/CS 10 .00 2 00000000 .00
.......... 44(0272) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001230 FLEXISENSOR ADULT 00719 0998-00-0076-05 51.46 PK=1PK .00 1 00000000 .00
FLEXISENSOR A 154.38 PK=3PK/PK 3 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000067 FLEXISENSOR ADULT BANDAGE 00719 0683-00-0409-02 103.08 BX=1BX .00 1 00000000 .00
FLEXISENSOR A 103.08 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001112 FLOW SELECTOR,STANDARD 01304 715-PM1000 28.38 EA=1EA .00 1 00000000 .00
FLOW SELECTOR 28.38 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 57
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501303 FLOW TRON 00033 DVT10 17.29 EA=1EA .00 1 00031110 254.00
FLOW TRON 00249 MDS601MD 17.29 EA=1EA/EA 1 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000303 FOG FREE MASK GREEN 00249 NON27378A 7.8617 BX=1BX .00 1 00000000 .00
FOG FREE MASK 47.17 CS=6BX/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000302 FOG FREE MASK W/ SHIELD OR 00249 NON27710 8.95 BX=1BX .00 1 00000000 .00
FOG FREE MASK 53.70 CS=6BX/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500091 FOLEY TRAY 14FR 00249 DYND160414 21.036 EA=1EA .00 1 00000000 128.00
FOLEY TRAY 14 210.36 CS=10EA/CS 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500092 FOLEY TRAY 16FR 00249 BRD800361 6.725 CS=1EA .00 1 00000000 288.00
FOLEY TRAY 16 00062 27-802016 67.25 CS=10EA/CS 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500093 FOLEY TRAY 18FR 00249 BRD800362 6.725 EA=1EA .00 1 00000000 288.00
FOLEY TRAY 18 67.25 CS=10EA/CS 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501636 FOLEY TRAY URINE METER 16F 00249 0620303316A 18.94 EA=1EA .00 1 00000000 131.00
FOLEY TRAY UR 189.41 CS=10EA/CS 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501637 FOLEY TRAY URINE METER 18F 00249 0620303318A 18.94 EA=1EA .00 1 00000000 .00
FOLEY TRAY UR 189.41 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 58
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001591 FOLEY TRICOT STAT LOK 00257 0620FOL0102 3.01 EA=1EA .00 1 00000000 .00
FOLEY TRICOT 75.31 CS=25EA/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001292 FOREARM PADDED LT,LG. 00585 79-71977 4.26 EA=1EA .00 1 00000000 18.00
FOREARM PADDE 4.26 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001291 FOREARM PADDED RT,LG. 00585 79-71987 4.26 EA=1EA .00 1 00000000 18.00
FOREARM PADDE 4.26 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001317 FOREARM SPLINT LEFT 00585 79-71973 4.26 EA=1EA .00 1 00000000 .00
FOREARM SPLIN 4.26 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001398 FOREARM SPLINT LEFT 00585 79-71972 4.36 EA=1EA .00 1 00000000 .00
FOREARM SPLIN 4.36 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001302 FOREARM SPLINT LEFT MED. 00585 79-71975 4.32 EA=1EA .00 1 00000000 18.00
FOREARM SPLIN 4.32 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001281 FOREARM SPLINT R 00585 79-71985 4.32 EA=1EA .00 1 00000000 18.00
FOREARM SPLIN 4.32 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001490 FROG FINGER SPLINT 13/4" 00522 VC5407 22.00 EA=1EA .00 1 00000000 18.00
FROG FINGER S 22.00 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 59
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001488 FROG FINGER SPLINT 21/4 00522 VC5406 22.00 EA=1EA .00 1 00000000 18.00
FROG FINGER S 22.00 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001489 FROG FINGER SPLINT 3" 00522 VC5408 22.00 EA=1EA .00 1 00000000 18.00
FROG FINGER S 22.00 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500403 GAIT TRANSFER BELT 00249 MDT828203 3.5983 EA=1EA .00 1 00000000 35.00
GAIT TRANSFER 21.59 CS=6EA/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501390 GASTROSTOMY TUBE 00058 51364 23.37 EA=1EA .00 1 00000000 163.00
GASTROSTOMY T 00249 DYND70320 23.37 EA=1EA/EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500172 GAUZE 2X2 8PLY S 00249 PRM21224H 1.94 EA=1EA .00 1 00031110 2.00
GAUZE 2X2 8PL 1.94 BX=1BX 1 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 1.94 1 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001697 GAUZE 2X2 NS 00249 PRM21208C .724 PK=1PK .00 1 00000000 .00
GAUZE 2X2 NS 18.10 CS=25PK/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .7464 1 .00 3 00000000 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500157 GAUZE 4X4 X12PLY S 00249 NON21424 .0548 EA=1EA .00 1 00031110 14.00
GAUZE 4X4 X12 32.88 CS=600EA/CS 600 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500171 GAUZE4X4 16PLY S 00249 NON21428 .4205 EA=1EA .00 1 00031110 63.00
GAUZE4X4 16PL 53.82 CS=128EA/CS 128 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:Y MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 60
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2146224 GRANEE NEEDLE 00249 BAR9001C0212 22.57 EA=1EA .00 1 00000000 98.00
GRANEE NEEDLE 00043 9001C0212 225.70 BX=10EA/BX 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500031 GRIPPER 20GA X 1" 00249 PTX21286624 5.0675 EA=1EA .00 1 00000000 79.00
GRIPPER 20GA 00062 11-212866 60.81 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 31300025 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501304 GRIPPER NEEDLE 20 11/4 00249 PDI21286724 5.0675 EA=1EA .00 1 00000000 35.00
GRIPPER NEEDL 60.81 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001481 GUEDEL AIRWAY 100MM 00346 1-1504-100 .66 BX=1BX .00 1 00000000 14.00
GUEDEL AIRWAY 6.60 BX=10BX/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001478 GUEDEL AIRWAY 70MM 00346 1-1504-70 .66 BX=1BX .00 1 00000000 14.00
GUEDEL AIRWAY 6.60 BX=10BX/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001479 GUEDEL AIRWAY 80MM 00346 1-1504-80 .66 BX=1BX .00 1 00000000 14.00
GUEDEL AIRWAY 6.60 BX=10BX/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001480 GUEDEL AIRWAY 90MM 00346 1-1504-90 .66 BX=1BX .00 1 00000000 14.00
GUEDEL AIRWAY 6.60 BX=10BX/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000584 HANGING FILES 00052 ESS415215 3.40 BX=1BX .00 1 00000000 .00
HANGING FILES 3.40 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 61
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501000 HEEL PROTECTOR 00249 NON081440PH 4.91 EA=1EA .00 1 00000000 135.00
HEEL PROTECTO 00304 6115 4.91 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1446221 HEMORRHOIDECTOMY INTERNAL BY RUBBER .00 EA= .00 1 00000000 546.00
HEMORRHOIDECT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 46221 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446260 HEMORROIDECTOMY COMPLEX .00 EA= .00 1 00000000 2276.00
HEMORROIDECTO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 46260 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
80001266 HIBICLENS 16OZ. 00257 158057516 9.51 EA=1EA .00 1 00000000 .00
HIBICLENS 16O 114.12 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000642 HIGHLIGHTERS-GREEN 00499 UNV08862 .6658 EA=1EA .00 1 00000000 .00
HIGHLIGHTERS- 7.99 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000643 HIGHLIGHTERS-PINK 00052 UNV08865 .6658 EA=1EA .00 1 00000000 .00
HIGHLIGHTERS- 7.99 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000644 HIGHLIGHTERS-YELLOW 00118 UNV08861 .6658 EA=1EA .00 1 00000000 .00
HIGHLIGHTERS- 00361 UNV08861 7.99 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 62
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001311 HIP/KNEE KIT 00249 THE210301 41.73 EA=1EA .00 1 00000000 143.00
HIP/KNEE KIT 41.73 EA=1EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1499239 HOSPITAL DISCHARGE > 30 MINS .00 EA= .00 1 00000000 180.00
HOSPITAL DISC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300020 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99239 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499238 HOSPITAL DISCHARGE DAY MNGMT <30 MIN .00 EA= .00 1 00000000 144.00
HOSPITAL DISC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300020 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99238 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
90001111 HUMIDIFIER 500ML.W/ADAPTER 00107 04-2D0803 3.17 EA=1EA .00 1 00000000 .00
HUMIDIFIER 50 37.98 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001131 HUMIDIFIER W/ADAPTER 760ML. 00249 HUD3709 1.147 EA=1EA .00 1 00000000 .00
HUMIDIFIER W/ 11.47 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1410180 I & D COMPLEX POST OP WOUND INFECTIO .00 EA= .00 1 00000000 592.00
I & D COMPLEX .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10180 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410140 I & D OF HEMATOMA SEROMA OR FLUID CO .00 EA= .00 1 00000000 335.00
I & D OF HEMA .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10140 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 63
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1410081 I & D OF PILONIDAL CYST COMPLICATED .00 EA= .00 1 00000000 619.00
I & D OF PILO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10081 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410080 I & D OF PILONIDAL CYST SIMPLE .00 EA= .00 1 00000000 347.00
I & D OF PILO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10080 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410061 I&D COMPLICATED OR MULTIPLE .00 EA= .00 1 00000000 523.00
I&D COMPLICAT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10061 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2501426 I.V.CONN.EXTENSION SET 00044 7N8300 1.7517 EA=1EA .00 1 00000000 38.00
I.V.CONN.EXTE 00249 BHL7N8301 350.34 CS=200EA/CS 200 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001536 ICE BAGS 00661 S-7494 52.00 CS=1CS .00 1 00000000 .00
ICE BAGS 52.00 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500006 ICE PACK 00249 NON4420 .663 EA=1EA .00 1 00000000 32.00
ICE PACK 66.30 CS=100EA/CS 100 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001123 ID BANDS BLUE 00249 MDS133037B 46.07 BX=1BX .00 1 00000000 .00
ID BANDS BLUE 46.07 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 64
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001516 ID BANDS PURPLE DNR 00431 WBCDNA-8 42.95 BX=1BX .00 1 00000000 .00
ID BANDS PURP 42.95 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001274 ID BANDS RED 00249 MDS133037R 43.11 BX=1BX .00 1 00000000 .00
ID BANDS RED 00107 8592 43.11 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001118 ID BANDS RED ALLERGY 00257 518984516PDJ 24.10 BX=1BX .00 1 00000000 .00
ID BANDS RED 24.10 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001517 ID BANDS YELLOW FALL RISK 00431 WBCFRA-3 63.27 EA=1EA .00 1 00000000 .00
ID BANDS YELL 63.27 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500415 IMPER STOCKINETTE-LG 00249 1259000274 3.27 EA=1EA .00 1 00000000 40.00
IMPER STOCKIN 49.08 CS=15EA/CS 15 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500414 IMPER STOCKINETTE-M 00249 1259000273 2.08 EA=1EA .00 1 00000000 40.00
IMPER STOCKIN 31.25 CS=15EA/CS 15 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000738 IN-LINE AEROSOL H2O TRAPS 01304 45276 1.86 EA=1EA .00 1 00000000 12.00
IN-LINE AEROS 92.75 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2800013 INCESION AND DRAINAGE SHOULDER AREA .00 EA= .00 1 00000000 865.00
INCESION AND .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 23030 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 65
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1446040 INCISION AND DRAINAGE OF ISCHIORECTA .00 EA= .00 1 00000000 2015.00
INCISION AND .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 46040 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800001 INCISION AND DRAINAGE OF SUBMUCOSAL .00 EA= .00 1 00000000 531.00
INC AND DRAIN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45005 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800002 INCISION AND DRAINAGE SHOULDER AREA .00 EA= .00 1 00000000 865.00
INC AND DRAIN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 10121 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410121 INCISION AND REMOVAL OF FOREIGN BODY .00 EA= .00 1 00000000 712.00
INCISION AND .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10121 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410120 INCISION AND REMOVAL OF FOREIGN BODY .00 EA= .00 1 00000000 311.00
INCISION AND .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10120 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446083 INCISION OF THROMBOSED HEMORRHOID EX .00 EA= .00 1 00000000 351.00
INCISION OF T .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 46083 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499223 INITIAL HOSPITAL CARE HIGH COMPLEXIT .00 EA= .00 1 00000000 380.00
INITIAL HOSPI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99223 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 66
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000640 INK PENS BLACK 00118 BICGSF11BK 2.29 BX=1BX .00 1 00000000 .00
INK PENS BLAC 00361 382241 2.29 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000639 INK PENS BLUE 00499 UNV27411 1.55 BX=1BX .00 1 00000000 .00
INK PENS BLUE 1.55 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000638 INK PENS RED 00499 UNV27412 1.19 BX=1BX .00 1 00000000 .00
INK PENS RED 1.19 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1499254 INPATIENT CONSULT COMPREHENSIVE .00 EA= .00 1 00000000 358.00
INPATIENT CON .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99254 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499253 INPATIENT CONSULT DETAILED .00 EA= .00 1 00000000 286.00
INPATIENT CON .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99253 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499252 INPATIENT CONSULT EXPANDED PROBLEM .00 EA= .00 1 00000000 232.00
INPATIENT CON .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99252 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499255 INPATIENT CONSULT HIGH COMPLEXITY .00 EA= .00 1 00000000 450.00
INPATIENT CON .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99255 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 67
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499251 INPATIENT CONSULT PROBLEM FOCUSED .00 EA= .00 1 00000000 153.00
INPATIENT CON .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99251 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
90001136 INSP.FILTERS/760 00394 4-074601-00 51.30 EA=1EA .00 1 00000000 .00
INSP.FILTERS/ 51.30 CS=1EA/CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001106 INSULIN SYRINGE 00249 SWD511110Z 28.06 BX=1BX .00 1 00000000 .00
INSULIN SYRIN 28.06 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001476 INSULIN SYRINGE LL 00249 SWD8100777Z .478 EA=1EA .00 1 00000000 .00
INSULIN SYRIN 28.68 BX=60EA/BX 60 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500011 INSYTE AUTOGUARD 24GA. 00249 BMG4251601Z 1.5854 EA=1EA .00 1 00000000 88.00
INSYTE AUTOGU 79.27 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001642 INTERMEC DURATHEM11 LABELS 00754 E15532 12.61 EA=1EA .00 1 00000000 .00
INTERMEC DURA 100.90 CS=8EA/CS 8 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500012 INTROCAN 22X1 00249 BMG4251628Z 1.5854 EA=1EA .00 1 00000000 88.00
INSYTE AUTOGU 00039 4251628-02 79.27 BX=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 68
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500013 INTROCAN 20X1 00249 BMG4251652Z 1.5854 EA=1EA .00 1 00000000 88.00
INSYTE AUTOGU 00039 4251652-02 79.27 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500016 INTROCAN 14G 00249 BMG4251717H 1.60 EA=1EA .00 1 00000000 39.00
INTROCAN 14G 1.60 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500015 INTROCAN 16G 00249 4052 .94 EA=1EA .00 1 00000000 39.00
INTROCAN 16G 46.95 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500014 INTROCAN 18G 00249 BMG4251687Z 1.5854 EA=1EA .00 1 00000000 88.00
INTROCAN 18G 79.27 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000628 INVISIBLE TAPE 00118 UNV83436 1.89 RL=1RL .00 1 00000000 .00
INVISIBLE TAP 00361 STP487908 1.89 RL=1RL/RL 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001596 IO NEEDLE ADULT 00437 V9001 120.00 EA=1EA .00 1 00000000 895.00
IO NEEDLE ADU 120.00 BX=1EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001597 IO NEEDLE PED. 00437 V9018 105.00 EA=1EA .00 1 00000000 895.00
IO NEEDLE PED 525.00 BX=5EA/BX 5 .00 2 00000000 .00
.......... 44(0272) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001598 IO PLACEMENT 00053 XX 305.00 EA=1EA .00 1 00000000 417.00
IO PLACEMENT 305.00 EA=1EA 1 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36680 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 69
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000290 IRRIGATION SYRINGE 00257 3583067000 .74 EA=1EA .00 1 00000000 .00
IRRIGATION SY 37.00 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500280 IRRIGATION TRAY 00249 DYND20102 .844 EA=1EA .00 1 00000000 45.00
IRRIGATION TR 16.88 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500281 IRRIGATION TRAY PISTON 00249 DYNC2303 1.7665 EA=1EA .00 1 00000000 54.00
IRRIGATION TR 35.33 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000144 ISOLATION GOWN 00249 NON27236XL 3.404 PK=1PK .00 1 00000000 .00
ISOLATION GOW 17.02 CS=5PK/CS 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000994 ISOLATION MASK-YELLOW 00249 NON27120 3.105 BX=1BX .00 1 00000000 .00
ISOLATION MAS 00218 4515A 18.63 CS=6BX/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501365 IV BASIC SOL. SET 2C8425 00044 2C8425 2.4533 EA=1EA .00 1 00000000 29.00
IV BASIC SOL. 00249 BHL2C8425 117.76 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501367 IV BURETROL ADD-ON SET 00044 2C7565 2.25 EA=1EA .00 1 00000000 30.00
IV BURETROL A 108.18 CS=48EA/CS 48 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501368 IV CATH EXT.SET 2N3374 00044 2N3374 1.95 EA=1EA .00 1 00000000 45.00
IV CATH EXT.S 00249 389.40 CS=200EA/CS 200 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 70
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501427 IV CONN CAP 00249 BHL7N8399 1.0858 EA=1EA .00 1 00000000 23.00
IV CONN CAP 217.15 CS=200EA/CS 200 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501371 IV CONT-FLO SET NON-VENTED 2C 00793 M46445690 4.371 EA=1EA .00 1 00031110 68.00
CONT-FLO SET 00249 BHL2C8537 131.13 CS=30EA/CS 30 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501372 IV CONT-FLO VENTED 2C8541 00044 2C8541 3.2833 EA=1EA .00 1 00000000 117.00
IV CONT-FLO V 157.60 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501373 IV DIAL-A-FLO EXT. 00103 S2-12 .83 EA=1EA .00 1 00000000 23.00
IV DIAL-A-FLO 50.00 CS=60EA/CS 60 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501369 IV FAT SET 00044 2C1106 1.99 EA=1EA .00 1 00000000 .00
IV FAT SET 95.45 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501370 IV FILTER SET 2H8671 00249 BHL2H8671 3.0496 EA=1EA .00 1 00000000 24.00
IV FILTER SET 146.38 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501375 IV SECONDARY MED SET 2C746 00793 M77460030 1.1085 EA=1EA .00 1 00031110 12.00
IV SECONDARY 00249 BHL2C7461 44.34 CS=40EA/CS 40 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501534 IV SET MINI DRIP OR 2C854 00044 2C8546 3.2467 EA=1EA .00 1 00000000 117.00
IV SET MINI D 00249 BHL2C8546 155.84 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 71
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500984 IV START KIT 00249 DYND74271 .6652 EA=1EA .00 1 00000000 34.00
IV START KIT 00084 IV330 66.52 CS=100EA/CS 100 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500179 K-PADS 00249 070766N410CC 11.94 EA=1EA .00 1 00000000 203.00
K-PADS 119.43 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500114 KANGAROO DOUBLE FEEDIND BAG 00249 SWD773656 2.1893 EA=1EA .00 1 00000000 79.00
KANGAROO 65.68 CS=30EA/CS 30 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500113 KANGAROO WITH ICE POUCH 00443 8884773600 4.7357 EA=1EA .00 1 00000000 35.00
KANGAROO 142.07 CS=30EA/CS 30 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500176 KERLIX S 00249 PRM25865 .4374 EA=1EA .00 1 00000000 14.00
KERLIX S 43.74 CS=100EA/CS 100 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:Y MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500178 KERLIX SUPER 00249 3583004308 .77 EA=1EA .00 1 00000000 8.00
KERLIX SUPER 7.71 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000163 KLING 2" 00249 NON25492 1.3563 BG=1BG .00 1 00000000 .00
KLING 2" 10.85 CS=8BG/CS 8 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500159 KLING 2" S 00249 NON25496 .1221 EA=1EA .00 1 00000000 32.00
KLING 2" S 11.72 BX=96EA/BX 96 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 72
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000164 KLING 3" 00249 NON25493 1.9425 BG=1BG .00 1 00000000 .00
KLING 3" 15.54 CS=8BG/CS 8 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500160 KLING 3" S 00249 NON25497 .1435 EA=1EA .00 1 00000000 41.00
KLING 3" S 13.78 CS=96EA/CS 96 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000165 KLING 4" 00257 6904 1.56 BG=1BG .00 1 00000000 .00
KLING 4" 12.46 CS=8BG/CS 8 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500161 KLING 4" S 00249 NON25498 .1809 EA=1EA .00 1 00000000 52.00
KLING 4" S 17.37 CS=96EA/CS 96 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000166 KLING 6" 00257 6906 5.72 BG=1BG .00 1 00000000 .00
KLING 6" 5.72 BG=1BG/BG 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500162 KLING 6" S 00249 NON25499 .32 EA=1EA .00 1 00000000 59.00
KLING 6" S 15.36 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500377 KNEE HIGH LG 00249 MDS160664 4.8925 EA=1EA .00 1 00000000 153.00
KNEE HIGH LG 00432 2040009 58.71 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500376 KNEE HIGH MED 00249 MDS160644 4.8925 EA=1EA .00 1 00000000 153.00
KNEE HIGH MED 00432 204008 58.71 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 73
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500375 KNEE HIGH SM 00249 MDS160624 3.6942 EA=1EA .00 1 00000000 153.00
KNEE HIGH SM 44.33 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500378 KNEE HIGH XL 00432 204010 5.871 EA=1EA .00 1 00000000 153.00
KNEE HIGH XL 00249 MDS160684 58.71 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500485 KNEE IMMOB 16" LG 00249 ORT2410016 20.98 BX=1BX .00 1 00000000 322.00
KNEE IMMOB 16 20.98 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500484 KNEE IMMOB 16" MED 00420 1877-504-16 18.20 BX=1BX .00 1 00000000 725.00
KNEE IMMOB 16 18.20 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500483 KNEE IMMOB 16" UNIVERSAL 00249 ORT2410016 21.40 BX=1BX .00 1 00000000 725.00
KNEE IMMOB SM 21.40 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500486 KNEE IMMOB 16"XL 00420 187750616 18.20 BX=1BX .00 1 00000000 322.00
KNEE IMMOB 16 18.20 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500489 KNEE IMMOB 22" LG 00420 187750522 19.28 BX=1BX .00 1 00000000 322.00
KNEE IMMOB 22 19.28 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500488 KNEE IMMOB 22" MD 00420 187750422 20.54 BX=1BX .00 1 00000000 322.00
KNEE IMMOB 22 20.54 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 74
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500490 KNEE IMMOB 22"XL 00420 187750622 19.28 BX=1BX .00 1 00000000 322.00
KNEE IMMOB 22 19.28 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500487 KNEE IMMOB UNIVERSAL 22" 00249 ORT2411022 25.20 BX=1BX .00 1 00000000 322.00
KNEE IMMOB 22 25.20 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500860 KNEE SLEEVES SCD LARGE 00657 3583005489 33.38 EA=1EA .00 1 00000000 113.00
KNEE SLEEVES 166.91 CS=5EA/CS 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501045 KUMPE 5FR 40CM 00254 54038KA2 11.50 EA=1EA .00 1 00000000 124.00
KUMPE 5FR 40 00058 31-407 57.50 BX=5EA/BX 5 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501046 KUMPE 5FR 65CM 00254 56538KA2 11.50 EA=1EA .00 1 00000000 124.00
KUMPE 5FR 65C 00058 31-409 57.50 BX=5EA/BX 5 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000245 KY JELLY 2.7 00249 MDS032273Z 5.1317 BX=1BX .00 1 00000000 .00
KY JELLY 2.7 00062 24-3627D 30.79 CS=6BX/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000246 KY JELLY 4OZ. 00249 MDS032290Z .7825 EA=1EA .00 1 00000000 .00
KY JELLY 4OZ. 9.39 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001442 LAP CHOLE PACK 00249 DYNJS0310 34.1525 EA=1EA .00 1 00000000 210.00
LAP CHOLE PAC 136.61 CS=4EA/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 75
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1444970 LAPARASCOPIC APPENDECTOMY .00 EA= .00 1 00000000 2721.00
LAPARASCOPIC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44970 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499407 LAPAROSCOPY SURG WITH REMOVAL OF ADN .00 EA= .00 1 00000000 1612.00
LAPARO SURG W .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 58661 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2504033 LARGE ADULT BP CUFF 00249 MDS9914HP 4.272 EA=1EA .00 1 00000000 .00
LARGE ADULT B 21.36 PK=5EA/PK 5 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 4.272 1 .00 3 00000000 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001321 LASER LABELS AND ARM BANDS 00306 WBW61 66.75 PK=1PK .00 1 00000000 .00
LASER LABELS 00107 7263 267.00 CS=4PK/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000096 LEG BAG 00249 DYND12574H 1.98 EA=1EA .00 1 00000000 .00
LEG BAG 1.98 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001306 LEG SPLINT FEMORAL 14" 00585 79-72295 36.39 EA=1EA .00 1 00000000 311.00
LEG SPLINT FE 36.39 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000097 LEG STRAP 00249 1821-000316 3.07 EA=1EA .00 1 00000000 .00
LEG STRAP 30.74 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 76
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000619 LEGAL PADS -LETTER YELLOW 00052 UNV10630 1.2492 EA=1EA .00 1 00000000 .00
LEGAL PADS -L 00361 815080 14.99 PK=12EA/EA 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000618 LEGAL PADS-SMALL YELLOW 00052 UNV46200 .7908 EA=1EA .00 1 00000000 .00
LEGAL PADS-SM 00361 163832 9.49 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001299 LEMON GLYCERIN SWABSTICK 00249 MDS090600 2.313 BX=1BX .00 1 00000000 .00
LEMON GLYCERI 23.13 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001087 LETTER HEAD CCH 00783 CCH 94.10 BX=1BX .00 1 00000000 .00
LETTER HEAD C 941.00 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500108 LEVIN TUBE 10FR 00249 4130-085750 1.96 EA=1EA .00 1 00000000 29.00
LEVIN TUBE 10 98.00 CS=50EA/CS 50 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500109 LEVIN TUBE 12FR 00249 SWD265314H .1288 EA=1EA .00 1 00000000 29.00
LEVIN TUBE 12 6.44 EA=1EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500110 LEVIN TUBE 14FR 00249 4130-85752 .9158 EA=1EA .00 1 00000000 29.00
LEVIN TUBE 14 45.79 CS=50EA/CS 50 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000721 LG DISP VINYL NASAL MASK 01304 83312104EA 14.49 EA=1EA .00 1 00000000 44.00
LG DISP VINYL 14.49 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 77
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90000724 LG/NARR DISP VINYL NASAL M 01304 73312123EA 14.49 EA=1EA .00 1 00000000 44.00
LG/NARR DISP 14.49 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000462 LIFE PAK 6,7,8 00356 804700-003 1.00 EA=1EA .00 1 00000000 .00
LIFE PAK 6,7, 10.04 BX=10BX/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000463 LIFE PAK 9,10 00356 11240000013 6.56 RL=1RL .00 1 00000000 .00
LIFE PAK 9,10 19.68 BX=3RL/BX 3 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501325 LIGAMAX EL5ML 00202 EL5ML 130.03 EA=1EA .00 1 00000000 1042.00
LIGAMAX EL5ML 00249 ETHEL5ML 390.09 BX=3EA/BX 3 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500154 LIMB HOLDER 00304 2532 6.69 EA=1EA .00 1 00000000 90.00
LIMB HOLDER 00249 NON243074 6.69 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000194 LOTION 00249 MSC095001 .1761 EA=1EA .00 1 00000000 .00
LOTION 16.91 CS=96EA/CS 96 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500048 LUMBAR PUNT TRAY 00249 BXT4301CH 8.16 EA=1EA .00 1 00000000 115.00
LUMBAR PUNT. 8.16 EA=1EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1499411 LYSIS OF ADHESIONS SALPINGOLYSIS OVA .00 EA= .00 1 00000000 2181.00
LYSIS OF ADHE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 58740 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 78
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001270 MAGNETIC INSTRUMENT PAD 00257 603425D001 3.63 CS=1CS .00 1 00000000 .00
MAGNETIC INST 108.92 CS=30CS/CS 30 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001443 MAJOR EXTREMITY PACK 00249 DYNJS0804 32.155 EA=1EA .00 1 00000000 328.00
MAJOR EXTREMI 128.62 CS=4EA/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501346 MAJOR LAP PACK (NEW) 00249 DYNJS0301 46.01 EA=1EA .00 1 00000000 352.00
MAJOR LAP PAC 92.02 CS=2EA/CS 2 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501124 MALE CATH TEXAS SMALL 00249 DYND12303H 1.51 EA=1EA .00 1 00000000 39.00
MALE CATH TEX 1.51 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000648 MARKER-BLACK 00052 AVE08888 .7908 EA=1EA .00 1 00000000 .00
MARKER-BLACK 9.49 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501263 MASTISOL 00249 FRN052348Z 1.6242 EA=1EA .00 1 00000000 20.00
MASTISOL 77.96 BX=48EA/BX 48 .00 2 00000000 .00
.......... 78(0250) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500536 MAX 30 INFLATION 00104 G31027 30.00 BX=1BX .00 1 00000000 277.00
MAX 30 INFLAT 00058 M0067101131 30.00 BX=1BX/BX 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000761 MED CONCENTR AD O2 MASK-SI 01304 301180 .55 EA=1EA .00 1 00000000 54.00
MED CONCENTR 27.50 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 79
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90000722 MED/SMA DISP VINYL NASAL M 01304 73312105EA 14.49 EA=1EA .00 1 00000000 44.00
MED/SMA DISP 14.49 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2504022 MEDIHONEY 2X2 SHEET 00249 DER31815 37.445 EA=1EA .00 1 00031110 100.00
MEDIHONEY SHE 449.34 CS=12EA/CS 12 .00 2 00031220 .00
.......... 43(0270) INV.GL=41115091 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2504021 MEDIHONEY GEL 00249 DER31815 11.5733 EA=1EA .00 1 00031110 63.00
MEDIHONEY 138.88 CS=12EA/CS 12 .00 2 00031220 .00
.......... 43(0270) INV.GL=41115091 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001232 MEDIPORE DRESSING 00257 4509003562 9.04 BX=1BX .00 1 00000000 .00
MEDIPORE DRES 36.15 CS=4BX/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501560 MEDIPORE DRESSING 3566 00249 4509003566 .52 EA=1EA .00 1 00000000 7.00
MEDIPORE DRES 52.42 CS=100EA/CS 100 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501164 MEFIX 4" 00249 ALA311099H 7.02 BX=1BX .00 1 00000000 119.00
MEFIX 4" 7.02 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501189 MEFIX 6" 00249 ALA311599H 10.5125 BX=1BX .00 1 00000000 53.00
MEFIX 6" 10.5125 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001446 MERITZ PLUS 00249 MDS8840128 15.51 EA=1EA .00 1 00000000 .00
MERITZ PLUS 62.04 CS=4EA/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 80
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90000755 METHACHOLINE CHALLE ASTHMA 01304 26773100 28.26 EA=1EA .00 1 00000000 90.00
METHACHOLINE 28.26 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500980 MIDSTREAM 00249 DYND30240 .6207 EA=1EA .00 1 00031110 56.00
MIDSTREAM 62.07 CS=100EA 100 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000466 MINDRAY RECORDING PAPER 00263 0683-00-0505-02 3.49 RL=1RL .00 1 00000000 .00
MINDRAY 34.90 BX=10RL/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501337 MINI ACCESS KIT 5FR. 00916 MAK501N/A 35.00 BX=1BX .00 1 00000000 78.00
MINI ACCESS K 35.00 BX=1BX/BX 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000704 MINI-HEART 30CC CONT NEBUL 01304 963100611EA 17.25 EA=1EA .00 1 00000000 74.00
MINI-HEART 30 17.25 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001590 MITTS 00573 2826 1.07 EA=1EA .00 1 00000000 .00
MITTS 12.80 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1444139 MOBILIZATION OF SPLENIC FLEXURE .00 EA= .00 1 00000000 464.00
MOBILIZATION .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44139 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 81
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001116 MONOCRYL 4-0 Y845G 00249 ETHY845G 50.37 BX=1BX .00 1 00000000 .00
MONOCRYL 4-0 50.37 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500196 MOUTHWASH 00249 CTR000413 .2013 EA=1EA .00 1 00000000 .00
MOUTHWASH 12.08 CS=60EA/CS 60 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001486 MULTI ABSORBER 00547 8003138 15.40 EA=1EA .00 1 00000000 .00
MULTI ABSORBE 92.37 CS=6EA/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000765 NASAL AIRWAY 00249 HUD1088 6.00 EA=1EA .00 1 00031110 69.00
300.00 CS=50EA/CS 50 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000740 NASAL CANNULA EZ WRAP (EAR 01304 771016 .85 EA=1EA .00 1 00000000 .00
NASAL CANNULA 42.35 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001563 NASAL CANNULA W/25FT.TUBIN 01304 301-104 1.81 EA=1EA .00 1 00000000 35.00
NASAL CANNULA 45.32 CS=25EA/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501245 NASAL TAMPON 00249 440402 10.044 EA=1EA .00 1 00000000 63.00
NASAL TAMPON 00251 440402 100.44 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000706 NASOPHARYNGEAL AIRWAY 20FR 01304 76123120 4.02 EA=1EA .00 1 00000000 40.00
NASOPHARYNGEA 40.17 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 82
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90000707 NASOPHARYNGEAL AIRWAY 22FR 01304 76123122 4.02 EA=1EA .00 1 00000000 40.00
NASOPHARYNGEA 40.17 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000708 NASOPHARYNGEAL AIRWAY 24FR 01304 763123124 5.61 EA=1EA .00 1 00000000 40.00
NASOPHARYNGEA 56.13 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000709 NASOPHARYNGEAL AIRWAY 26FR 01304 76123126 5.61 EA=1EA .00 1 00000000 40.00
NASOPHARYNGEA 56.13 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000710 NASOPHARYNGEAL AIRWAY 28FR 01304 76123128 5.61 EA=1EA .00 1 00000000 40.00
NASOPHARYNGEA 56.13 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000711 NASOPHARYNGEAL AIRWAY 30FR 01304 562123130 2.64 EA=1EA .00 1 00000000 40.00
NASOPHARYNGEA 26.43 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000712 NASOPHARYNGEAL AIRWAY 32FR 01304 76123132 5.61 EA=1EA .00 1 00000000 40.00
NASOPHARYNGEA 56.13 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000713 NASOPHARYNGEAL AIRWAY 34FR 01304 76123134 5.61 EA=1EA .00 1 00000000 40.00
NASOPHARYNGEA 56.13 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000714 NASOPHARYNGEAL AIRWAY 36FR 01304 76123136 2.64 EA=1EA .00 1 00000000 40.00
NASOPHARYNGEA 26.43 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 83
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90000766 NEBULIZER 00396 301200 1.1308 EA=1EA .00 1 00031110 42.00
NEBULIZER 00249 HCS4483 56.54 CS=50EA/CS 50 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000029 NEEDLE 25X2 00249 358381-200441 8.98 BX=1BX .00 1 00000000 .00
NEEDLE 25X2 8.98 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000564 NEEDLE COUNTER 00257 31142337 8.73 BX=1BX .00 1 00000000 .00
NEEDLE COUNTE 69.80 BX=8BX/BX 8 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500052 NEEDLE LOCK DEVICE 00044 2C7833 .50 EA=1EA .00 1 00000000 5.00
NEEDLE LOCK D 49.91 BX=100EA/BX 100 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000053 NG STRIP 00249 CURNASTUB50 .5182 EA=1EA .00 1 00000000 .00
NG STRIP 25.91 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000773 NIPPLE ADAPTORS 01304 26-33-2600 .66 EA=1EA .00 1 00000000 .00
NIPPLE ADAPTO 32.89 PK=50EA/PK 50 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501419 NITREX WIRES 00916 MAK001N 2.30 EA=1EA .00 1 00000000 71.00
NITREX WIRES 23.00 BX=10EA/BX 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500334 NONFENESTRATED TOWEL 00249 BXT3520Z .3412 EA=1EA .00 1 00000000 5.00
NONFENESTRATE 17.06 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 84
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001091 NOTEBOOK 1" 00052 UNV20962 3.1658 EA=1EA .00 1 00000000 .00
NOTEBOOK 1" 00361 374815 3.1658 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000677 NOTEBOOK 2" 00052 UNV20982 5.99 EA=1EA .00 1 00000000 .00
NOTEBOOK 2" 00361 648814 5.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001095 NOTEBOOK 3" 00052 UNV20992 7.99 EA=1EA .00 1 00000000 .00
NOTEBOOK 3" 00361 374819 7.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000678 NOTEBOOK-1.5" 00499 UNV20972 3.79 EA=1EA .00 1 00000000 .00
NOTEBOOK-1.5" 3.79 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001305 NOVO INSULIN NEEDLES 00249 NOV185275 57.63 BX=1BX .00 1 00000000 .00
NOVO INSULIN 57.63 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500265 NUGAUZE 1" 00249 NON255015 1.7183 EA=1EA .00 1 00000000 53.00
NUGAUZE 1" 20.62 CS=12EA 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000175 NUGAUZE 4X4 00257 3460007634 2.03 PK=1PK .00 1 00000000 .00
NUGAUZE 4X4 20.30 CS=10PK/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500267 NUGAUZE IDOFORM.50 00249 NON256125 1.5767 EA=1EA .00 1 00000000 53.00
NUGAUZE IDOFO 18.92 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 85
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500268 NUGAUZE IODOFORM 1" 00249 NON256015 1.9667 EA=1EA .00 1 00000000 135.00
NUGAUZE IODOF 23.60 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501200 NUGAUZE PACK IODOFORM 1/4 00249 NON256145 1.5092 BT=1BT .00 1 00000000 53.00
NUGAUZE PACK 18.11 CS=12BT/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500264 NUGAUZE PACKING 1/2 00249 NON255125 1.5708 EA=1EA .00 1 00000000 46.00
NUGAUZE PACKI 18.85 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501199 NUGAUZE PACKING 1/4 00249 NON255145 1.4358 BT=1BT .00 1 00000000 53.00
NUGAUZE PACKI 17.23 CS=12BT/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000305 NURSES CAP 00249 BRLB77-4502 2.794 BX=1BX .00 1 00000000 .00
NURSES CAP 13.97 CS=5BX/CS 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000772 O2 SWIVELED/TAPERED NIPPLE 01304 301195 .26 EA=1EA .00 1 00000000 .00
O2 SWIVELED/T 13.20 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000756 O2 TUBING 7’ EXTENSION 00396 301145EA .3458 EA=1EA .00 1 00031110 20.00
O2 TUBING 7’ 00249 HCS4507 17.29 CS=50EA/CS 50 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501246 OB PADS PK 00249 NON241281 1.0146 PK=1PK .00 1 00000000 .00
OB PADS PK 24.35 CS=24PK/CS 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 86
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499235 OBSERVATION OR INPATIENT HOSPITAL CA .00 EA= .00 1 00000000 340.00
OBSERVATION O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99235 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499236 OBSERVATION OR INPATIENT HOSPITAL CA .00 EA= .00 1 00000000 438.00
OBSERVATION O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99236 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499234 OBSERVATION OR IP STAY INCLUDING ADM .00 EA= .00 1 00000000 241.00
OBSERVATION O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99234 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
80001406 ODOR ELIMINATOR 00249 CRR101003 2.0608 EA=1EA .00 1 00000000 .00
ODOR ELIMINAT 98.92 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000234 ONE-STEP SAFETY LANCET 00249 SRG1SLN20010C 6.198 BX=1BX .00 1 00000000 .00
ONE-STEP SAFE 00062 75-200100N 92.97 CS=15BX/CS 15 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500274 OPSITE 10X5.50 00249 MMM1627Z 1.102 EA=1EA .00 1 00000000 155.00
OPSITE 10X5.5 22.04 BX=20EA/BX 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500275 OPSITE 4X5.50 00249 MSC2304 .5994 EA=1EA .00 1 00000000 54.00
OPSITE 4X5.50 29.97 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 87
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2800016 OVARIAN CYSTECTOMY UNILATERAL OR BIL .00 EA= .00 1 00000000 1846.00
OVAR CYST UB .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 58925 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
80000620 PAPER CLIPS-JUMBO 00361 UNV72220 11.49 BX=1BX .00 1 00000000 .00
PAPER CLIPS-J 00118 UNV72220 11.49 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000621 PAPER CLIPS-SM. 00499 UNV72210 4.99 BX=1BX .00 1 00000000 .00
PAPER CLIPS-S 00118 UNV72210 4.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1460220 PARTIAL REMOVAL OF THYROID .00 EA= .00 1 00000000 1741.00
PARTIAL REMOV .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 60220 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
80000417 PAT.BELONGING BAG 00249 NON026310 2.531 PK=1PK .00 1 00000000 .00
PAT.BELONGING 00062 99-BELB 25.31 CS=10PK/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
25014343 PATIENT BED PAD 00249 MDT8445B1 29.97 EA=1EA .00 1 00031110 100.00
PATIENT BED P 29.97 EA=1EA/EA 1 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501342 PATIENT CHAIR PAD 00249 MDT82145C6 15.53 EA=1EA .00 1 00000000 90.00
PATIENT CHAIR 93.18 CS=6EA/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 88
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001150 PDS 11 SUTURE Z497G 00257 23000Z497G 42.90 BX=1BX .00 1 00000000 .00
PDS 11 SUTURE 42.90 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000703 PED. W/ SWIVEL AEROSOL MAS 00249 HCS4631B .6654 EA=1EA .00 1 00000000 49.00
PED. W/ SWIVE 33.27 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501103 PED.MULTI-LUMEN CENTRAL CA 00249 ARWAK14553 46.732 EA=1EA .00 1 00000000 232.00
PED.MULTI-LUM 233.66 CS=5EA/CS 5 .00 2 00000000 .00
.......... 50(0278) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: C1751 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
90000690 PEDIACTIC O2 HIGH F10 NONR 01304 771130EA 3.52 EA=1EA .00 1 00000000 69.00
PEDIACTIC O2 3.52 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000691 PEDIACTRIC MED CONCEN 02 M 01304 355222EA 1.25 EA=1EA .00 1 00000000 54.00
PEDIACTRIC ME 1.25 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000365 PEDIALYTE 00249 R-L59892Z 2.5275 EA=1EA .00 1 00000000 .00
PEDIALYTE 10.11 PK=4EA/PK 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000692 PEDIATRIC MULTI VENT OXYGE 01304 361089EA 2.61 EA=1EA .00 1 00000000 69.00
PEDIATRIC MUL 130.41 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 89
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90000693 PEDIATRIC NASAL CANNULA 00249 HCS4518 .9772 EA=1EA .00 1 00031110 35.00
PEDIATRIC NAS 48.86 CS=50EA/CS 50 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501247 PEDIATRIC URINE BAG 00249 MDS190510 .509 EA=1EA .00 1 00000000 11.00
PEDIATRIC URI 25.45 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501067 PEDIATRIC WRIST SPLINT L 00249 IMP121816 30.25 EA=1EA .00 1 00000000 41.00
PEDIATRIC WRI 00123 79-87291 30.25 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501066 PEDIATRIC WRIST SPLINT R 00249 ORT19900RXXS 11.88 EA=1EA .00 1 00000000 41.00
PEDIATRIC WRI 00123 79-87281 11.88 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001498 PEDICAP 6 01304 507-PEDICAP 6 9.45 CS=1CS .00 1 00000000 26.00
PEDICAP 6 56.70 CS=6CS/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000360 PEG BOARD REC 00783 PBR .00 PK=1PK .00 1 00000000 .00
PEG BOARD REC .00 CS=10PK/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500496 PELVIC TRACTION BELT 00420 74302 11.45 EA=1EA .00 1 00000000 45.00
PELVIC TRACTI 11.45 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500498 PELVIC TRACTION BELT 00420 74104 11.45 BX=1BX .00 1 00000000 45.00
PELVIC TRACTI 11.45 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 90
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500440 PELVIC TRACTION BELT 34-38 00420 74303 9.66 BX=1BX .00 1 00000000 45.00
PELVIC TRACTI 9.66 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500441 PELVIC TRACTION BELT 38-42 00420 74304 9.66 BX=1BX .00 1 00000000 45.00
PELVIC TRACTI 9.66 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500442 PELVIC TRACTION BELT 42-46 00420 74305 9.66 BX=1BX .00 1 00000000 45.00
PELVIC TRACTI 9.66 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500443 PELVIC TRACTION BELT 46-52 00420 74306 9.66 BX=1BX .00 1 00000000 45.00
PELVIC TRACTI 9.66 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501127 PELVIC TRACTION BELT UNIVE 00420 1678-001 14.16 BX=1BX .00 1 00000000 45.00
PELVIC TRACTI 14.16 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000637 PENCILS 00118 UNV55400 .39 BX=1BX .00 1 00000000 .00
PENCILS .39 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001502 PHILLIP EKG PAPER 00249 GCO32016653 87.17 CS=1CS .00 1 00000000 .00
PHILLIP EKG P 87.17 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000346 PHYSICIAN ORDERS 00783 HFS14 49.50 BX=1BX .00 1 00000000 .00
PHYSICIAN ORD 495.00 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 91
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501421 PICC TRAY 00487 21-2904-24 50.40 EA=1EA .00 1 00000000 377.00
PICC TRAY 252.00 CS=5EA/CS 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000008 PILLOW 00249 PM1824-15 1.3483 EA=1EA .00 1 00000000 .00
PILLOW 16.18 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001528 PILLOWS REUSABLE 00249 MDT219683 3.69 EA=1EA .00 1 00000000 .00
PILLOWS REUSA 3.69 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500068 PLEUREVAC 00249 HUDA705008LF 59.6567 EA=1EA .00 1 00000000 527.00
PLEUREVAC 178.97 CS=3EA/CS 3 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000769 POCKET CHAMBER 01304 317-621-210 7.52 EA=1EA .00 1 00000000 26.00
POCKET CHAMBE 75.15 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000626 POST-ITS 1 1/2X2 YELLOW 00499 UNV35662 .5242 EA=1PK .00 1 00000000 .00
POST-ITS 1 1/ 6.29 PK=12PK/PK 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000625 POST-ITS-3X3 YELLOW 00052 UNV35688 1.2492 EA=1PK .00 1 00000000 .00
POST-ITS-3X3 00361 562896 14.99 PK=12PK/PK 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500452 POST-OP SHOE MEN LG 00420 161123 7.65 EA=1EA .00 1 00000000 99.00
POST-OP SHOE 7.65 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 92
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500453 POST-OP SHOE MEN XL 00420 161124 6.05 EA=1EA .00 1 00000000 99.00
POST-OP SHOE 6.05 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500451 POST-OP SHOE MN MD 00249 ORT30400MM 7.55 EA=1EA .00 1 00000000 99.00
POST-OP SHOE 7.55 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500450 POST-OP SHOE MN S 00420 161121 6.84 EA=1EA .00 1 00000000 99.00
POST-OP SHOE 6.84 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501473 POST-OP SHOE PEDIATRIC 00420 8601-697-01 11.73 EA=1EA .00 1 00000000 99.00
POST-OP SHOE 11.73 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500446 POST-OP SHOE YOUTH 00420 860169702 11.73 EA=1EA .00 1 00000000 99.00
POST-OP SHOE 11.73 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500449 POST-OP WOMEN LG 00249 ORT30300WL 10.70 EA=1EA .00 1 00000000 99.00
POST-OP WOMEN 10.70 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500448 POST-OP WOMENS MD 00249 ORT30400WM 7.55 EA=1EA .00 1 00000000 99.00
POST-OP WOMEN 7.55 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500447 POST-OP WOMENS SM 00249 ORT30400WS 7.55 EA=1EA .00 1 00000000 99.00
POST-OP WOMEN 7.55 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 93
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001285 POSTERIOR ELBOW LG. 00585 79-71137 13.37 EA=1EA .00 1 00000000 39.00
POSTERIOR ELB 13.37 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001284 POSTERIOR ELBOW MD. 00585 79-71135 13.10 EA=1EA .00 1 00000000 39.00
POSTERIOR ELB 13.10 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001286 POSTERIOR ELBOW XL 00585 79-71138 13.37 EA=1EA .00 1 00000000 39.00
POSTERIOR ELB 13.37 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001386 POSTERIOR TIB/FIB LARGE 30 00123 79-72297 19.52 EA=1EA .00 1 00000000 39.00
POSTERIOR TIB 19.52 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001283 POSTERIOR TIBULA LG. 00249 SDJ7972283 23.28 EA=1EA .00 1 00000000 69.00
POSTERIOR TIB 23.28 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001282 POSTERIOR TIBULA SPLINT MD 00123 79-72285 20.16 EA=1EA .00 1 00000000 69.00
POSTERIOR TIB 20.16 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001312 POSTTERIOR TIB/FIB SMALL 00249 SDJ7972283 20.02 EA=1EA .00 1 00000000 69.00
POSTTERIOR TI 20.02 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000195 POWDER 00249 MSC095390 .4422 EA=1EA .00 1 00000000 .00
POWDER 15.92 CS=36EA/CS 36 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 94
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2146225 PPH STAPLE GUN 00249 BAR9001C0212 22.57 EA=1EA .00 1 00000000 924.00
PPH STAPLE GU 00043 9001C0212 225.70 BX=10EA/BX 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001376 PREFILLED NS SYRINGE 10ML 00257 723306546 7.94 BX=1BX .00 1 00000000 10.00
PREFILLED NS 238.14 CS=30BX/CS 30 .00 2 00000000 .00
.......... 78(0250) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000170 PROBE COVER CRITIKON 00257 1720008815 19.90 BX=1BX .00 1 00000000 .00
PROBE COVER C 19.90 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000242 PROBE COVER WELCH ALLYN 00062 75-05031 66.85 BX=1BX .00 1 00000000 .00
PROBE COVER W 00249 W-A05031750 66.85 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501146 PROCEDURE TRAY (PICC) 00487 21-2501-01 26.20 EA=1EA .00 1 00000000 377.00
PROCEDURE TRA 262.00 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2146227 PROLENE MESH PMII 3X6 00249 ETHPMII 78.815 EA=1EA .00 1 00000000 478.00
PRLENEMESHP3X 00043 9001C0212 472.89 BX=6EA/BX 6 .00 2 00000000 .00
.......... 50(0278) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: C1781 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
80001431 PRONOVA 6-0 00257 230003805H 288.34 BX=1BX .00 1 00000000 .00
PRONOVA 6-0 288.34 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 95
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001500 PROTEST BI TEST PACK 00452 PT-3-BITP 155.43 CS=1CS .00 1 00000000 .00
PROTEST BI TE 155.43 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001119 PROXIMATE LINEAR CUTTER TC 00249 TCR75 69.20 EA=1EA .00 1 00000000 173.00
PROXIMATE LIN 830.35 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500681 PULSE OXISENSOR ADULT 00263 0600-00-0121 10.9917 EA=1EA .00 1 00031110 234.00
PULSE OXISENS 00249 MM01859 263.80 CS=24EA/CS 24 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501620 PULSE OXISENSOR ADULT (OR) 00249 4110001001 8.98 EA=1EA .00 1 00000000 104.00
PULSE OXISENS 179.69 CS=20EA/CS 20 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500682 PULSE OXISENSOR PED. 00263 00600-00-0122 12.9765 EA=1EA .00 1 00031110 203.00
PULSE OXISENS 00249 MMO1860 259.53 CS=20EA/CS 20 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1410160 PUNCTURE ASPIRATION OF ABSCESS HEMAT .00 EA= .00 1 00000000 232.00
PUNCTURE ASPI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 10160 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
80001447 PURPLE ID BAND 00257 518905033PDM 88.25 BX=1BX .00 1 00000000 .00
PURPLE ID BAN 88.25 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 96
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000464 PYXIS PAPER 00302 107071-01 1.95 RL=1RL .00 1 00000000 .00
PYXIS PAPER 97.65 PK=50RL/PK 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501098 QUIK -COMBO ELECTRODE ADUL 00295 11996000091 24.05 EA=1EA .00 1 00000000 179.00
QUIK -COMBO E 00249 PHY1199600091 24.05 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501178 QUIK-COMBO PEDIATRIC 00295 3010107-000 45.00 EA=1EA .00 1 00000000 194.00
QUIK-COMBO PE 00249 PHY19600093PK 45.00 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501544 QUIK-PACE ELECTRODES 00249 PHY996000017 26.085 EA=1EA .00 1 00031110 240.00
QUIK-PACE ELE 00295 11996-000017 26.085 EA=1EA/EA 1 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001644 RAPICIDE GLUT HIGH LEVEL 00249 SDCML020127 24.83 EA=1EA .00 1 00000000 .00
OPA 28 00248 ML02-0059 99.32 CS=4EA/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500202 RAZOR 00249 BRN1333Z .394 EA=1EA .00 1 00031110 10.00
RAZOR 00062 80-02 3.94 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001135 RE/X EXP FILTER/760 00394 G-060526-00 102.60 EA=1EA .00 1 00000000 .00
RE/X EXP FILT 102.60 CS=1EA/CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001535 READY BATH COMPLETE 00249 MSC095304 .7073 EA=1EA .00 1 00000000 .00
READY BATH CO 21.22 CS=30EA/CS 30 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 97
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500085 RED RUBBER 10FR 00249 DYND13510 .8275 EA=1EA .00 1 00000000 20.00
RED RUBBER 10 9.93 CS=12EA/CS 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500086 RED RUBBER 12 FR 00249 0620-94120 .87 EA=1EA .00 1 00000000 20.00
RED RUBBER 12 87.00 CS=100EA/CS 100 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500087 RED RUBBER 14FR 00249 0620-94140 .83 EA=1EA .00 1 00000000 20.00
RED RUBBER 14 82.75 CS=100EA/CS 100 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500088 RED RUBBER 16FR 00257 0620-94160 .80 EA=1EA .00 1 00000000 20.00
RED RUBBER 16 80.00 CS=100EA/CS 100 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500089 RED RUBBER 18FR 00249 0620-94180 .83 EA=1EA .00 1 00000000 20.00
RED RUBBER 18 82.75 CS=100EA/CS 100 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1499418 REOPENING OF RECENT LAPAROTOMY .00 EA= .00 1 00000000 2567.00
REOPENING OF .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 49002 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
280017 REPAIR INCARCERATED INGUINAL HERNIA .00 EA= .00 1 00000000 1424.00
REP INC ING 5 .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 49507 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 98
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499413 REPAIR INITAL INCISIONAL OR VENTRAL .00 EA= .00 1 00000000 2273.00
REPAIR INITAL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 49561 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1449505 REPAIR INITIAL INGUINAL HERNIA AGE 5 .00 EA= .00 1 00000000 1817.00
REPAIR INITIA .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 49505 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
90002195 RESPIRONIC MED NASAL CONT 01304 73-302180 51.35 EA=1EA .00 1 00000000 44.00
RESPIRONIC ME 51.35 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90002199 RESPIRONICS LG GOLDS NAS M 01304 73-302356 57.00 EA=1EA .00 1 00000000 44.00
RESPIRONICS L 57.00 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90002197 RESPIRONICS LG NASAL CONT 01304 73-302188 41.44 EA=1EA .00 1 00000000 44.00
RESPIRONICS L 41.44 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90002198 RESPIRONICS MED GOLDS NAS 01304 73-302354 57.00 EA=1EA .00 1 00000000 44.00
RESPIRONICS M 57.00 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90002196 RESPIRONICS SM NASAL CONT 01304 73-302187 51.35 EA=1EA .00 1 00000000 44.00
RESPIRONICS S 51.35 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 99
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501253 RHINO ROCKET 00249 SGY11S05008AS 23.445 EA=1EA .00 1 00000000 63.00
RHINO ROCKET 93.78 BX=4EA/BX 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001044 RHYTHM STRIPS 00062 D3247P 53.25 BX=1BX .00 1 00000000 .00
RHYTHM STRIPS 00265 1234 532.50 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501255 RIB BELT FEMALE 00420 2722-008 .29 EA=1EA .00 1 00000000 98.00
RIB BELT FEMA 3.49 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501254 RIB BELT MALE 00420 2721-008 .29 EA=1EA .00 1 00000000 98.00
RIB BELT MALE 3.49 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000664 RUBBERBANDS 00499 UNV00432 9.99 BX=1BX .00 1 00000000 .00
RUBBERBANDS 9.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001262 SAFE SORB 00249 DYNDS1500B 1.2286 EA=1EA .00 1 00000000 .00
SAFE SORB 117.95 CS=96EA/CS 96 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000493 SAFETY GLASSES 00249 NON24770H 1.78 EA=1EA .00 1 00000000 .00
SAFETY GLASSE 1.78 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001215 SAFETY NEEDLE 18X11/2 00257 3.58382E+11 21.40 BX=1BX .00 1 00000000 .00
SAFETY NEEDLE 21.40 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 100
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001238 SAFETY NEEDLE 21X1 00249 B-D305764Z 15.175 BX=1BX .00 1 00000000 .00
SAFETY NEEDLE 15.175 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001239 SAFETY NEEDLE 22X1 00249 SWD850210Z 9.35 BX=1BX .00 1 00000000 .00
SAFETY NEEDLE 9.35 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001216 SAFETY NEEDLE 22X11/2 00249 B-D305763Z 15.175 BX=1BX .00 1 00000000 .00
SAFETY NEEDLE 15.175 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001217 SAFETY NEEDLE 23X1 00249 B-D305762Z 15.175 BX=1BX .00 1 00000000 .00
SAFETY NEEDLE 15.175 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001219 SAFETY NEEDLE 25X1 00249 B-D305916Z 11.075 BX=1BX .00 1 00000000 .00
SAFETY NEEDLE 11.075 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001218 SAFETY NEEDLE 25X11/2 00249 SYRS100257Z 21.84 BX=1BX .00 1 00000000 .00
SAFETY NEEDLE 21.84 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001221 SAFETY NEEDLE 25X5/8 00249 B-D305901Z 11.0775 BX=1BX .00 1 00000000 .00
SAFETY NEEDLE 11.0775 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001391 SAFETY NEEDLES 18X1 00249 SWD850810Z 12.82 BX=1BX .00 1 00000000 .00
SAFETY NEEDLE 12.82 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 101
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000235 SAFETY PINS 00257 286730392C .89 BG=1BG .00 1 00000000 .00
SAFETY PINS 10.62 BX=12BG/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500222 SAFETY SCALPEL 10 00249 MDS15310 1.707 EA=1EA .00 1 00000000 32.00
SAFETY SCALPE 17.07 BX=1BX/10 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500223 SAFETY SCALPEL 11 00249 MDS153111 1.301 EA=1EA .00 1 00000000 32.00
SAFETY SCALPE 13.01 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500224 SAFETY SCALPEL 15 00249 MDS15315 .8708 EA=1EA .00 1 00000000 14.00
SAFETY SCALPE 10.45 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500111 SALEM SUMP 16FR 00249 DYND72016H 2.87 EA=1EA .00 1 00000000 65.00
SALEM SUMP 16 2.87 EA=1EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500112 SALEM SUMP 18FR 00249 DYND72018H 3.47 EA=1EA .00 1 00000000 29.00
SALEM SUMP 18 3.47 EA=1EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1499410 SALPINGO-OOHORECTOMY COMPLETE OR PAR .00 EA= .00 1 00000000 1807.00
SALPINGO OOHO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 58720 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 102
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001349 SALUTE INSTRUMENT 00467 113077 230.00 EA=1EA .00 1 00000000 .00
SALUTE INSTRU 1150.00 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000199 SCISSOR SHARP/BLUNT 00249 DYND04000 1.7904 EA=1EA .00 1 00000000 .00
SCISSOR SHARP 44.76 BX=25EA/BX 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501378 SENSI-TOUCH GLOVES 61/2 00249 MSG4065Z .2456 EA=1EA .00 1 00031110 12.00
SENSI-TOUCH G 12.28 BX=50EA/BX 50 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501379 SENSI-TOUCH GLOVES 7.0 00249 MSG4070Z .2456 EA=1EA .00 1 00031110 12.00
SENSI-TOUCH G 12.28 BX=50EA/BX 50 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501380 SENSI-TOUCH GLOVES 71/2 00249 MSG4075Z .2456 EA=1EA .00 1 00031110 12.00
SENSI-TOUCH G 12.28 BX=50EA/BX 50 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501381 SENSI-TOUCH GLOVES 8.0 00249 MSG4080Z .2456 EA=1EA .00 1 00031110 12.00
SENSI-TOUCH G 12.28 BX=50EA/BX 50 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501201 SHAMPOO 00249 MSC095006 .28 EA=1EA .00 1 00000000 .00
SHAMPOO 26.69 CS=96EA/CS 96 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001336 SHAMPOO CAP 00249 MSC095230 .9678 EA=1EA .00 1 00000000 .00
SHAMPOO CAP 38.71 CS=30EA/CS 40 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 103
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001060 SHARP CONT. LAB 00249 KDL31143665 5.0033 EA=1EA .00 1 00000000 .00
SHARP CONT. L 30.02 CS=6EA/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000040 SHARP CONT.17 GAL 00249 KDL8991 13.582 EA=1EA .00 1 00000000 .00
SHARP CONT.17 00062 68-8980C 67.91 CS=5EA/CS 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=41115109 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000041 SHARP CONT.NEEDLE 00249 3.58331E+11 .94 EA=1EA .00 1 00000000 .00
SHARP CONT.NE 75.20 CS=80EA/CS 80 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001034 SHARP CONTAINER HK 00249 BEH175020 113.12 CS=1CS .00 1 00000000 .00
SHARP CONTAIN 113.12 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000645 SHARPIE-BLACK FINE POINT 00499 SAN30001 11.99 EA=1EA .00 1 00000000 .00
SHARPIE-BLACK 11.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000646 SHARPIE-XTRA FINE POINT BL 00499 125443 .8158 EA=1EA .00 1 00000000 .00
SHARPIE-XTRA 9.79 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501203 SHAVING CREAM 00249 MSC095014 .5314 EA=1EA .00 1 00000000 .00
SHAVING CREAM 76.52 CS=144EA/CS 144 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000582 SHEET PROTECTOR TOP 00499 UNV-21125 13.99 BX=1BX .00 1 00000000 .00
SHEET PROTECT 13.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 104
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000306 SHOECOVER 00249 CRI2002 4.82 BX=1BX .00 1 00000000 .00
SHOECOVER 14.46 CS=3BX/CS 3 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500434 SHOULDER BRACE MENS SM 00420 78301 7.32 BX=1BX .00 1 00000000 128.00
SHOULDER BRAC 7.32 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500437 SHOULDER BRACE MENS XL 00249 ORT16100XL 13.71 BX=1BX .00 1 00000000 128.00
SHOULDER BRAC 13.71 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500433 SHOULDER BRACE WOMEN XL 00420 78404 7.24 BX=1BX .00 1 00000000 128.00
SHOULDER BRAC 7.24 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500436 SHOULDER MENS LG 00249 ORT16100L 12.77 BX=1BX .00 1 00000000 128.00
SHOULDER MENS 12.77 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500435 SHOULDER MENS MD 00249 ORT16100M 17.49 BX=1BX .00 1 00000000 128.00
SHOULDER MENS 17.49 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500432 SHOULDER WOMEN LG 00249 ORT16100L 12.28 BX=1BX .00 1 00000000 128.00
SHOULDER WOME 12.28 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500431 SHOULDER WOMEN MD 00420 78402 9.28 BX=1BX .00 1 00000000 128.00
SHOULDER WOME 9.28 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 105
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500430 SHOULDER WOMEN SM 00249 ORT16100S 19.49 BX=1BX .00 1 00000000 128.00
SHOULDER WOME 19.49 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501466 SILVERSORB 1" 00249 MSC9310EP 2.5333 BX=1BX .00 1 00031110 51.00
SILVERSORB 1" 76.00 BX=30EA/BX 30 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2330511 SIMPLE PROCEDURE ER .00 EA= .00 1 00000000 230.00
SIMPLE PROCED .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501458 SINGLE BASIN SET 00249 DYNJ06610A 3.8517 EA=1EA .00 1 00000000 24.00
SINGLE BASIN 23.11 CS=6EA/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500197 SITZ BATH 00249 DYND801020 1.619 EA=1EA .00 1 00000000 90.00
SITZ BATH 16.19 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500862 SKIN MARKERS 00249 DYNJSM01 .369 EA=1EA .00 1 00000000 20.00
SKIN MARKERS 18.45 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2504035 SMALL ADULT BP CUFF 00249 MDS9912HP 3.904 EA=1EA .00 1 00000000 .00
SMALL ADULT B 19.52 PK=5EA/PK 5 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 3.904 1 .00 3 00000000 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000723 SMALL DISPOS VINYL NASAL M 01304 73312102EA 14.49 EA=1EA .00 1 00000000 44.00
SMALL DISPOS 14.49 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 106
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001392 SODIUM CHLORIDE INJECTION 00257 4131118881 312.75 CS=1CS .00 1 00000000 .00
SODIUM CHLORI 312.75 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001501 SODIUM CHLORIDE INJECTION 00257 723306544 .48 EA=1EA .00 1 00000000 .00
SODIUM CHLORI 231.31 CS=480EA/CS 480 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001387 SONY COLOR FILM ACCESS LAB 00085 UPT210BL 260.00 BX=1BX .00 1 00000000 .00
SONY COLOR FI 260.00 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001240 SONY COLOR PRINT 2010 00435 UPC-2010 85.00 BX=1BX .00 1 00000000 .00
SONY COLOR PR 85.00 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001241 SONY COLOR PRINT 5010 00435 UPC-501 140.00 BX=1BX .00 1 00000000 .00
SONY COLOR PR 140.00 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000285 SORBASAN 4X4 00257 202079409218 4.17 EA=1EA .00 1 00000000 25.00
SORBASAN 4X4 41.70 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000465 SPACELAB PAPER 00249 SHE307438001 1.816 RL=1RL .00 1 00000000 .00
SPACELAB PAPE 18.16 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500182 SPECIMEN CUP STERILE 00249 DYND30330 .113 EA=1EA .00 1 00031110 23.00
SPECIMEN CUP 00084 ST6 11.30 CS=100EA/CS 100 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 107
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000174 SPONGE DRAINAGE 4X4 6PLY 00249 NON256000H 2.51 BX=1BX .00 1 00000000 .00
SPONGE DRAINA 2.51 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000177 SPONGES 4X4 NS 00249 PRM21412C 2.823 PK=1PK .00 1 00000000 .00
SPONGES 4X4 N 28.23 CS=10PK/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500055 SPRING WIRE GUIDE 00035 AW14735 9.87 EA=1EA .00 1 00000000 40.00
SPRING WIRE G 246.75 CS=25EA/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000632 STAPLE REMOVER 00499 UNV00700 .23 EA=1EA .00 1 00000000 .00
STAPLE REMOVE .23 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500201 STAPLER REM.TRAY 00249 DYNJ04058Z .7683 EA=1EA .00 1 00000000 16.00
STAPLER REM.T 9.22 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000631 STAPLES 00118 UNV79000 1.29 BX=1BX .00 1 00000000 .00
STAPLES 1.29 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001428 STATLOCK PICC PLUS 00257 PIC0220 4.33 EA=1EA .00 1 00000000 .00
STATLOCK PICC 216.73 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500272 STERI-STRIP .25 00249 NON250114Z .4006 EA=1EA .00 1 00000000 41.00
STERI-STRIP . 20.03 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 108
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500273 STERI-STRIP .50 00249 MMMR1547Z .8362 EA=1EA .00 1 00000000 35.00
STERI-STRIP . 41.81 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501260 STERI-STRIPS W8514 (OR) 00249 NON250114Z 1.0708 EA=1EA .00 1 00000000 18.00
STERI-STRIPS 53.54 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500534 STERILE GUIDE 18GA NEEDLES 00249 BAR9001C0212 22.652 EA=1EA .00 1 00000000 144.00
STERILE GUIDE 00043 9001C0212 226.52 BX=10EA/BX 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001400 STERIS HAND SANITIZER 00249 DBU118187 5.3854 EA=1EA .00 1 00000000 .00
STERIS 64.625 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=41115109 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001220 STETHOSCOPE ISOLATION 00249 MDS9543 2.34 EA=1EA .00 1 00000000 .00
STETHOSCOPE I 2.34 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001433 STIFF GUIDE WIRE 00035 GS3508 69.30 EA=1EA .00 1 00000000 .00
STIFF GUIDE W 346.50 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000413 STOCKINETTE 3" 00249 MDT221203 5.49 BX=1BX .00 1 00000000 .00
STOCKINETTE 3 5.49 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000412 STOCKINETTE 4" 00249 MDT221204 7.18 BX=1BX .00 1 00000000 .00
STOCKINETTE 4 7.18 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 109
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001181 STOMADHESIVE POWDER 00257 1638025510 3.20 EA=1EA .00 1 00000000 .00
STOMADHESIVE 3.20 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001180 STOMEHESIVE PASTE 00249 SQU183910 2.07 EA=1EA .00 1 00000000 .00
STOMEHESIVE P 2.07 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000183 STOOL CUPS 00249 DYND30510 .894 PK=1PK .00 1 00000000 .00
STOOL CUPS 22.35 CS=25PK/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500309 STOPCOCK 3-WAY 00249 MDXMX412SL 1.4022 EA=1EA .00 1 00000000 25.00
STOPCOCK 3-WA 70.11 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000586 STRAIGHT CUT END TAB FOLDE 00361 24110 27.99 BX=1BX .00 1 00000000 .00
STRAIGHT CUT 00118 SMD24110 27.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501366 STRAIGHT TYPE BLOOD SET 2C 00793 M46443160 3.5437 EA=1EA .00 1 00000000 110.00
STRAIGHT TYPE 00249 BHL2C8750H 106.31 CS=30EA/CS 30 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000342 STRAWS 00249 NON02325 3.7724 BX=1BX .00 1 00000000 .00
STRAWS 00380 1234 94.31 CS=25BX/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001340 STYROFOAM CUP 8OZ. 00692 318 17.45 CS=1CS .00 1 00000000 .00
STYROFOAM CUP 17.45 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 110
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499231 SUBSEQUENT HOSPITAL CARE 15 MINS .00 EA= .00 1 00000000 102.00
SUBSEQUENT HO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99231 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499232 SUBSEQUENT HOSPITAL CARE PER DAY 25 .00 EA= .00 1 00000000 139.00
SUBSEQUENT HO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300020 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99232 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499233 SUBSEQUENT HOSPITAL VISIT .00 EA= .00 1 00000000 259.00
SUBSEQUENT HO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99233 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499224 SUBSEQUENT OBSERVATION CARE 15 MINS .00 EA= .00 1 00000000 66.00
SUBSEQUENT OB .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99224 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2500084 SUCTION CANNISTER 1200 00249 BXT65651395 1.668 EA=1EA .00 1 00031110 54.00
SUCTION CANNI 50.04 CS=30EA/CS 30 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500077 SUCTION CATH 10FR 00249 DYND41900 .28 EA=1EA .00 1 00031110 18.00
SUCTION CATH 28.47 CS=100EA/CS 100 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500078 SUCTION CATH 12FR 00249 DYND41901H 1.40 EA=1EA .00 1 00031110 18.00
SUCTION CATH 1.40 EA=1EA/EA 1 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 111
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500079 SUCTION CATH 14FR 00249 DYND41902H 1.40 EA=1EA .00 1 00031110 18.00
SUCTION CATH 1.40 EA=1EA/EA 1 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500080 SUCTION CATH 16FR 00249 DYND41903 .2242 EA=1EA .00 1 00031110 41.00
SUCTION CATH 22.42 CS=100EA/CS 100 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500081 SUCTION CATH 18FR 00249 DYND40904 .32 EA=1EA .00 1 00031110 18.00
SUCTION CATH 31.90 CS=100EA/CS 100 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500075 SUCTION CATH 6FR 00249 413085370 .58 EA=1EA .00 1 00031110 18.00
SUCTION CATH 58.00 CS=100EA/CS 100 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500076 SUCTION CATH 8FR 00249 DYND41908H 1.40 EA=1EA .00 1 00031110 18.00
SUCTION CATH 1.40 EA=1EA 1 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500082 SUCTION CATH TRAY 14FR 00249 DYND41442 1.2486 EA=1EA .00 1 00031110 68.00
SUCTION CATH 44.95 CS=36EA/CS 36 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000311 SUR.GLOVES ALOETOUCH 6.0 00249 MDS206060Z .93 EA=1EA .00 1 00000000 .00
SUR.GLOVES AL 46.50 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501397 SURE SEAL 00249 2610085200 11.73 BX=1BX .00 1 00000000 7.00
SURE SEAL 11.73 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 112
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000217 SURG.BLADES 10 00257 0723-371110 12.32 BX=1BX .00 1 00000000 .00
SURG.BLADES 1 12.32 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000218 SURG.BLADES 11 00257 0723-371111 13.685 BX=1BX .00 1 00000000 .00
SURG.BLADES 1 13.685 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000220 SURG.BLADES 15 00249 B-D371153Z 15.74 BX=1BX .00 1 00000000 .00
SURG.BLADES 1 15.74 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500316 SURG.GLOVES 81/2 00249 407008327 .89 EA=1EA .00 1 00031110 12.00
SURG.GLOVES 8 44.33 BX=50EA/BX 50 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500312 SURG.GLOVES ALOE-TOUCH 61/ 00249 MSG1065Z 1.3736 EA=1EA .00 1 00031110 12.00
SURG.GLOVES A 34.34 BX=25EA/BX 25 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500313 SURG.GLOVES ALOETOUCH 7 00249 MSG1070Z 1.4016 EA=1EA .00 1 00031110 12.00
SURG.GLOVES A 35.04 BX=25EA/BX 25 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500314 SURG.GLOVES ALOETOUCH 7.5 00249 MSG1075Z 1.3736 EA=1EA .00 1 00031110 12.00
SURG.GLOVES A 34.34 BX=25EA/BX 25 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500315 SURG.GLOVES ALOETOUCH 8.0 00249 MSG1080Z 1.4016 EA=1EA .00 1 00031110 12.00
SURG.GLOVES A 35.04 BX=25EA/BX 25 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 113
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000301 SURG.MASK (BLUE) 00249 NON27376 7.9217 BX=1BX .00 1 00000000 .00
SURG.MASK (BL 47.53 CS=6BX/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000304 SURGEON CAPS 00249 NON28626 7.80 BX=1BX .00 1 00000000 .00
SURGEON CAPS 39.00 CS=5BX/CS 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001696 SURGEON GLOVE 6.0 00249 MSG1060Z 1.4016 EA=1EA .00 1 00000000 .00
SURGEON GLOVE 35.04 BX=25EA/BX 25 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 1.4016 1 .00 3 00000000 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001520 SURGEON GLOVES LF,PF 7.0 00257 407008514 76.63 BX=1BX .00 1 00000000 .00
SURGEON GLOVE 76.63 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001519 SURGEON GLOVES LF,PF 71/2 00257 407008515 76.63 BX=1BX .00 1 00000000 .00
SURGEON GLOVE 76.63 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000300 SURGICAL GOWN XL 00249 DYNJP2307P 3.3658 EA=1EA .00 1 00000000 .00
SURGICAL GOWN 80.78 CS=24EA/CS 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1446270 SURGICAL TREATMENT OF ANAL FISTULA .00 EA= .00 1 00000000 1502.00
SURGICAL TREA .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 46270 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 114
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500474 SURGICEL 2X3 00249 ETH1953Z 51.2333 EA=1EA .00 1 00000000 79.00
SURGICEL 2X3 614.80 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500473 SURGICEL 4X8 00249 1952 52.14 EA=1EA .00 1 00000000 143.00
SURGICEL 4X8 625.71 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500237 SUSPENSORY LG 00249 IMP091103 4.86 EA=1EA .00 1 00000000 21.00
SUSPENSORY L 4.86 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500236 SUSPENSORY MD 00249 IMP091102 4.86 EA=1EA .00 1 00000000 21.00
SUSPENSORY MD 4.86 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500238 SUSPENSORY XL 00249 723202612 4.36 EA=1EA .00 1 00000000 21.00
SUSPENSORY XL 4.36 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500200 SUTURE REM.TRAY 00249 DYND70900 .8146 EA=1EA .00 1 00000000 36.00
SUTURE REM.TR 40.73 CS=50EA/CS 50 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000036 SYRINGE 10CC 00249 B-D309604 12.975 BX=1BX .00 1 00000000 .00
SYRINGE 10CC 25.95 CS=2BX/CS 2 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000057 SYRINGE 20CC 00249 SYR120010 35.07 BX=1BX .00 1 00000000 .00
SYRINGE 20CC 00062 68-9661 35.07 CS=4BX/CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 115
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000060 SYRINGE 3CC 00249 SYR103010 6.7325 BX=1BX .00 1 00000000 .00
SYRINGE 3CC 00062 68-1610 53.86 CS=8BX/CS 8 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000035 SYRINGE 5CC 00249 SYR105010 8.5575 BX=1BX .00 1 00000000 .00
SYRINGE 5CC 34.23 CS=4BX/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000065 SYRINGE 60CC CT 00249 B-D309620Z 11.89 BX=1BX .00 1 00000000 .00
SYRINGE 60CC 11.89 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000064 SYRINGE 60CC LL 00249 B-D309653Z 11.89 BX=1BX .00 1 00000000 .00
SYRINGE 60CC 11.89 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501068 SYRINGE EAR 2OZ 00249 DYND70280 .4136 EA=1EA .00 1 00000000 11.00
SYRINGE EAR 2 20.68 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001377 SYRINGE PREFILLED NS 3ML 00257 723306544 7.62 BX=1BX .00 1 00000000 .00
SYRINGE PREFI 228.61 CS=30BX/CS 30 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000629 TAPE DISPENSER 00052 MMMC38 4.99 EA=1EA .00 1 00000000 .00
TAPE DISPENSE 00361 649245 4.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000876 TAPE MICROPORE 00249 NON260001D .4669 EA=1EA .00 1 00000000 .00
TAPE MICROPOR 67.24 CS=144EA/CS 144 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 116
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000995 TB MASK 00249 MMM1860 10.485 BX=1BX .00 1 00000000 .00
TB MASK 62.91 CS=6BX/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001300 TB MASK SMALL 00249 MMM1860S 10.485 BX=1BX .00 1 00000000 .00
TB MASK SMALL 62.91 CS=6BX/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001105 TB SYRINGE 00249 B-D305945Z 29.85 BX=1BX .00 1 00000000 .00
TB SYRINGE 29.85 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500992 TEGERDERM IV 00249 MSC2302 .2391 EA=1EA .00 1 00000000 23.00
TEGERDERM IV 23.91 BX=100EA/BX 100 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000117 TELEMETRY POUCH 00249 35960MC500 .79 EA=1EA .00 1 00000000 .00
TELEMETRY POU 39.65 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500289 TELFA 4X8 ADH 00257 3583005111 .55 EA=1EA .00 1 00000000 14.00
TELFA 4X8 AD 27.29 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500288 TELFA 3X4 NON-ADH. 00249 NON25710 1.0762 EA=1EA .00 1 00000000 14.00
TELFA 3X4 NON 53.81 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500287 TELFA 3X8 NON-ADH 00249 NON25720Z .0912 EA=1EA .00 1 00000000 6.00
TELFA 3X8 NON 4.56 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 117
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500533 TEMP SHARP HOLDER 00249 DYNJNDLNEST .643 EA=1EA .00 1 00000000 .00
TEMP SHARP HO 32.15 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000341 TERRI-WIPES 00249 NON260506 2.15 BX=1BX .00 1 00000000 .00
TERRI-WIPES 00062 10-DW501 21.50 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2599999 TEST ITEM 00249 TEST123 8.8878 EA=1 EA .00 1 00000000 .00
TEST ITEM 159.98 CS=18EA/CS 18 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 8.8878 1 .00 3 00000000 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500381 THIGH HIGH LG 00432 204029 8.04 EA=1EA .00 1 00000000 115.00
THIGH HIGH LG 00249 MDS160860 40.20 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500380 THIGH HIGH MED 00249 MDS160844 8.1417 EA=1EA .00 1 00000000 115.00
THIGH HIGH ME 48.85 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500379 THIGH HIGH SM 00249 MDS160824 9.2567 EA=1EA .00 1 00000000 115.00
THIGH HIGH SM 55.54 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500382 THIGH HIGH XL 00249 MDS160884 9.785 EA=1EA .00 1 00000000 259.00
THIGH HIGH XL 58.71 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000720 THOMAS ENDOTRACH TUBE HOLD 01304 780500EA 5.11 EA=1EA .00 1 00000000 .00
THOMAS ENDOTR 5.11 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 118
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90000726 THOMAS ENDTRACH TUBE HOLD 01304 780400EA 5.11 EA=1EA .00 1 00000000 .00
THOMAS ENDTRA 5.11 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500046 THORACENTESIS TRAY 00035 AK01000 59.59 EA=1EA .00 1 00000000 313.00
THORACENTESIS 00249 ARWAK01000H 595.90 CS=10EA/CS 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1499408 THYROIDECTOMY, REMOVAL OF ALL REMAIN .00 EA= .00 1 00000000 2696.00
THROIDECTOMY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 60260 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2501425 TIP STOPS 00249 GMO114555H 2.48 EA=1EA .00 1 00000000 15.00
TIP STOPS 2.48 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000192 TONGUE BLADE NON 00257 5937W0D3002 3.25 BX=1BX .00 1 00000000 .00
TONGUE BLADE 3.25 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000193 TONGUE BLADE S 00249 MDS202075 1.673 BX=1BX .00 1 00000000 .00
TONGUE BLADE 16.73 CS=1BX/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501235 TOOTHBRUSHES 00249 MDS136000 .0344 EA=1EA .00 1 00000000 .00
TOOTHBRUSHES 4.95 BX=144BX/BX 144 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 119
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501195 TOOTHPASTE 00249 NONTP6IZ .1101 EA=1EA .00 1 00000000 .00
TOOTHPASTE 15.86 CS=144EA/CS 144 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001334 TOURNIQUET 00249 DYND75020 170.30 BX=1BX .00 1 00000000 .00
TOURNIQUET 00462 ML14325 170.30 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500083 TRACH CLEANING TRAY 00249 DYND40589 1.8935 EA=1EA .00 1 00031110 50.00
TRACH CLEANIN 37.87 CS=20EA/CS 20 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000090 TRACH TUBE HOLDER 00249 1821000240 2.77 EA=1EA .00 1 00000000 .00
TRACH TUBE HO 27.65 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000702 TRACHEOSTOMY OXYGEN MASK 01304 355245 1.57 EA=1EA .00 1 00000000 60.00
TRACHEOSTOMY 78.25 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000188 TRANSPORE TAPE 1" 00249 MMM15271 6.394 BX=1BX .00 1 00000000 .00
TRANSPORE TAP 63.94 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000189 TRANSPORE TAPE 2" 00249 MMM15272 6.591 BX=1BX .00 1 00000000 .00
TRANSPORE TAP 65.91 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000336 TRASH BAGS 24X33 00249 HTBD4832RC 23.107 CS=1CS .00 1 00000000 .00
TRASH BAGS 24 00380 5595806 23.107 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=41115109 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 120
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90000337 TRASHBAGS 43X48 00249 HTBX7658AK 26.8075 CS=1CS .00 1 00000000 .00
TRASHBAGS 43X 00380 1298845 26.8075 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=41115109 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500044 TRIPLE LUM CATH 20FR. 00035 CDC-45703-P1A 104.87 EA=1EA .00 1 00000000 822.00
TRIPLE LUM CA 00249 ARWDC42703P1A 524.35 CS=5EA/CS 5 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: C1751 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
80000295 TUBING NON-CONDUCTIVE 00249 BXTN7100RL 8.305 BX=1BX .00 1 00000000 .00
TUBING NON-CO 8.305 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501249 TWIN-CATH MULTIPLE -LUMEN 00249 ARWIV01100H 4.17 EA=1EA .00 1 00000000 44.00
TWIN-CATH MUL 4.17 EA=1EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001383 ULTRA SONIC GEL 00249 MDS092010 12.79 EA=1EA .00 1 00000000 .00
ULTRA SONIC G 51.16 CS=4EA/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500986 UNDERPADS 00249 MSC281226 .0967 EA=1EA .00 1 00000000 11.00
UNDERPADS 00074 KC7176 14.50 CS=150EA/CS 150 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501039 UNIVERSAL ARM SLING 00249 ORT11010D 9.4125 EA=1EA .00 1 00000000 65.00
ARM SLING UNI 00432 1796-12-10 37.65 CS=4EA/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 121
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501117 UNNA BOOT (WHITE BOX) 00249 GHFUNNA4H 11.12 BX=1BX .00 1 00000000 98.00
UNNA BOOT (WH 11.12 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500402 UNNA BOOT MEDICO PASTE 00249 4927001053 6.85 BX=1BX .00 1 00000000 98.00
UNNA BOOT MED 68.51 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1443248 UP GI ENDO W/ INSERT GUIDE WIRE THEN .00 EA= .00 1 00000000 901.00
UP GI ENDO W/ .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43248 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443245 UP GI ENDO W/DILAT GASTRIC OUT OBSTR .00 EA= .00 1 00000000 928.00
UP GI ENDO W/ .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43245 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443251 UP GI ENDOSCOPY WITH REMOVAL OF TUMO .00 EA= .00 1 00000000 1122.00
UP GI ENDOSCO .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43251 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443247 UPPER GASTROINTESTINAL ENDOSCOPY WIT .00 EA= .00 1 00000000 928.00
UPPER GASTROI .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43247 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443249 UPPER GI ENDOSCOPY WITH BALLOON DILA .00 EA= .00 1 00000000 986.00
UPPER GI ENDO .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43249 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 122
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500999 URETHRAL CATH TRAY 00249 BRD772415 1.2295 EA=1EA .00 1 00031110 110.00
URETHRAL CATH 00062 21-802214 24.59 CS=20EA/CS 20 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500185 URINALS 00249 DYND80235S .3194 EA=1EA .00 1 00000000 14.00
URINALS 00084 910 15.33 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500262 URINE FILTER 00249 2748010713 .08 EA=1EA .00 1 00000000 8.00
URINE FILTER 20.70 BX=250EA/BX 250 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000063 URINE JAR 24HR 00249 DYND80024 .985 EA=1EA .00 1 00000000 .00
URINE JAR 24H 19.70 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500244 URINE TOLET MEASURE 00249 DYND36600 .2354 EA=1EA .00 1 00000000 45.00
URINE TOLET M 23.54 CS=100EA/CS 100 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500291 UROMETER 00249 DYND17403 6.262 EA=1EA .00 1 00000000 212.00
UROMETER 62.62 CS=10EA/CS 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000023 VAC NEEDLE 21GA 00249 358381-216041 5.55 BX=1BX .00 1 00000000 .00
VAC NEEDLE 21 5.55 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501287 VAGINAL PACKING 00249 4684010026 5.05 EA=1EA .00 1 00000000 30.00
VAGINAL PACKI 121.24 CS=24EA/CS 24 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 123
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500276 VASELINE GAUZE 3X9 00249 CUR251390Z .3744 EA=1EA .00 1 00000000 12.00
VASELINE GAUZ 18.72 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001338 VASELINE LIP THERAPY 00257 123302831HP .92 EA=1EA .00 1 00000000 .00
VASELINE LIP 22.11 BX=24EA/BX 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000248 VASELINE TUBE 00249 MSC095034 1.8383 EA=1EA .00 1 00000000 .00
VASELINE TUBE 22.06 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000725 VENTISURE AD CO2 RESUS BAG 01304 3015582 25.63 EA=1EA .00 1 00000000 221.00
VENTISURE AD 410.12 CS=16EA/CS 16 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000744 VENTISURE DIS INFANT RESUS 01304 76750 81.75 EA=1EA .00 1 00000000 221.00
VENTISURE DIS 81.75 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000743 VENTISURE DISP PED RESUS B 01304 3015580EA 32.20 EA=1EA .00 1 00000000 221.00
VENTISURE DIS 32.20 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500153 VEST REST LG 00249 MDT828024 6.4783 EA=1EA .00 1 00031110 99.00
VEST REST LG 38.87 CS=6EA/CS 6 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500152 VEST REST MD 00249 MDT828022 6.4783 EA=1EA .00 1 00000000 99.00
VEST REST MD 38.87 CS=6EA/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 124
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500151 VEST REST SM 00249 MDT828020 6.115 EA=1EA .00 1 00031110 99.00
VEST REST SM 36.69 CS=6EA/CS 6 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501290 VEST RESTRAINT XL 00249 52557991628 8.49 EA=1EA .00 1 00000000 99.00
VEST RESTRAIN 84.88 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001700 VOMIT BAG 00249 NON80328 10.0917 PK=1PK .00 1 00000000 .00
VOMIT BAG 60.55 CS=6PK/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 10.0917 1 .00 3 00000000 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500253 WAFER 1.50 00249 SQU125258 .901 EA=1EA .00 1 00000000 39.00
WAFER 1.50 9.01 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500254 WAFER 1.75 00249 SQU125259 .901 EA=1EA .00 1 00000000 39.00
WAFER 1.75 9.01 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500255 WAFER 2.25 00249 1638125260 .908 EA=1EA .00 1 00000000 39.00
WAFER 2.25 00072 125260 9.08 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500256 WAFER 2.75 00249 SQU125261 .901 EA=1EA .00 1 00000000 39.00
WAFER 2.75 00072 125261 9.01 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500252 WAFER SURFIT 1.25 00249 SQU125257 .901 EA=1EA .00 1 00000000 39.00
WAFER SURFIT 9.01 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 125
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500890 WALKING BOOT PNEUMATIC LG. 00249 ORT28610L 85.12 BX=1BX .00 1 00000000 344.00
WALKING BOOT 00123 O1F-L 85.12 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500889 WALKING BOOT PNEUMATIC MED 00249 ORT28610M 85.12 BX=1BX .00 1 00000000 344.00
WALKING BOOT 00123 O1F-M 85.12 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500891 WALKING BOOT PNEUMATIC SM. 00249 ORT28610S 66.28 BX=1BX .00 1 00000000 344.00
WALKING BOOT 66.28 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500864 WARMING BLANKETS-ER/ICU 00093 243 7.049 EA=1EA .00 1 00000000 119.00
WARMING BLANK 00249 CSZ82243 70.49 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500863 WARMING BLANKETS-SURGERY 00093 443 9.719 EA=1EA .00 1 00000000 119.00
WARMING BLANK 00249 CSZ82443 97.19 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000338 WATER SOLUBLE BG 00249 NON02800 7.405 PK=1PK .00 1 00000000 .00
WATER SOLUBLE 29.62 CS=4PK/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001027 WHITE-OUT 00052 PAP-56401 24.99 EA=1EA .00 1 00000000 .00
WHITE-OUT 00361 131383 24.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500557 WIRE GUIDE 145CM 00264 G09607 44.38 EA=1EA .00 1 00000000 128.00
WIRE GUIDE 14 44.38 EA=1EA/EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 126
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000318 WRAP 24 00249 GEM3124 45.00 PK=1PK .00 1 00000000 .00
WRAP 24 45.00 CS=1PK/CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000317 WRAP 36 00249 GEM3136 19.9933 PK=1PK .00 1 00000000 .00
WRAP 36 59.98 CS=3PK/CS 3 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000307 WRAP 54 00249 GEM4154 40.68 PK=1PK .00 1 00000000 .00
WRAP 54 40.68 CS=1PK/PK 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501037 WRIST SPLINT R 00432 1769-02 8.33 EA=1EA .00 1 00000000 92.00
WRIST SPLINT 00249 ORT18000R 8.33 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501036 WRIST SPLINT COCKUP L 00432 1769-03 8.33 EA=1EA .00 1 00000000 92.00
WRIST SPLINT 00249 ORT18000L 8.33 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500278 XEROFORM 4X4 00249 CUR253440Z .9864 EA=1EA .00 1 00000000 9.00
XEROFORM 4X4 24.66 BX=25EA/BX 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500277 XEROFORM 5X9 00249 CUR253590WZ .729 EA=1EA .00 1 00000000 16.00
XEROFORM 5X9 36.45 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500297 YANK.SUCTION W/TUBING 00249 16080034910 1.41 EA=1EA .00 1 00031110 171.00
YANK.SUCTION 28.11 CS=20EA/CS 20 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 127
TIME: 08:24 ITEM MASTER LIST DEPT# 002 ROUTINE INPATIENT H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500296 YANKAUER SUCTION 00249 DYND50130 .258 EA=1EA .00 1 00031110 171.00
YANKAUER SUCT 12.90 CS=50EA/CS 50 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000359 YELLOW/WHITE CHARGE LABELS 00107 7228 127.60 BX=1BX .00 1 00000000 .00
YELLOW LABLES 127.60 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001683 ZEBRA THERMAL RIBBON NS 00107 7589 12.95 EA=1EA .00 1 00000000 .00
ZEBRA THERMAL 12.95 EA=1EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 12.95 1 .00 3 00000000 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500391 ZIM-FLEX CAST TAPE 4" 00420 889704 7.78 EA=1EA .00 1 00000000 70.00
ZIM-FLEX CAST 77.77 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 128
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2113291 A/V ANASTOMOSIS OPEN .00 EA= .00 1 00000000 1775.00
A/V ANASTOMOS .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36818 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890000 ABSCESS I&D .00 EA= .00 1 00000000 337.00
ABSCESS I&D .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 10061 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113302 ACCESS AV DIAL GRAFT .00 EA= .00 1 00000000 4336.00
ACCESS AV DIA .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36147 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113311 ACCESS AV FISTULOGRAM .00 EA= .00 1 00000000 4336.00
AV FISTULOGRA .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36901 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113275 ADDTL STENT PLACEMEN .00 EA= .00 1 00000000 3106.00
ADDTL STENT P .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 37206 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800006 ADJACENT TISSUE TRANSFER OR REARRANG .00 EA= .00 1 00000000 1467.00
ADJACENT TISS .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 14000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800011 ADJACENT TISSUE TRANSFER OR REARRANG .00 EA= .00 1 00000000 1211.00
ADJACENT TISS .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 14000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 129
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1410009 ADMIN PNEUMOCOCCAL VACCINE (MEDICARE .00 EA= .00 1 00000000 25.00
ADMIN PNEUMOC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0009 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1415734 ADVANCEMENT FLAPS TRUNK .00 EA= .00 1 00000000 6260.00
ADVANCEMENT F .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 15734 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1427613 ALBUTEROL INHALATION SOLUTION .00 EA= .00 1 00000000 12.00
ALBUTEROL INH .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J7613 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1495117 ALLERGY MULTIPLE- PROF SVS ALLERGY I .00 EA= .00 1 00000000 42.00
ALLERGY MULTI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 95117 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1495115 ALLERGY SINGLE- PROFESSIONAL SERVICE .00 EA= .00 1 00000000 28.00
ALLERGY SINGL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 95115 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
8040009 ANESTHESIA SERVICES .00 EA= .00 1 00000000 18.00
ANESTHESIA SE .00 .00 2 00000000 .00
.......... 65(0370) INV.GL= EXP.GL= .00 .00 3 31300080 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45384 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
8040010 ANESTHESIA UNITS .00 EA= .00 1 00000000 18.00
ANESTHESIA UN .00 .00 2 00000000 .00
.......... 65(0370) INV.GL= EXP.GL= .00 .00 3 31300080 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45384 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 130
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2113267 ANGIOPLASTY ART BLKG .00 EA= .00 1 00000000 2662.00
ANGIOPLASTY A .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 35475 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113299 ANGIOPLASTY FEM-POP .00 EA= .00 1 00000000 2574.00
ANGIOPLASTY F .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 35474 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113312 ANGIOPLASTY NO STENT .00 EA= .00 1 00000000 20385.50
ANGIOPLAS W/O .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36902 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113313 ANGIOPLASTY W/ STENT .00 EA= .00 1 00000000 41202.05
ANGIOPLASTY W .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36903 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410438 ANNUAL WELLNESS VISIT INITIAL VISIT .00 EA= .00 1 00000000 468.00
ANNUAL WELLNE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0438 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446600 ANOSCOPY DX W OR W/OUT SPECIMEN COLL .00 EA= .00 1 00000000 204.00
ANOSCOPY DX W .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 46600 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444950 APPENDECTOMY .00 EA= .00 1 00000000 2221.00
APPENDECTOMY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44950 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 131
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1444960 APPENDECTOMY RUPTURED OPEN .00 EA= .00 1 00000000 2776.00
APPENDECTOMY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44960 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1429130 APPLICATION OF FINGER SPLINT STATIC .00 EA= .00 1 00000000 120.00
APPLICATION O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29130 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1429125 APPLICATION OF SHORT ARM SPLINT (FOR .00 EA= .00 1 00000000 180.00
APPLICATION O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29125 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113286 ART EXT-ARM .00 EA= .00 1 00000000 1775.00
ART EXT-ARM .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36120 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420600 ARTHROCENTESIS ASPIRATION AND/OR INJ .00 EA= .00 1 00000000 168.00
ARTHROCENTESI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20600 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420605 ARTHROCENTESIS ASPIRATION AND/OR INJ .00 EA= .00 1 00000000 174.00
ARTHROCENTESI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20605 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420610 ARTHROCENTESIS ASPIRATION OR INJECTI .00 EA= .00 1 00000000 206.00
ARTHROCENTESI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20610 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 132
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1427644 ATROVENT NONCOMPOUNDED UNIT DOSE FOR .00 EA= .00 1 00000000 12.00
ATROVENT NONC .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J7644 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113303 AV GRAFT DIAL PROC .00 EA= .00 1 00000000 2129.00
AV GRAFT DIAL .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36148 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1423420 B-12 INJECTION UP TO 1000 MCG .00 EA= .00 1 00000000 7.50
B-12 INJECTIO .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J3420 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113317 BALLOON ANGIOPLASTY .00 EA= .00 1 00000000 4336.00
BALLOON ANGIO .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36907 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
4111334 BB TRANSFUSE BLOOD PRODUCT .00 EA= 1.00 1 00000000 1063.00
TRANSFUSE BLD .00 .00 2 00000000 .00
....P..... 6B(0391) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36430 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411101 BIOPSY OF SKIN SUBQ (INCLUDING SIMPL .00 EA= .00 1 00000000 87.00
BIOPSY OF SKI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11101 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411100 BIOPSY OF SKIN SUBQ TISSUE (INCLUDIN .00 EA= .00 1 00000000 174.00
BIOPSY OF SKI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11100 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 133
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2800015 BIOPSY OR EXCISION OF LYMPH NODE OPE .00 EA= .00 1 00000000 617.00
BIO EXC LYMPH .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 38500 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499415 BIOPSY SOFT TISSUE OF NECK OR THORAX .00 EA= .00 1 00000000 382.00
BIOPSY SOFT T .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 21550 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800012 BIOPSY SOFT TISSUE OF THIGH OR KNEE .00 EA= .00 1 00000000 430.00
BIOPSY SOFT O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 27323 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1482272 BLOOD OCCULT PERFORMED FOR OTHER THA .00 EA= .00 1 00000000 23.00
BLOOD OCCULT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 82272 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1494664 BREATHING TREATMENT-DEMONSTRATION AN .00 EA= .00 1 00000000 69.00
BREATHING TRE .00 .00 2 00000000 .00
.......... 7D(0460) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 94664 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890001 BRIEF OUTPATIENT VIS .00 EA= .00 1 00000000 148.00
BRIEF OUTPATI .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99211 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330496 BURN DRESSING WITH SILVADENE .00 EA= .00 1 00000000 102.00
BURN DRESSING .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 16000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 134
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2113282 CANNULATION OF GRAFT .00 EA= .00 1 00000000 3194.00
CANNULATION O .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36800 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113294 CATH ART PLACEMENT .00 EA= .00 1 00000000 1775.00
CATH ART PLAC .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36246 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1485025 CBC .00 EA= .00 1 00000000 39.00
CBC .00 .00 2 00000000 .00
.......... 55(0300) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 85025 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1436556 CENTRAL LINE > 5 YRS .00 EA= .00 1 00031110 659.00
CENTRAL LINE .00 .00 2 00031220 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 36556 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890004 CENTRAL LINE FLUSH .00 EA= .00 1 00000000 222.00
CENTRAL LINE .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99211 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330500 CENTRAL LINE INSERTION .00 EA= .00 1 00000000 985.00
CENTRAL LINE .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36556 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890005 CENTRAL LINE REMOVAL .00 EA= .00 1 00000000 81.00
CENTRAL LINE .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36589 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 135
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1410101 CERVICAL OR VAGINAL CANCER SCRENING .00 EA= .00 1 00000000 119.00
CERVICAL OR V .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0101 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443760 CHANGE OF GASTOSTOMY TUBE PERCUTANIO .00 EA= .00 1 00000000 392.00
CHANGE OF GAS .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43760 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1417250 CHEMICAL CAUTERIZATION OF GRANULATIO .00 EA= .00 1 00000000 132.00
CHEMICAL CAUT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 17250 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1447562 CHOLECYSTECTOMY LAPARASCOPIC .00 EA= .00 1 00000000 3123.00
CHOLECYSTECTO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 47562 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1447600 CHOLECYSTECTOMY OPEN .00 EA= .00 1 00000000 3123.00
CHOLECYSTECTO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 47600 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1447563 CHOLECYSTECTOMY W/ CHOLANGIOGRAM .00 EA= .00 1 00000000 3331.00
CHOLECYSTECTO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 47563 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1447605 CHOLECYSTECTOMY W/ CHOLANGIOGRAPHY .00 EA= .00 1 00000000 3331.00
CHOLECYSTECTO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 47605 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 136
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1444626 CLOSURE OF ENTEROSTOMY W/ RESECTION .00 EA= .00 1 00000000 3715.00
CLOSURE OF EN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 44626 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444140 COLECTOMY PARTIAL .00 EA= .00 1 00000000 4413.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44140 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444204 COLECTOMY PARTIAL W/ ANASTOMOSIS .00 EA= .00 1 00000000 4877.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44204 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444207 COLECTOMY PARTIAL W/ ANASTOMOSIS W/ .00 EA= .00 1 00000000 6037.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44207 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444208 COLECTOMY PARTIAL W/ ANASTOMOSIS W/ .00 EA= .00 1 00000000 6271.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44208 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444146 COLECTOMY PARTIAL W/ COLOPROCTOSTOMY .00 EA= .00 1 00000000 6921.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44146 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444143 COLECTOMY PARTIAL W/ END COLOSTOMY A .00 EA= .00 1 00000000 4503.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44143 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 137
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1444160 COLECTOMY PARTIAL W/ REMOVAL OF TERM .00 EA= .00 1 00000000 4181.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44160 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444205 COLECTOMY PARTIAL W/REMOVAL TERMINAL .00 EA= .00 1 00000000 4645.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44205 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444211 COLECTOMY TOTAL ABDOMINAL W/ PROCTEC .00 EA= .00 1 00000000 8129.00
COLECTOMY TOT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44211 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445378 COLONOSCOPY .00 EA= .00 1 00000000 1049.00
COLONOSCOPY .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
------------------------------------------------------------------------------------------------------------------------------------
1445383 COLONOSCOPY FLEXIBLE TO SPLENIC FLEX .00 EA= .00 1 00000000 1424.00
COLONOSCOPY F .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 45383 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445382 COLONOSCOPY FLEXIBLE W/ CONTROL OF B .00 EA= .00 1 00000000 1340.00
COLONOSCOPY F .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 45382 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444394 COLONOSCOPY THROUGH STOMA W/ REMOVAL .00 EA= .00 1 00000000 1693.00
COLONOSCOPY T .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 44394 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 138
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1413132 COLONOSCOPY W/ BIOPSY .00 EA= .00 1 00000000 1591.00
COLONOSCOPY W .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 13132 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445380 COLONOSCOPY W/ BIOPSY .00 EA= .00 1 00000000 1154.00
COLONOSCOPY W .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 45380 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445386 COLONOSCOPY W/ DILATION BY BALLOON 1 .00 EA= .00 1 00000000 1165.00
COLONOSCOPY W .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 45386 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445381 COLONOSCOPY W/ DIRECTED SUBMUCOSAL I .00 EA= .00 1 00000000 1300.00
COLONOSCOPY W .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 45381 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445384 COLONOSCOPY W/BIOPSY BY HOT BIOSPY F .00 EA= .00 1 00000000 1486.00
COLONOSCOPY W .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 45384 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445385 COLONOSCOPY W/BIOPSY SNARE .00 EA= .00 1 00000000 1486.00
COLONOSCOPY W .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 45385 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410122 COLORECTAL CANCER SCREENING COLONOSC .00 EA= .00 1 00000000 1105.00
COLORECTAL CA .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0121 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 139
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1410328 COLORECTAL SCREENING WELCOME TO MEDI .00 EA= .00 1 00000000 80.00
COLORECTAL SC .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0328 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1480053 COMPREHENSIVE METABOLIC PANEL .00 EA= .00 1 00000000 61.00
COMPREHENSIVE .00 .00 2 00000000 .00
.......... 56(0301) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 80053 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499394 COMPREHENSIVE PHYSICAL 12-17 .00 EA= .00 1 00000000 175.00
COMPREHENSIVE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99394 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499395 COMPREHENSIVE PHYSICAL 18-39 .00 EA= .00 1 00000000 236.00
COMPREHENSIVE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99395 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499396 COMPREHENSIVE PHYSICAL 40-64 YRS .00 EA= .00 1 00000000 258.00
COMPREHENSIVE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99396 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499397 COMPREHENSIVE PHYSICAL >65 .00 EA= .00 1 00000000 292.00
COMPREHENSIVE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99397 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330502 CONSCIOUS SEDATION .00 EA= .00 1 00000000 525.00
CONSCIOUS SED .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99144 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 140
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
890006 CONSTIPATION REMOVAL .00 EA= .00 1 00000000 212.00
CONSTIPATION .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2113304 CONTRAST INJ VEN DEV .00 EA= .00 1 00000000 89.00
CONTRAST INJ .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36598 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1482570 CREATININE OTHER SOURCE .00 EA= .00 1 00000000 33.00
CREATININE OT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 82570 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330514 CRITICAL CARE 30-74 MIN .00 EA= .00 1 00000000 1969.00
CRITICAL CARE .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 9929125 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330515 CRITICAL CARE EACH ADDTL 30 MIN .00 EA= .00 1 00000000 525.00
CRITICAL CARE .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 9929225 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499292 CRITICAL CARE EVAL/MGT EA ADDITIONAL .00 EA= .00 1 00031110 302.00
CRITICAL CARE .00 .00 2 00031220 .00
SERVICE .......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99292 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499291 CRITICAL CARE EVAL/MGT FIRST 30-74 M .00 EA= .00 1 00031110 604.00
CRITICAL CARE .00 .00 2 00031220 .00
SERVICE .......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99291 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 141
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1417340 CRYO SURGERY-ACNE .00 EA= .00 1 00000000 104.00
CRYO SURGERY- .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 17340 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1487070 CULTURE BACTERIAL ANY OTHER SOURCE E .00 EA= .00 1 00000000 40.00
CULTURE BACTE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 87070 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890007 CYST DRAINAGE SIMPLE .00 EA= .00 1 00000000 231.00
CYST DRAINAGE .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 10080 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890008 CYST REMOVAL SIMPLE .00 EA= .00 1 00000000 263.00
CYST REMOVAL .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 10040 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411044 DEBRIDEMENT BONE FIRS 20 SQ CM OR LE .00 EA= .00 1 00000000 828.00
DEBRIDEMENT B .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 11044 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411043 DEBRIDEMENT MUSCLE AND/OR FASCIA FIR .00 EA= .00 1 00000000 497.00
DEBRIDEMENT M .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 11043 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411000 DEBRIDEMENT OF EXTENSIVE EZCEMATOUS .00 EA= .00 1 00000000 200.00
DEBRIDEMENT O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 11000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 142
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1411720 DEBRIDEMENT OF NAIL 1 TO 5 .00 EA= .00 1 00000000 92.00
DEBRIDEMENT O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11720 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411721 DEBRIDEMENT OF NAILS BY ANY METHOD 6 .00 EA= .00 1 00000000 125.00
DEBRIDEMENT O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11721 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411040 DEBRIDEMENT SKIN-PARTIAL THICKNESS .00 EA= .00 1 00000000 150.00
DEBRIDEMENT S .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 11040 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411042 DEBRIDEMENT SUBCUTANEOUS TISSUE FIRS .00 EA= .00 1 00000000 232.00
DEBRIDEMENT S .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 11042 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113273 DECLOT VAS ACC DEVIC .00 EA= .00 1 00000000 710.00
DECLOT VAS AC .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36593 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1429590 DENIS-BROWNE SPLNT-LEG SPLINT .00 EA= .00 1 00000000 145.00
DENIS-BROWNE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29590 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446924 DESTR OF LES ANUS EXTENSIVE (EX LASE .00 EA= .00 1 00000000 2013.00
DESTR OF LES .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 46924 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 143
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1417280 DESTRUCTION MALIGNANT LESION .00 EA= .00 1 00000000 287.00
DESTRUCTION M .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 17280 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1417260 DESTRUCTION MALIGNANT LESION < .5 CM .00 EA= .00 1 00000000 211.00
DESTRUCTION M .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 17260 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1417263 DESTRUCTION MALIGNANT LESION TRUNK/A .00 EA= .00 1 00000000 313.00
DESTRUCTION M .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 17263 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446900 DESTRUCTION OF LESION ANUS SIMPLE CH .00 EA= .00 1 00000000 607.00
DESTRUCTION O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 46900 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446922 DESTRUCTION OF LESION ANUS SIMPLE SU .00 EA= .00 1 00000000 1087.00
DESTRUCTION O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 46922 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1417000 DESTRUCTION PRMLGNT LESION (ACTINIC .00 EA= .00 1 00000000 183.00
DESTRUCTION P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 17000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1417003 DESTRUCTION PRMLGNT LESION 2-14 EACH .00 EA= .00 1 00000000 41.00
DESTRUCTION P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 17003 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 144
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1443450 DILATION OF ESOPHAGUS BY UNGUIDED SO .00 EA= .00 1 00000000 284.00
DILATION OF E .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43450 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490702 DIPHTERIA TETANUS TOXOIDS (DT) ADM T .00 EA= .00 1 00000000 45.00
DIPHTERIA TET .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90702 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490700 DIPHTHERIA TETANUS TOXOIDS/PERTUSSIS .00 EA= .00 1 00000000 56.00
DIPHTHERIA TE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90700 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890009 DIRECT ADMIT OBSERVA .00 EA= .00 1 00000000 162.00
DIRECT ADMIT .00 .00 2 00000000 .00
.......... EJ(0762) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0379 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499419 DRAINAGE OF PERITIONEAL ABSCESS OR L .00 EA= .00 1 00000000 3897.00
DRAINAGE OF P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 49020 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800008 DRESSINGS AND OR DEBRIEDEMENT OR PAR .00 EA= .00 1 00000000 192.00
DRESSINGS AND .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 16020 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1480100 DRUG SCREEN QUALITATIVE .00 EA= .00 1 00000000 135.00
DRUG SCREEN Q .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 80100 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 145
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1469210 EAR IRRIGATION (RMVL IMPACTED WAX) .00 EA= .00 1 00000000 127.00
EAR IRRIGATIO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 69210 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1493010 ECG ROUTINE INTERPRETATION AND REPOR .00 EA= .00 1 00000000 48.00
ECG ROUTINE I .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 93010 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499071 EDUCATIONAL SUPPLIES AND HANDOUTS .00 EA= .00 1 00000000 .00
EDUCATIONAL S .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99071 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443235 EGD UPPER GASTROINESTINAL EDOSCOPY D .00 EA= .00 1 00000000 779.00
EGD UPPER GAS .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43235 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443244 EGD WITH BAND LIGATION OF ESOPHAGEAL .00 EA= .00 1 00000000 1156.00
EGD WITH BAND .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43244 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443239 EGD WITH BIOPSY UPPER GASTROINTESTIN .00 EA= .00 1 00000000 903.00
EGD WITH BIOP .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43239 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443255 EGD WITH CONTROL OF BLEEDING ANY MET .00 EA= .00 1 00000000 1190.00
EGD WITH CONT .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43255 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 146
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1443246 EGD WITH PEG TUBE PLACEMENT .00 EA= .00 1 00000000 1558.00
EGD WITH PEG .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43246 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410405 EKG ROUNTINE INTERPRET/REPORT SCREEN .00 EA= .00 1 00000000 57.00
EKG ROUNTINE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0405 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410403 EKG WELCOME TO MEDICARE PHYSICAL .00 EA= .00 1 00000000 57.00
EKG WELCOME T .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0403 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1493000 EKG-ECG ROUTINE ECG W/AT LEAST 12 LD .00 EA= .00 1 00000000 101.00
EKG-ECG ROUTI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 93000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2310024 EMERGENCY ROOM LEVEL I .00 EA= .00 1 00000000 390.00
ER LEVEL I .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 9928125 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2310025 EMERGENCY ROOM LEVEL II .00 EA= .00 1 00000000 500.00
ER LEVEL II .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 9928225 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2310026 EMERGENCY ROOM LEVEL III .00 EA= .00 1 00000000 680.00
ER LEVEL III .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 9928325 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 147
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2310027 EMERGENCY ROOM LEVEL IV .00 EA= .00 1 00000000 925.00
ER LEVEL IV .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 9928425 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2310028 EMERGENCY ROOM LEVEL V .00 EA= .00 1 00000000 1250.00
ER LEVEL V .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 9928525 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499285 EMERGENCY ROOM VISIT HIGH COMPLEXITY .00 EA= .00 1 00000000 702.00
EMERGENCY ROO .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99285 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499284 EMERGENCY ROOM VISIT MEDIUM COMPLEXI .00 EA= .00 1 00000000 470.00
EMERGENCY ROO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99284 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499283 EMERGENCY ROOM VISIT MINIMUM COMPLEX .00 EA= .00 1 00000000 315.00
EMERGENCY ROO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99283 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113300 ENDOVENOUS ABLATION .00 EA= .00 1 00000000 710.00
ENDOVENOUS AB .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36478 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800003 ENTERECTOMY, RESECTION OR SMALL INTE .00 EA= .00 1 00000000 4204.00
ENTERECTOMY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 44120 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 148
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499409 ENTEROLYSIS FREEING OF INTESTINAL AD .00 EA= .00 1 00000000 2681.00
ENTEROLYSIS .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44005 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2310005 ER SCREENING FEE .00 EA= .00 1 00000000 54.00
ER SCREENING .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99281 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800007 ESCHAROTOMY INITAL INCISION .00 EA= .00 1 00000000 494.00
ESCHOROTOMY I .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 16035 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499211 ESTABLISHED PT LEVEL 1 (5 MINS-NURSE .00 EA= .00 1 00000000 61.00
ESTABLISHED P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99211 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499212 ESTABLISHED PT LEVEL 2 (10 MINS) .00 EA= .00 1 00000000 86.00
ESTABLISHED P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99212 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499213 ESTABLISHED PT LEVEL 3 (15 MINS) .00 EA= .00 1 00031110 110.00
ESTABLISHED P .00 .00 2 00031220 .00
SERVICE .......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99213 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499214 ESTABLISHED PT LEVEL 4 (25 MINS) .00 EA= .00 1 00000000 160.00
ESTABLISHED P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99214 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 149
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499215 ESTABLISHED PT LEVEL 5 (40 MINS) .00 EA= .00 1 00000000 256.00
ESTABLISHED P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99215 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411740 EVACUATION OF SUBUNGUAL HEMATOMA .00 EA= .00 1 00000000 153.00
EVACUATION OF .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11740 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411402 EXC B9 LES MRGN XCP SKT 1.1-2.0CM .00 EA= .00 1 00000000 364.00
EXC B9 LES MR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11402 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411403 EXC B9 LESIO MRGN 2.1-3.0 CM .00 EA= .00 1 00000000 467.00
EXC B9 LESIO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11403 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411400 EXC B9 LESION SCP SK TGS .5 CM< .00 EA= .00 1 00000000 239.00
EXC B9 LESION .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11400 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411422 EXC BENIGN LESION SCALP/NECK/HANDS/F .00 EA= .00 1 00000000 387.00
EXC BENIGN LE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11422 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411401 EXC BENIGN LESION TRUNK/ARMS/LESGS 0 .00 EA= .00 1 00000000 285.00
EXC BENIGN LE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11401 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 150
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1411606 EXC MAL LES W/MRGN T/A/L > 4.0 CM .00 EA= .00 1 00000000 852.00
EXC MAL LES W .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11606 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411621 EXC MALIGNANT LESION .5/CM .00 EA= .00 1 00000000 426.00
EXC MALIGNANT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11621 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411623 EXC MALIGNANT LESION 2.1 TO 3.0 CM S .00 EA= .00 1 00000000 639.00
EXC MALIGNANT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11623 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411600 EXC MALIGNANT LESION TRUNK/ARMS/LEGS .00 EA= .00 1 00000000 391.00
EXC MALIGNANT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11600 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411440 EXC OTHER BENIGN LESION INCL MARGINS .00 EA= .00 1 00000000 285.00
EXC OTHER BEN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11440 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113276 EXCH ART CATH .00 EA= .00 1 00000000 1242.00
EXCH ART CATH .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 37209 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499416 EXCISION BENIGN LESION INCLUDING MAR .00 EA= .00 1 00000000 266.00
EXCISION BENI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 11421 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 151
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2800005 EXCISION MALIGNANT LESION INCLUDING .00 EA= .00 1 00000000 423.00
EXCISION MALI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11640 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1419125 EXCISION OF BREAST LESION .00 EA= .00 1 00000000 1550.00
EXCISION OF B .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 19125 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1419120 EXCISION OF CYST OF BREAST .00 EA= .00 1 00000000 1292.00
EXCISION OF C .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 19120 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1425111 EXCISION OF GANGLION CYST WRIST .00 EA= .00 1 00000000 1427.00
EXCISION OF G .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 25111 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499412 EXCISION OF LESION OF TENDON SHEATH .00 EA= .00 1 00000000 892.00
EXCISION OF L .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 27630 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411750 EXCISION OF NAIL AND NAIL MATRIX PAR .00 EA= .00 1 00000000 690.00
EXCISION OF N .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11750 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411772 EXCISION OF PILONIDAL CYST COMPLICAT .00 EA= .00 1 00000000 2023.00
EXCISION OF P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11772 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 152
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1445171 EXCISION OF RECTAL TUMOR TRANSANAL A .00 EA= .00 1 00000000 2418.00
EXCISION OF R .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45171 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800010 EXCISION OF SKIN AND SUBCUTANEOUS TI .00 EA= .00 1 00000000 679.00
EXCISION OF S .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11470 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446320 EXCISION OF THROMBOSED HEMORRHOID EX .00 EA= .00 1 00000000 455.00
EXCISION OF T .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 46320 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499417 EXCISION OR DESTRUCTION OPEN INTRA A .00 EA= .00 1 00000000 2936.00
EXCISION OR D .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 49203 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1421930 EXCISION TUMOR SOFT TISSU OF BACK .00 EA= .00 1 00000000 1595.00
EXC TUM BACK .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 21930 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800014 EXCISION TUMOR SOFT TISSUE OF FACE S .00 EA= .00 1 00000000 1268.00
EXC TUM 2MM .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 21014 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499414 EXCISION TUMOR SOFT TISSUE OF PELVIS .00 EA= .00 1 00000000 1480.00
EXCISION TUMO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 27048 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 153
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2800009 EXCISION TUMOR SOFT TISSUE OF SHOULD .00 EA= .00 1 00000000 1013.00
EXCISION TUMO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 23071 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1424075 EXCISION TUMOR SOFT TISSUE OF UPPER .00 EA= .00 1 00000000 1759.00
EXC TUM UP AR .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 24075 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800004 EXPLORATORY LAPAROTOMY EXPLORATORY C .00 EA= .00 1 00000000 2640.00
EXPLORATORY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 49000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330518 EXTERNAL PACEMAKER .00 EA= .00 1 00000000 525.00
EXTERNAL PACE .00 .00 2 00000000 .00
.......... 7L(0482) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 92953 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
920027 FACILITY FEE MD .00 EA= .00 1 00000000 300.00
FAC FEE MD .00 .00 2 00000000 .00
.......... PQ(0914) INV.GL= EXP.GL= .00 .00 3 31300009 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0463 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446200 FISSURECTOMY INCLUDING SPHINCTEROTOM .00 EA= .00 1 00000000 1275.00
FISSURECTOMY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 46200 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445331 FLEX SIGMOID WITH BIOPSY SINGLE OR M .00 EA= .00 1 00000000 480.00
FLEX SIGMOID .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45331 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 154
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
4420130 FLUORO GUIDE FOR ASPIRATION OF S .00 EA= .00 1 00000000 340.00
FLUOROSCOPY G .00 .00 2 00000000 .00
.......... 77(0320) INV.GL= EXP.GL= .00 .00 3 31300044 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:N CHG @ ORD ENTRY:N AUTO COMP ORD:N VIEW UNVER ORD:Y PRT ORD SLIP:B CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 62270 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113321 FLUOROGUIDE FOR VEIN DEVICE .00 EA= .00 1 00000000 642.00
FLUOROGUIDE .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 77001 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330516 FOLEY CATH INSERTION .00 EA= .00 1 00000000 185.00
FOLEY CATH IN .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 51702 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
920030 FOLLOW UP 5 MINUTES .00 EA= .00 1 00000000 150.00
FOLLOW UP 5 M .00 .00 2 00000000 .00
.......... PQ(0914) INV.GL= EXP.GL= .00 .00 3 31300009 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99211 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890018 G TUBE INSERTION .00 EA= .00 1 00000000 160.00
G TUBE INSERT .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 43760 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490649 GARDASIL HPV VACCINE .00 EA= .00 1 00000000 282.00
GARDASIL HPV .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90649 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330505 GASTRIC INTUBATION LAVAGE .00 EA= .00 1 00000000 335.00
GASTRIC INTUB .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 43753 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 155
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1491110 GI TRACT IMAGING INTRALUMAL ESOPH TH .00 EA= .00 1 00000000 2107.00
GI TRACT IMAG .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 91110 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490470 H1N1 VACCINATION .00 EA= .00 1 00000000 49.00
H1N1 VACCINAT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90470 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1419141 H1N1 VACCINATION ADMINISTRATION .00 EA= .00 1 00000000 25.00
H1N1 VACCINAT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G9141 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1484703 HCG QUALITATIVE .00 EA= .00 1 00000000 71.00
HCG QUALITATI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 84703 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1492552 HEARING TEST-PURE TONE ADIOMETRY AIR .00 EA= .00 1 00000000 49.00
HEARING TEST- .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 92552 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1485018 HEMOGLOBIN (HGB) .00 EA= .00 1 00000000 19.00
HEMOGLOBIN (H .00 .00 2 00000000 .00
.......... 55(0300) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 85018 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1483036 HEMOGLOBIN A1C .00 EA= .00 1 00000000 68.00
HEMOGLOBIN A1 .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 83036 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 156
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1446221 HEMORRHOIDECTOMY INTERNAL BY RUBBER .00 EA= .00 1 00000000 546.00
HEMORRHOIDECT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 46221 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446947 HEMORRHOIDOPEXY BY STAPLING .00 EA= .00 1 00000000 1214.00
HEMORRHOIDOPE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 46947 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446260 HEMORROIDECTOMY COMPLEX .00 EA= .00 1 00000000 2276.00
HEMORROIDECTO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 46260 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1493233 HOLTER MONITOR .00 EA= .00 1 00000000 172.00
HOLTER MONITO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 93233 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499341 HOME VISIT INITIAL VISIT .00 EA= .00 1 00000000 197.00
HOME VISIT IN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99341 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499239 HOSPITAL DISCHARGE > 30 MINS .00 EA= .00 1 00000000 180.00
HOSPITAL DISC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300020 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99239 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499238 HOSPITAL DISCHARGE DAY MNGMT <30 MIN .00 EA= .00 1 00000000 144.00
HOSPITAL DISC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300020 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99238 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 157
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1410180 I & D COMPLEX POST OP WOUND INFECTIO .00 EA= .00 1 00000000 592.00
I & D COMPLEX .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10180 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410140 I & D OF HEMATOMA SEROMA OR FLUID CO .00 EA= .00 1 00000000 335.00
I & D OF HEMA .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10140 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410081 I & D OF PILONIDAL CYST COMPLICATED .00 EA= .00 1 00000000 619.00
I & D OF PILO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10081 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410080 I & D OF PILONIDAL CYST SIMPLE .00 EA= .00 1 00000000 347.00
I & D OF PILO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10080 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1456405 I & D OF VULVA AND PERINEAL ABSCESS .00 EA= .00 1 00000000 424.00
I & D OF VULV .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 56405 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410061 I&D COMPLICATED OR MULTIPLE .00 EA= .00 1 00000000 523.00
I&D COMPLICAT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10061 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890016 I&D HEMATOMA .00 EA= .00 1 00000000 213.00
I&D HEMATOMA .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 10140 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 158
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2113283 I&D HEMATOMA PERIGRA .00 EA= .00 1 00000000 89.00
I&D HEMATOMA .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 37799 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113281 I&D PERIGRAFT SEROMA .00 EA= .00 1 00000000 89.00
I&D PERIGRAFT .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 37799 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410060 I&D SIMPLE OR SINGLE .00 EA= .00 1 00000000 261.00
I&D SIMPLE OR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10060 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490460 IMMUNIZATION ADMINISTRATION THROUGH .00 EA= .00 1 00000000 49.00
IMMUNIZATION .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90460 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1449568 IMPLANTATION OF MESH/W INCISIONAL HE .00 EA= .00 1 00000000 876.00
IMPLANTATION .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 49568 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1449587 INCARCERATED UMBILICAL HERNIA .00 EA= .00 1 00000000 2103.00
INCARCERATED .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 49587 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800013 INCESION AND DRAINAGE SHOULDER AREA .00 EA= .00 1 00000000 865.00
INCESION AND .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 23030 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 159
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1446040 INCISION AND DRAINAGE OF ISCHIORECTA .00 EA= .00 1 00000000 2015.00
INCISION AND .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 46040 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800001 INCISION AND DRAINAGE OF SUBMUCOSAL .00 EA= .00 1 00000000 531.00
INC AND DRAIN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45005 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800002 INCISION AND DRAINAGE SHOULDER AREA .00 EA= .00 1 00000000 865.00
INC AND DRAIN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 10121 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410121 INCISION AND REMOVAL OF FOREIGN BODY .00 EA= .00 1 00000000 712.00
INCISION AND .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10121 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410120 INCISION AND REMOVAL OF FOREIGN BODY .00 EA= .00 1 00000000 311.00
INCISION AND .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10120 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446083 INCISION OF THROMBOSED HEMORRHOID EX .00 EA= .00 1 00000000 351.00
INCISION OF T .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 46083 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410008 INFLUENZA ADMINISTRATION (MEDICARE O .00 EA= .00 1 00000000 25.00
INFLUENZA ADM .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0008 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 160
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1402038 INFLUENZA VACCINE 3 YEARS AND OLDER .00 EA= .00 1 00000000 34.00
INFLUENZA VAC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: Q2038 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490658 INFLUENZA VACCINE AGE 3 YRS + .00 EA= .00 1 00000000 34.00
INFLUENZA VAC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90658 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490656 INFLUENZA VACCINE PRESERVATIVE FREE .00 EA= .00 1 00000000 33.00
INFLUENZA VAC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90656 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490662 INFLUENZA VIRUS VACCINE SPLIT VIRUS .00 EA= .00 1 00000000 80.00
INFLUENZA VIR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90662 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499382 INITIAL COMPREH PHYSICAL AGE 1 TO 4 .00 EA= .00 1 00000000 183.00
INITIAL COMPR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99382 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499384 INITIAL COMPREHENSIVE PHYSICAL 12-17 .00 EA= .00 1 00000000 210.00
INITIAL COMPR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99384 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499386 INITIAL COMPREHENSIVE PHYSICAL 40-64 .00 EA= .00 1 00000000 310.00
INITIAL COMPR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99386 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 161
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499387 INITIAL COMPREHENSIVE PHYSICAL > 65 .00 EA= .00 1 00000000 349.00
INITIAL COMPR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99387 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499383 INITIAL COMPREHENSIVE PHYSICAL AGE 5 .00 EA= .00 1 00000000 196.00
INITIAL COMPR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99383 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499381 INITIAL COMPREHENSIVE PHYSICAL- UNDE .00 EA= .00 1 00000000 170.00
INITIAL COMPR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99381 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499385 INITIAL COMPREHENSIVE PREVENTIVE PHY .00 EA= .00 1 00000000 284.00
INITIAL COMPR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99385 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499222 INITIAL HOSPITAL CARE 50 MINS .00 EA= .00 1 00000000 252.00
INITIAL HOSPI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99222 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499223 INITIAL HOSPITAL CARE HIGH COMPLEXIT .00 EA= .00 1 00000000 380.00
INITIAL HOSPI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99223 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499221 INITIAL HOSPITAL CARE PER DAY 30 MIN .00 EA= .00 1 00000000 187.00
INITIAL HOSPI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99221 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 162
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499303 INITIAL NURSING FACILITY CARE 25 MIN .00 EA= .00 1 00000000 216.00
INITIAL NURSI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99304SW FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499304 INITIAL NURSING FACILITY CARE 25 MIN .00 EA= .00 1 00000000 216.00
INITIAL NURSI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99304 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499305 INITIAL NURSING FACILITY PER DAY 35 .00 EA= .00 1 00000000 303.00
INITIAL NURSI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99305 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499311 INITIAL NURSING FACILITY PER DAY 35 .00 EA= .00 1 00000000 303.00
INITIAL NURSI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99305SW FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499306 INITIAL NURSING FACILITY PER DAY 45 .00 EA= .00 1 00000000 368.00
INITIAL NURSI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300020 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99306 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499312 INITIAL NURSING FACILITY PER DAY 45 .00 EA= .00 1 00000000 368.00
INITIAL NURSI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99306SW FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499218 INITIAL OBSERVATION CARE LOW SEVERIT .00 EA= .00 1 00000000 168.00
INITIAL OBSER .00 .00 2 00000000 .00
.......... EJ(0762) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99218 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 163
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499219 INITIAL OBSERVATION CARE MODERATE SE .00 EA= .00 1 00000000 229.00
INITIAL OBSER .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99219 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499220 INITIAL OBSERVATION CARE PER DAY .00 EA= .00 1 00000000 287.00
INITIAL OBSER .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99220 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410402 INITIAL PREVENTATIVE PHYSICAL WELCOM .00 EA= .00 1 00000000 399.00
INITIAL PREVE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0402 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113278 INJ EXT VENOGRAPHY .00 EA= .00 1 00000000 532.00
INJ EXT VENOG .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36005 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113306 INJ LUMBAR OR SACRAL .00 EA= .00 1 00000000 887.00
INJ LUMBAR OR .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36595 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420550 INJ SINGLE TENDON SHEATH OR LIGAMENT .00 EA= .00 1 00000000 163.00
INJ SINGLE TE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20550 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113279 INJECT ANTIOBOTIC IM .00 EA= .00 1 00000000 89.00
INJECT ANTIOB .00 .00 2 00000000 .00
.......... 3I(0260) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 164
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1420553 INJECT SINGLE/MULTIPLE TRIGGER POINT .00 EA= .00 1 00000000 198.00
INJECT SINGLE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20553 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420170 INJECTION ADRENALINE UP TO 1 ML AMPU .00 EA= .00 1 00000000 3.00
INJECTION ADR .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J0170 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1464413 INJECTION ANESTHETIC AGENT CERVICAL .00 EA= .00 1 00000000 649.00
INJECTION ANE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 64413 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1464412 INJECTION ANESTHETIC AGENT SPINAL AC .00 EA= .00 1 00000000 731.00
INJECTION ANE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 64412 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420702 INJECTION BETAMETHASONE SODIUM PHOSP .00 EA= .00 1 00000000 4.00
INJECTION BET .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J0702 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420704 INJECTION BETAMETHASONE SODIUM PHOSP .00 EA= .00 1 00000000 4.00
INJECTION BET .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J0704 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1421100 INJECTION DECADRON 1 MG .00 EA= .00 1 00000000 30.00
INJECTION DEC .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J1100 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 165
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1421000 INJECTION DEPO-ESTRADIOL UP TO 5MG .00 EA= .00 1 00000000 24.00
INJECTION DEP .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J1000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1421200 INJECTION DIPHENHYDRAMINE HCI UP TO .00 EA= .00 1 00000000 3.00
INJECTION DIP .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J1200 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1423410 INJECTION HYDROXYZINE HCL VISTARIL U .00 EA= .00 1 00000000 4.00
INJECTION HYD .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J3410 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1422001 INJECTION LIDOCAINE FOR INTRAVENOUS .00 EA= .00 1 00000000 50.00
INJECTION LID .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J2001 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1421055 INJECTION MEDROXYPROGESTERONE ACETAT .00 EA= .00 1 00000000 88.00
INJECTION MED .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J1055 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1422175 INJECTION MEPERIDINE PER 100 MG .00 EA= .00 1 00000000 7.00
INJECTION MEP .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J2175 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1421030 INJECTION METHYLPREDISOLONE ACETATE .00 EA= .00 1 00000000 12.00
INJECTION MET .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J1030 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 166
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1422300 INJECTION NALBUPHINE PER 10 MG .00 EA= .00 1 00000000 4.00
INJECTION NAL .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J2300 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1422550 INJECTION PHENERGEN PER 50 MG .00 EA= .00 1 00000000 6.00
INJECTION PHE .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J2550 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1421070 INJECTION TESTOSERONE CYPIONATE UP T .00 EA= .00 1 00000000 13.00
INJECTION TES .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J1070 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1421060 INJECTION TESTOSTERONE CYPIONATE AND .00 EA= .00 1 00000000 25.00
INJECTION TES .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J1060 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420526 INJECTION THERAPEUTIC CARPAL TUNNEL .00 EA= .00 1 00000000 219.00
INJECTION THE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20526 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420551 INJECTION(S) SINGLE TENDON ORIGIN/IN .00 EA= .00 1 00000000 168.00
INJECTION(S) .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20551 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499254 INPATIENT CONSULT COMPREHENSIVE .00 EA= .00 1 00000000 358.00
INPATIENT CON .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99254 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 167
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499253 INPATIENT CONSULT DETAILED .00 EA= .00 1 00000000 286.00
INPATIENT CON .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99253 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499252 INPATIENT CONSULT EXPANDED PROBLEM .00 EA= .00 1 00000000 232.00
INPATIENT CON .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99252 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499255 INPATIENT CONSULT HIGH COMPLEXITY .00 EA= .00 1 00000000 450.00
INPATIENT CON .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99255 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499251 INPATIENT CONSULT PROBLEM FOCUSED .00 EA= .00 1 00000000 153.00
INPATIENT CON .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99251 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113289 INSERT TUNNELED CVA .00 EA= .00 1 00000000 1775.00
INSERT TUNNEL .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36565 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113270 INSERT VEN ACC DEVIC .00 EA= .00 1 00000000 2662.00
INSERT VEN AC .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36558 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1493503 INSERTION AND PLACEMENT OF FLOW DIRE .00 EA= .00 1 00000000 707.00
INSERTION AND .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 93503 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 168
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1436558 INSERTION GROSHON/HICKMAN CENTRAL LI .00 EA= .00 1 00000000 2268.00
INSERTION GRO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36558 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113284 INSERTION PICC LINE .00 EA= .00 1 00000000 1331.00
INSERTION PIC .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36569 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1436561 INSERTION TUNNELED CENTRAL LINE/PORT .00 EA= .00 1 00000000 2062.00
INSERTION TUN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36561 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113292 INTER INF VENA CAVA .00 EA= .00 1 00000000 2662.00
INTER INF VEN .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 37620 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1474360 INTRALUM DILAT STRICTURES AND/OR OBS .00 EA= .00 1 00000000 203.00
INTRALUM DILA .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 74360 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113301 INTRO CATH AORTA .00 EA= .00 1 00000000 1730.00
INTRO CATH AO .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36200 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1731084 INTUBATION .00 EA= 1.00 1 31110017 750.00
INTUBATION .00 .00 2 31220017 .00
SERVICE .......z.. 84(0410) INV.GL= EXP.GL= .00 .00 3 31300017 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:N AUTO COMP ORD:N VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 31500 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 169
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2330517 INTUBATION BY PHYSICIAN .00 EA= .00 1 00000000 461.00
INTUBATION BY .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 31500 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1431500 INTUBATION ENDOTRACHEAL ER PROCEDURE .00 EA= .00 1 00000000 513.00
INTUBATION EN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 31500 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330493 IO PLACEMENT .00 EA= .00 1 00000000 417.00
IO PLACEMENT .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36680 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
90001598 IO PLACEMENT 00053 XX 305.00 EA=1EA .00 1 00000000 417.00
IO PLACEMENT 305.00 EA=1EA 1 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36680 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330504 IV HEPLOCK ONLY .00 EA= .00 1 00000000 57.00
IV HEPLOCK ON .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1423301 KENALOG INJECTION .00 EA= .00 1 00000000 6.00
KENALOG INJEC .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J3301 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1478708 KIDNEY IMAGING SINGLE STUDY WITH PHA .00 EA= .00 1 00000000 1064.00
KIDNEY IMAGIN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 78708 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 170
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1444970 LAPARASCOPIC APPENDECTOMY .00 EA= .00 1 00000000 2721.00
LAPARASCOPIC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44970 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499407 LAPAROSCOPY SURG WITH REMOVAL OF ADN .00 EA= .00 1 00000000 1612.00
LAPARO SURG W .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 58661 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444213 LAPAROSCOPY SURGICAL MOBILIZATION WI .00 EA= .00 1 00000000 696.00
LAPAROSCOPY S .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 44213 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1427614 LEVALBUTEROL INHAL SOL NONCOMPOUNDED .00 EA= .00 1 00000000 12.00
LEVALBUTEROL .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J7614 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113280 LIGATION AV FISTULA .00 EA= .00 1 00000000 2662.00
LIGATION AV F .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 37607 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1464445 LUMBAR INJECTION ANESTHETIC AGEN SCI .00 EA= .00 1 00000000 649.00
LUMBAR INJECT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 64445 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499411 LYSIS OF ADHESIONS SALPINGOLYSIS OVA .00 EA= .00 1 00000000 2181.00
LYSIS OF ADHE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 58740 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 171
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1419307 MASTECTOMY MODIFIED RADICAL .00 EA= .00 1 00000000 3620.00
MASTECTOMY MO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 19307 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1419301 MASTECTOMY PARTIAL LUMPECTOMY .00 EA= .00 1 00000000 1385.00
MASTECTOMY PA .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 19301 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113305 MECH REMOVAL OBS MAT .00 EA= .00 1 00000000 710.00
MECH REMOVAL .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36595 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1482043 MICROALBUMIN-QUANTITATIVE .00 EA= .00 1 00000000 64.00
MICROALBUMIN- .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 82043 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444139 MOBILIZATION OF SPLENIC FLEXURE .00 EA= .00 1 00000000 464.00
MOBILIZATION .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44139 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411730 NAIL AVULSION PARTIAL OR COMPLETE .00 EA= .00 1 00000000 332.00
NAIL AVULSION .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11730 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1497605 NEG PRESS WOUND THER <= 50 SQ CM .00 EA= .00 1 00000000 204.00
WND THER <=50 .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 97605 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 172
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1497606 NEG PRESS WOUND THER >50 SQ CM .00 EA= .00 1 00000000 220.00
WND THER >50 .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 97606 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499201 NEW PATIENT LEVEL 1 (10 MINS) .00 EA= .00 1 00000000 124.00
NEW PATIENT L .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99201 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499202 NEW PATIENT LEVEL 2 (20 MINS) .00 EA= .00 1 00000000 155.00
NEW PATIENT L .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99202 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499203 NEW PATIENT LEVEL 3 (30 MINS) .00 EA= .00 1 00000000 202.00
NEW PATIENT L .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99203 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499204 NEW PATIENT LEVEL 4 (45 MINS) .00 EA= .00 1 00000000 288.00
NEW PATIENT L .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99204 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499205 NEW PATIENT LEVEL 5 (60 MINS) .00 EA= .00 1 00000000 389.00
NEW PATIENT L .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99205 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499315 NURSING FACILITY DISCHARGE 30 MINS .00 EA= .00 1 00000000 225.00
NURSING FACIL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300020 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99315 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 173
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499318 NURSING FACILITY DISCHARGE 30 MINS .00 EA= .00 1 00000000 225.00
NURSING FACIL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99315SW FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499316 NURSING FACILITY DISCHARGE > 30 MINS .00 EA= .00 1 00000000 281.00
NURSING FACIL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300020 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99316 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499319 NURSING FACILITY DISCHARGE > 30 MINS .00 EA= .00 1 00000000 281.00
NURSING FACIL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99316SW FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2310007 OBSERVATION AUTO OBS .00 EA= .00 1 31110013 110.00
OBSERVATION R .00 .00 2 31220013 .00
.......... EJ(0762) INV.GL= EXP.GL= .00 .00 3 31300013 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99218 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499217 OBSERVATION CARE DISCHARGE .00 EA= .00 1 00000000 135.00
OBSERVATION C .00 .00 2 00000000 .00
.......... EJ(0762) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99217 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890010 OBSERVATION HOUR .00 EA= .00 1 31110013 36.00
OBSERVATION H .00 .00 2 31220013 .00
.......... EJ(0762) INV.GL= EXP.GL= .00 .00 3 31300013 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0378 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499235 OBSERVATION OR INPATIENT HOSPITAL CA .00 EA= .00 1 00000000 340.00
OBSERVATION O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99235 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 174
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499236 OBSERVATION OR INPATIENT HOSPITAL CA .00 EA= .00 1 00000000 438.00
OBSERVATION O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99236 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499234 OBSERVATION OR IP STAY INCLUDING ADM .00 EA= .00 1 00000000 241.00
OBSERVATION O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99234 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2310006 OBSERVATION ROOM RATE .00 EA= .00 1 00000000 36.00
OBSERVATION R .00 .00 2 00000000 .00
.......... EJ(0762) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99218 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499245 OFFICE CONSULT COMPREHENSIVE HIGH .00 EA= .00 1 00000000 485.00
OFFICE CONSUL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99245 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499244 OFFICE CONSULT COMPREHENSIVE-MODERAT .00 EA= .00 1 00000000 384.00
OFFICE CONSUL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99244 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499243 OFFICE CONSULT DETAILED .00 EA= .00 1 00000000 293.00
OFFICE CONSUL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99243 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499242 OFFICE CONSULT EXPANDED PROBLEM FOCU .00 EA= .00 1 00000000 230.00
OFFICE CONSUL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99242 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 175
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
9227005 OT APL LONG ARM SPLINT .00 EA= .00 1 31110092 176.00
OT APL LONG .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29105 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227016 OT APP FINGER SPLINT DY - 29131 .00 EA= 1.00 1 00000000 108.00
OT APP FINGER .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29131 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227006 OT APP FINGER SPLINT ST .00 EA= .00 1 31110092 84.00
OT APP FINGER .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29130 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227015 OT APP FINGER SPLINT ST - 29130 .00 EA= 1.00 1 00000000 84.00
OT APP FINGER .00 .00 2 00000000 .00
p......p.. 85(0420) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29130 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227021 OT APP LONG LEG SPLINT .00 EA= 1.00 1 00000000 155.00
OT APP LONG L .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29505 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227026 OT APP LONG LEG SPLINT .00 EA= .00 1 31110092 155.00
OT APP LONG L .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29505 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227003 OT APP SH ARM SPLINT DY .00 EA= .00 1 31110092 166.00
OT APP SH ARM .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29126 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 176
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
9227014 OT APP SH ARM SPLINT DY - 29126 .00 EA= 1.00 1 00000000 166.00
OT APP SH ARM .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29126 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227013 OT APP SH ARM SPLINT ST - 29125 .00 EA= 1.00 1 00000000 135.00
OT APP SH ARM .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29125 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227004 OT APP SH ARM ST .00 EA= .00 1 31110092 135.00
OT APP SH ARM .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29125 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227022 OT APP SHORT LEG SPLINT .00 EA= 1.00 1 00000000 136.00
OT APP SHORT .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 2
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29515 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227028 OT APP SHORT LEG SPLINT .00 EA= .00 1 31110092 135.00
OT AP SH LEG .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29515 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227012 OT APPL LONG ARM SPLINT .00 EA= 1.00 1 00000000 176.00
OT APPL LONG .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29105 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227011 OT STRAP HAND/FING .00 EA= .00 1 31110092 108.00
OT STRAP HAN .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29280 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 177
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
9227019 OT STRAPPING ELBO/WRIS .00 EA= 1.00 1 00000000 108.00
OT STRAPPING .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29260 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227010 OT STRAPPING ELBOW WRIST .00 EA= .00 1 31110092 108.00
OT STRAP ELB .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29260 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227020 OT STRAPPING HAND/FING .00 EA= 1.00 1 00000000 108.00
OT STRAPPING .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29280 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227023 OT STRAPPING HIP .00 EA= 1.00 1 00000000 128.00
OT STRAPPING .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 3
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29520 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227027 OT STRAPPING HIP .00 EA= .00 1 31110092 128.00
OT STRAP HIP .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29520 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227008 OT STRAPPING LOW BACK .00 EA= .00 1 31110092 116.00
OT STRAP LOW .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
9227017 OT STRAPPING LOW BACK .00 EA= 1.00 1 00000000 116.00
OT STRAPPING .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29799 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 178
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
9227001 OT STRAPPING OF ANKLE .00 EA= .00 1 31110092 89.00
OT STRAPPING .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29540 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227025 OT STRAPPING OF ANKLE .00 EA= 1.00 1 00000000 89.00
OT STRAPPING .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 5
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29540 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227002 OT STRAPPING OF KNEE .00 EA= .00 1 31110092 116.00
OT STRAPPING .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29530 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227024 OT STRAPPING OF KNEE .00 EA= 1.00 1 00000000 116.00
OT STRAPPING .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 4
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29530 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227009 OT STRAPPING SHOULDER .00 EA= .00 1 31110092 136.00
OT STRAPPING .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29240 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227018 OT STRAPPING SHOULDER .00 EA= 1.00 1 00000000 136.00
OT STRAPPING .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29240 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227041 OT STRAPPING THORAX .00 EA= 1.00 1 00000000 128.00
OT STRAPPING .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29200 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 179
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
9227007 OTAPP FINGER SPLINT DY .00 EA= .00 1 31110092 108.00
OT APP FINGER .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29131 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800016 OVARIAN CYSTECTOMY UNILATERAL OR BIL .00 EA= .00 1 00000000 1846.00
OVAR CYST UB .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 58925 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1400091 PAP SMEAR OBTAINING PREPARING AND CO .00 EA= .00 1 00000000 137.00
PAP SMEAR OBT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: Q0091 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1488150 PAP SMEAR-CYTOPATHOLOGY SLIDES CERVI .00 EA= .00 1 00000000 80.00
PAP SMEAR-CYT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 88150 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330519 PARACENTESIS .00 EA= .00 1 00000000 473.00
PARACENTESIS .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 49080 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411056 PARING/CUTTING B9 KERATOTIC LES 2-4 .00 EA= .00 1 00000000 126.00
PARING/CUTTIN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11056 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411055 PARING/CUTTING KERATOTIC LESION 1 .00 EA= .00 1 00000000 101.00
PARING/CUTTIN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11055 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 180
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1460220 PARTIAL REMOVAL OF THYROID .00 EA= .00 1 00000000 1741.00
PARTIAL REMOV .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 60220 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113277 PARTIAL REPLACE VAD .00 EA= .00 1 00000000 1331.00
PARTIAL REPLA .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36578 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499392 PERIODIC COMPREHENSIVE PHYSICAL EARL .00 EA= .00 1 00000000 148.00
PERIODIC COMP .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99392 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499391 PERIODIC COMPREHENSIVE PHYSICAL INFA .00 EA= .00 1 00000000 140.00
PERIODIC COMP .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99391 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499393 PERIODIC COMPREHENSIVE PHYSICAL-LATE .00 EA= .00 1 00000000 162.00
PERIODIC COMP .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99393 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410250 PHY REVIEW INTERPRET AND PT MGMT OF .00 EA= .00 1 00000000 55.00
PHY REVIEW IN .00 .00 2 00000000 .00
.......... CY(0000) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0250 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499374 PHYS SUPERVISION OF A PATIENT UNDER .00 EA= .00 1 00000000 164.00
PHYS SUPERVIS .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99374 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 181
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1410181 PHYSICIAN CERTIFICATION FOR MEDICARE .00 EA= .00 1 00000000 152.00
PHYSICIAN CER .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0180 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410179 PHYSICIAN RECERTIFICATION FOR MEDICA .00 EA= .00 1 00000000 115.00
PHYSICIAN REC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0179 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499378 PHYSICIAN SUPER HOSPICE PT 30 MIN OR .00 EA= .00 1 00000000 346.00
PHYSICIAN SUP .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99378 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499379 PHYSICIAN SUPER NURSING FACILITY PT .00 EA= .00 1 00000000 173.00
PHYSICIAN SUP .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99379 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499375 PHYSICIAN SUPER PT UNDER CARE OF HOM .00 EA= .00 1 00000000 303.00
PHYSICIAN SUP .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99375 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499380 PHYSICIAN SUPERVISION OF A NURSING F .00 EA= .00 1 00000000 272.00
PHYSICIAN SUP .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99380 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490732 PNEUMOCOCCAL VACCINE AGE 2YRS+ .00 EA= .00 1 00000000 72.00
PNEUMOCOCCAL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90732 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 182
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2330495 PORT-A-CATH BLOOD DRAW .00 EA= .00 1 00000000 51.00
PORT-A-CATH B .00 .00 2 00000000 .00
.......... 56(0301) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36591 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499024 POST OP .00 EA= .00 1 00000000 .00
POST OP .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99024 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499210 PREOP COLON OFFICE VISIT .00 EA= .00 1 00000000 .00
PREOP COLON O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99211N FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445300 PROCTOSIGMOIDOSCOPY FIGID DIAGNOSTIC .00 EA= .00 1 00000000 202.00
PROCTOSIGMOID .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45300 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1484153 PROSTATE SPECIFIC ANTIGEN-PSA TOTAL .00 EA= .00 1 00000000 107.00
PROSTATE SPEC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 84153 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445110 PROTECTOMY COMPLETE COMBINED ABDOMIN .00 EA= .00 1 00000000 6386.00
PROTECTOMY CO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45110 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1485610 PROTHROMBIN TIME (PT) .00 EA= .00 1 00000000 27.00
PROTHROMBIN T .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 85610 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 183
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
9127004 PT FUNCTIONAL EVALUATIO .00 EA= 1.00 1 00000000 86.00
PT FUNCTIONAL .00 .00 2 00000000 .00
p......p.. 85(0420) INV.GL= EXP.GL= .00 .00 3 31300091 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 4
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99203 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9121013 PT TENS INITIAL SET UP .00 EA= 1.00 1 00000000 108.00
PT TENS INITI .00 .00 2 00000000 .00
p......p.. 85(0420) INV.GL= EXP.GL= .00 .00 3 31300091 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 64550GP FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9127040 PT UNNA BOOT APPLICATIO .00 EA= 1.00 1 00000000 116.00
PT UNNA BOOT .00 .00 2 00000000 .00
p......p.. 85(0420) INV.GL= EXP.GL= .00 .00 3 31300091 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29580 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1494760 PULSE OX-NONINVASIVE EAR OR PULSE OX .00 EA= .00 1 00000000 41.00
PULSE OX-NONI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 94760 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410160 PUNCTURE ASPIRATION OF ABSCESS HEMAT .00 EA= .00 1 00000000 232.00
PUNCTURE ASPI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 10160 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1419000 PUNCTURE ASPIRATION OF CYST OF BREAS .00 EA= .00 1 00000000 226.00
PUNCTURE ASPI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 19000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499377 PYSICIAN SUPER OF A HOSPICE PT 15-29 .00 EA= .00 1 00000000 195.00
PYSICIAN SUPE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99377 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 184
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1487880 RAPID STREPT A .00 EA= .00 1 00000000 54.00
RAPID STREPT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 87880 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113322 REM TUNNELED CVAD W PORT/PUMP .00 EA= .00 1 00000000 3001.00
REM TUNN CVAD .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36590 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113290 REMOVAL FOREIGN BODY .00 EA= .00 1 00000000 355.00
REMOVAL FOREI .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20520 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1424200 REMOVAL FOREIGN BODY UPPER ARM .00 EA= .00 1 00000000 248.00
REMOVAL FOREI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 24200 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1465220 REMOVAL OF FOREIGN BODY EXTERNAL EYE .00 EA= .00 1 00000000 351.00
REMOVAL OF FO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 65220 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411200 REMOVAL OF SKIN TAGS UP TO 15 .00 EA= .00 1 00000000 161.00
REMOVAL OF SK .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11200 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113272 REMOVE VEN ACC DEVIC .00 EA= .00 1 00000000 1331.00
REMOVE VEN AC .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36589 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 185
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499418 REOPENING OF RECENT LAPAROTOMY .00 EA= .00 1 00000000 2567.00
REOPENING OF .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 49002 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113297 REP BLD VESS W/GRAFT .00 EA= .00 1 00000000 2129.00
REP BLD VESS .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 35266 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113296 REPAIR ANEURYSM .00 EA= .00 1 00000000 2662.00
REPAIR ANEURY .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 35011 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
280017 REPAIR INCARCERATED INGUINAL HERNIA .00 EA= .00 1 00000000 1424.00
REP INC ING 5 .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 49507 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499413 REPAIR INITAL INCISIONAL OR VENTRAL .00 EA= .00 1 00000000 2273.00
REPAIR INITAL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 49561 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1449560 REPAIR INITIAL INCISIONAL OF VENTRAL .00 EA= .00 1 00000000 2409.00
REPAIR INITIA .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 49560 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1449505 REPAIR INITIAL INGUINAL HERNIA AGE 5 .00 EA= .00 1 00000000 1817.00
REPAIR INITIA .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 49505 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 186
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1449565 REPAIR RECURRENT INCISIONAL OR VENTR .00 EA= .00 1 00000000 2629.00
REPAIR RECURR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 49565 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1449585 REPAIR UMBILICAL HERNIA AGE 5 YRS OR .00 EA= .00 1 00000000 1884.00
REPAIR UMBILI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 49585 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113298 REV ART BYPASS W/O .00 EA= .00 1 00000000 1775.00
REV ART BYPAS .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 35881 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113271 REVISE VEN ACC DEVIC .00 EA= .00 1 00000000 1331.00
REVISE VEN AC .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36581 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113288 REVISION AV FISTULA .00 EA= .00 1 00000000 1242.00
REVISION AV F .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36010 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420696 ROCEPHIN ANTIBIOTIC INJECTION PER 25 .00 EA= .00 1 00000000 4.00
ROCEPHIN ANTI .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J0696 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499410 SALPINGO-OOHORECTOMY COMPLETE OR PAR .00 EA= .00 1 00000000 1807.00
SALPINGO OOHO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 58720 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 187
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1410105 SCREENING COLONOSCOPY/HIGH RISK .00 EA= .00 1 00000000 1206.00
SCREENING COL .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0105 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410104 SCREENING FLEX SIGMOIDOSCOPY .00 EA= .00 1 00000000 380.00
SCREENING FLE .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0104 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
4560043 SENTINEL NODE INJECTION .00 EA= 2.00 1 00000000 200.00
SENT NODE INJ .00 .00 2 00000000 .00
n......n.P 42(0360) INV.GL= EXP.GL= .00 .00 3 31300045 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:N AUTO COMP ORD:N VIEW UNVER ORD:Y PRT ORD SLIP:B CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 38792 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411301 SHAVING OF DERMAL LESION SINGLE TRUN .00 EA= .00 1 00000000 192.00
SHAVING OF DE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11301 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411300 SHAVING OF EPIDERMAL /DERMAL LESION .00 EA= .00 1 00000000 156.00
SHAVING OF EP .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11300 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113285 SHUNT ARTERY TO VEIN .00 EA= .00 1 00000000 3549.00
SHUNT ARTERY .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36145 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445338 SIGMOIDOSCOPY FLEX DX W/REMOVALTUMOR .00 EA= .00 1 00000000 1040.00
SIGMOIDOSCOPY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45338 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 188
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1445531 SIGMOIDOSCOPY FLEX W/ BIOPSY SINGLE .00 EA= .00 1 00000000 480.00
SIGMOIDOSCOPY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45531 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445330 SIGMOIDOSCOPY FLEXIBLE DIAGNOSTIC .00 EA= .00 1 00000000 392.00
SIGMOIDOSCOPY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45330 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1412002 SIMPLE REPAIR OF SUPERFICIAL WOUND 7 .00 EA= .00 1 00000000 544.00
SIMPLE REPAIR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 12002 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1412001 SIMPLE REPAIR SUPERFICIAL WOUND .00 EA= .00 1 00000000 450.00
SIMPLE REPAIR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 12001 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1486580 SKN TEST-PPD .00 EA= .00 1 00000000 33.00
SKN TEST-PPD .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 86580 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499406 SMOKING AND TOBACCO CESSATION .00 EA= .00 1 00000000 44.00
SMOKING AND T .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99406 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410436 SMOKING AND TOBACCO CESSATON .00 EA= .00 1 00000000 44.00
SMOKING AND T .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0436 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 189
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499080 SPECIAL REPORTS MEDICAL RECORDS INSU .00 EA= .00 1 00000000 .00
SPECIAL REPOR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99080 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330520 SPINAL TAP .00 EA= .00 1 00000000 525.00
SPINAL TAP .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 62272 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890020 SPINAL/LUMBAR PUNCTU .00 EA= .00 1 00000000 525.00
SPINAL/LUMBAR .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 62270 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1494010 SPIROMETRY PLAIN .00 EA= .00 1 00000000 140.00
SPIROMETRY PL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 94010 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1438100 SPLENECTOMY TOTAL .00 EA= .00 1 00000000 6702.00
SPLENECTOMY T .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 38100 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499401 SPORTS PHYSICAL .00 EA= .00 1 00000000 25.00
SPORTS PHYSIC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99401F FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1487430 STREP GROUP A .00 EA= .00 1 00000000 41.00
STREP GROUP A .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 87430 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 190
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499231 SUBSEQUENT HOSPITAL CARE 15 MINS .00 EA= .00 1 00000000 102.00
SUBSEQUENT HO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99231 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499232 SUBSEQUENT HOSPITAL CARE PER DAY 25 .00 EA= .00 1 00000000 139.00
SUBSEQUENT HO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300020 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99232 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499233 SUBSEQUENT HOSPITAL VISIT .00 EA= .00 1 00000000 259.00
SUBSEQUENT HO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99233 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499308 SUBSEQUENT NURSING CARE 15 MINS .00 EA= .00 1 00000000 164.00
SUBSEQUENT NU .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99308 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499314 SUBSEQUENT NURSING CARE 15 MINS .00 EA= .00 1 00000000 164.00
SUBSEQUENT NU .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99308SW FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499309 SUBSEQUENT NURSING CARE 25 MINUTES .00 EA= .00 1 00000000 238.00
SUBSEQUENT NU .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300020 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99309 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499317 SUBSEQUENT NURSING CARE 25 MINUTES .00 EA= .00 1 00000000 238.00
SUBSEQUENT NU .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99309SW FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 191
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499310 SUBSEQUENT NURSING FACILITY CARE 35 .00 EA= .00 1 00000000 324.00
SUBSEQUENT NU .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300020 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99310 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499307 SUBSEQUENT NURSING HOME CARE .00 EA= .00 1 00000000 121.00
SUBSEQUENT NU .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99307 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499313 SUBSEQUENT NURSING HOME CARE .00 EA= .00 1 00000000 121.00
SUBSEQUENT NU .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99307SW FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499224 SUBSEQUENT OBSERVATION CARE 15 MINS .00 EA= .00 1 00000000 66.00
SUBSEQUENT OB .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99224 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499225 SUBSEQUENT OBSERVATION CARE 25 MINS .00 EA= .00 1 00000000 132.00
SUBSEQUENT OB .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99225 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499226 SUBSEQUENT OBSERVATION CARE 35 MINS .00 EA= .00 1 00000000 184.00
SUBSEQUENT OB .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99226 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1731068 SUCTION .00 EA= 1.00 1 31110017 79.00
SUCTION .00 .00 2 31220017 .00
.......z.. 84(0410) INV.GL= EXP.GL= .00 .00 3 31300017 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:N AUTO COMP ORD:N VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 31720 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 192
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1446270 SURGICAL TREATMENT OF ANAL FISTULA .00 EA= .00 1 00000000 1502.00
SURGICAL TREA .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 46270 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420670 SUTURE REMOVAL .00 EA= .00 1 00000000 1031.00
SUTURE REMOVA .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20670 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113287 SVC OR IVC PLACEMENT .00 EA= .00 1 00000000 1775.00
SVC OR IVC PL .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36010 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490715 TDAP > 7YRS IM .00 EA= .00 1 00000000 36.00
TDAP > 7YRS I .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90715 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
8041843 TEMPERAL ARTERY BIOPSY .00 EA= .00 1 00000000 512.00
TEMPERAL ARTE .00 .00 2 00000000 .00
.......... 65(0370) INV.GL= EXP.GL= .00 .00 3 31300080 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 37609 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1421080 TESTOSTERONE INJECTION .00 EA= .00 1 00000000 18.00
TESTOSTERONE .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J1080 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490703 TETANUS SHOT .00 EA= .00 1 00000000 48.00
TETANUS SHOT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90703 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 193
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1490718 TETANUS/DIPHTHERIA TOXOIDS (TD) ADM .00 EA= .00 1 00000000 44.00
TETANUS/DIPHT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90718 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1496372 THERAPEUTIC PROPHYLACTIC INJECTION .00 EA= .00 1 00031110 50.00
THERAPEUTIC P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96372 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330521 THORACENTESIS FOR ASPIRATION .00 EA= .00 1 00000000 499.00
THORACENTESIS .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 32421 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330522 THORACENTESIS W/WATER SEAL .00 EA= .00 1 00000000 525.00
THORACENTESIS .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 32422 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113269 THROMBECT AV FISTULA .00 EA= .00 1 00000000 3549.00
THROMBECT AV .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36870 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113314 THROMBECTOMY .00 EA= .00 1 00000000 24126.00
THROMBECTOMY .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36904 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113315 THROMBECTOMY W/ BALLOON .00 EA= .00 1 00000000 48762.00
THROMB W/ BAL .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36905 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 194
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2113316 THROMBECTOMY W/ STENT .00 EA= .00 1 00000000 73910.00
THROMB W/ STN .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36906 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1484443 THYROID STIMULATING HORMONE .00 EA= .00 1 00000000 97.00
THYROID STIMU .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 84443 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499408 THYROIDECTOMY, REMOVAL OF ALL REMAIN .00 EA= .00 1 00000000 2696.00
THROIDECTOMY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 60260 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1484436 THYROXINE TOTAL .00 EA= .00 1 00000000 39.00
THYROXINE TOT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 84436 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1421885 TORADOL KETOROLAC PER 15 MG .00 EA= .00 1 00000000 6.00
TORADOL KETOR .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J1885 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1731081 TRACH CARE .00 EA= 1.00 1 31110017 113.00
TRACH CARE .00 .00 2 31220017 .00
.......z.. 84(0410) INV.GL= EXP.GL= .00 .00 3 31300017 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:N AUTO COMP ORD:N VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 31720 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1431600 TRACHEOSTOMY PLANNED .00 EA= .00 1 00000000 1554.00
TRACHEOSTOMY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 31600 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 195
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2113274 TRANSCATH PLACE STEN .00 EA= .00 1 00000000 3549.00
TRANSCATH PLA .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 37205 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113293 TRANSCATH RETR FB .00 EA= .00 1 00000000 1730.00
TRANSCATH RET .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 37203 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113318 TRANSCATH STENT PLACEMENT .00 EA= .00 1 00000000 4336.00
TRANSCTH STNT .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36908 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1484460 TRANSFERASE ALANINE AMINO (ALT)(SGPT .00 EA= .00 1 00000000 27.00
TRANSFERASE A .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 84460 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890021 TRIGGER POINT INJECT .00 EA= .00 1 00000000 296.00
TRIGGER POINT .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20552 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420552 TRIGGER PT INJECTION .00 EA= .00 1 00000000 169.00
TRIGGER PT IN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20552 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1432551 TUBE THORACOSTOMY INCLUDES WATER SEA .00 EA= .00 1 00000000 661.00
TUBE THORACOS .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 32551 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 196
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
4560041 ULTRASOUND GUIDANCE NEEDLE WIRE IN B .00 EA= .00 1 00000000 559.00
US GUID NEED .00 .00 2 00000000 .00
u......u.P 42(0360) INV.GL= EXP.GL= .00 .00 3 31300045 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:N AUTO COMP ORD:N VIEW UNVER ORD:Y PRT ORD SLIP:B CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 19290 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1429580 UNNA BOOT .00 EA= .00 1 00000000 116.00
UNNA BOOT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29580 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443248 UP GI ENDO W/ INSERT GUIDE WIRE THEN .00 EA= .00 1 00000000 901.00
UP GI ENDO W/ .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43248 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443245 UP GI ENDO W/DILAT GASTRIC OUT OBSTR .00 EA= .00 1 00000000 928.00
UP GI ENDO W/ .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43245 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443251 UP GI ENDOSCOPY WITH REMOVAL OF TUMO .00 EA= .00 1 00000000 1122.00
UP GI ENDOSCO .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43251 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443247 UPPER GASTROINTESTINAL ENDOSCOPY WIT .00 EA= .00 1 00000000 928.00
UPPER GASTROI .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43247 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443249 UPPER GI ENDOSCOPY WITH BALLOON DILA .00 EA= .00 1 00000000 986.00
UPPER GI ENDO .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43249 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 197
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1481002 URINALYIS BY DIPSTICK OR TABLE NON-A .00 EA= .00 1 00000000 24.00
URINALYIS BY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 81002 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1481001 URINALYSIS BY DIPSTICK OR TABLET REA .00 EA= .00 1 00000000 31.00
URINALYSIS BY .00 .00 2 00000000 .00
.......... 58(0307) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 81001 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1481003 URINALYSIS DIP STICK/TABLET RGNT/AUT .00 EA= .00 1 00000000 25.00
URINALYSIS DI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 81003 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490472 VACCINE ADMINISTRATION EACH ADDITION .00 EA= .00 1 00000000 26.00
VACCINE ADMIN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90472 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490471 VACCINE ADMINISTRATION FIRST SHOT .00 EA= .00 1 00000000 49.00
VACCINE ADMIN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90471 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113319 VEIN EMBOLIZATION .00 EA= .00 1 00000000 4336.00
VEIN EMBOLIZA .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36909 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
4111020 VENI PUNCTURE .00 EA= .00 1 00000000 28.00
VENI PUNCTURE .00 .00 2 00000000 .00
.......... 55(0300) INV.GL= EXP.GL= .00 .00 3 31300041 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36415 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 198
TIME: 08:24 ITEM MASTER LIST DEPT# 003 I/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1436415 VENIPUNCTURE .00 EA= .00 1 00000000 21.00
VENIPUNCTURE .00 .00 2 00000000 .00
.......... 55(0300) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36415 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113320 VENOGRAPHY .00 EA= .00 1 00000000 3420.00
VENOGRAPHY .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 75827 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113295 VESSEL MAPPING DIALY .00 EA= .00 1 00000000 887.00
VESSEL MAPPIN .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0365 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499172 VISUAL FUNCTION SCREENING .00 EA= .00 1 00000000 62.00
VISUAL FUNCTI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99172 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411765 WEDGE EXCOF SKIN NAIL FOLD (INGROWN .00 EA= .00 1 00000000 409.00
WEDGE EXCOF S .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11765 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1487210 WET PREP-SMR PRIM SRC WET MOUNT NFCT .00 EA= .00 1 00000000 27.00
WET PREP-SMR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 87210 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490736 ZOSTER SHINGLES VACCINE LIVE SUBCUTA .00 EA= .00 1 00000000 356.00
ZOSTER SHINGL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90736 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 199
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2113291 A/V ANASTOMOSIS OPEN .00 EA= .00 1 00000000 1775.00
A/V ANASTOMOS .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36818 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890000 ABSCESS I&D .00 EA= .00 1 00000000 337.00
ABSCESS I&D .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 10061 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113302 ACCESS AV DIAL GRAFT .00 EA= .00 1 00000000 4336.00
ACCESS AV DIA .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36147 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113311 ACCESS AV FISTULOGRAM .00 EA= .00 1 00000000 4336.00
AV FISTULOGRA .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36901 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113275 ADDTL STENT PLACEMEN .00 EA= .00 1 00000000 3106.00
ADDTL STENT P .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 37206 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800006 ADJACENT TISSUE TRANSFER OR REARRANG .00 EA= .00 1 00000000 1467.00
ADJACENT TISS .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 14000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800011 ADJACENT TISSUE TRANSFER OR REARRANG .00 EA= .00 1 00000000 1211.00
ADJACENT TISS .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 14000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 200
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1410009 ADMIN PNEUMOCOCCAL VACCINE (MEDICARE .00 EA= .00 1 00000000 25.00
ADMIN PNEUMOC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0009 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1415734 ADVANCEMENT FLAPS TRUNK .00 EA= .00 1 00000000 6260.00
ADVANCEMENT F .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 15734 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1427613 ALBUTEROL INHALATION SOLUTION .00 EA= .00 1 00000000 12.00
ALBUTEROL INH .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J7613 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1495117 ALLERGY MULTIPLE- PROF SVS ALLERGY I .00 EA= .00 1 00000000 42.00
ALLERGY MULTI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 95117 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1495115 ALLERGY SINGLE- PROFESSIONAL SERVICE .00 EA= .00 1 00000000 28.00
ALLERGY SINGL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 95115 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
8040009 ANESTHESIA SERVICES .00 EA= .00 1 00000000 18.00
ANESTHESIA SE .00 .00 2 00000000 .00
.......... 65(0370) INV.GL= EXP.GL= .00 .00 3 31300080 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45384 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
8040010 ANESTHESIA UNITS .00 EA= .00 1 00000000 18.00
ANESTHESIA UN .00 .00 2 00000000 .00
.......... 65(0370) INV.GL= EXP.GL= .00 .00 3 31300080 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45384 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 201
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2113267 ANGIOPLASTY ART BLKG .00 EA= .00 1 00000000 2662.00
ANGIOPLASTY A .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 35475 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113299 ANGIOPLASTY FEM-POP .00 EA= .00 1 00000000 2574.00
ANGIOPLASTY F .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 35474 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113312 ANGIOPLASTY NO STENT .00 EA= .00 1 00000000 20385.50
ANGIOPLAS W/O .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36902 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113313 ANGIOPLASTY W/ STENT .00 EA= .00 1 00000000 41202.05
ANGIOPLASTY W .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36903 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410438 ANNUAL WELLNESS VISIT INITIAL VISIT .00 EA= .00 1 00000000 468.00
ANNUAL WELLNE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0438 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446600 ANOSCOPY DX W OR W/OUT SPECIMEN COLL .00 EA= .00 1 00000000 204.00
ANOSCOPY DX W .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 46600 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444950 APPENDECTOMY .00 EA= .00 1 00000000 2221.00
APPENDECTOMY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44950 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 202
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1444960 APPENDECTOMY RUPTURED OPEN .00 EA= .00 1 00000000 2776.00
APPENDECTOMY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44960 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1429130 APPLICATION OF FINGER SPLINT STATIC .00 EA= .00 1 00000000 120.00
APPLICATION O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29130 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1429125 APPLICATION OF SHORT ARM SPLINT (FOR .00 EA= .00 1 00000000 180.00
APPLICATION O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29125 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113286 ART EXT-ARM .00 EA= .00 1 00000000 1775.00
ART EXT-ARM .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36120 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420600 ARTHROCENTESIS ASPIRATION AND/OR INJ .00 EA= .00 1 00000000 168.00
ARTHROCENTESI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20600 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420605 ARTHROCENTESIS ASPIRATION AND/OR INJ .00 EA= .00 1 00000000 174.00
ARTHROCENTESI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20605 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420610 ARTHROCENTESIS ASPIRATION OR INJECTI .00 EA= .00 1 00000000 206.00
ARTHROCENTESI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20610 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 203
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1427644 ATROVENT NONCOMPOUNDED UNIT DOSE FOR .00 EA= .00 1 00000000 12.00
ATROVENT NONC .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J7644 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113303 AV GRAFT DIAL PROC .00 EA= .00 1 00000000 2129.00
AV GRAFT DIAL .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36148 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1423420 B-12 INJECTION UP TO 1000 MCG .00 EA= .00 1 00000000 7.50
B-12 INJECTIO .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J3420 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113317 BALLOON ANGIOPLASTY .00 EA= .00 1 00000000 4336.00
BALLOON ANGIO .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36907 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
4111334 BB TRANSFUSE BLOOD PRODUCT .00 EA= 1.00 1 00000000 1063.00
TRANSFUSE BLD .00 .00 2 00000000 .00
....P..... 6B(0391) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36430 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411101 BIOPSY OF SKIN SUBQ (INCLUDING SIMPL .00 EA= .00 1 00000000 87.00
BIOPSY OF SKI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11101 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411100 BIOPSY OF SKIN SUBQ TISSUE (INCLUDIN .00 EA= .00 1 00000000 174.00
BIOPSY OF SKI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11100 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 204
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2800015 BIOPSY OR EXCISION OF LYMPH NODE OPE .00 EA= .00 1 00000000 617.00
BIO EXC LYMPH .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 38500 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499415 BIOPSY SOFT TISSUE OF NECK OR THORAX .00 EA= .00 1 00000000 382.00
BIOPSY SOFT T .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 21550 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800012 BIOPSY SOFT TISSUE OF THIGH OR KNEE .00 EA= .00 1 00000000 430.00
BIOPSY SOFT O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 27323 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1482272 BLOOD OCCULT PERFORMED FOR OTHER THA .00 EA= .00 1 00000000 23.00
BLOOD OCCULT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 82272 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1494664 BREATHING TREATMENT-DEMONSTRATION AN .00 EA= .00 1 00000000 69.00
BREATHING TRE .00 .00 2 00000000 .00
.......... 7D(0460) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 94664 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890001 BRIEF OUTPATIENT VIS .00 EA= .00 1 00000000 148.00
BRIEF OUTPATI .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99211 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330496 BURN DRESSING WITH SILVADENE .00 EA= .00 1 00000000 102.00
BURN DRESSING .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 16000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 205
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2113282 CANNULATION OF GRAFT .00 EA= .00 1 00000000 3194.00
CANNULATION O .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36800 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113294 CATH ART PLACEMENT .00 EA= .00 1 00000000 1775.00
CATH ART PLAC .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36246 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1485025 CBC .00 EA= .00 1 00000000 39.00
CBC .00 .00 2 00000000 .00
.......... 55(0300) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 85025 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1436556 CENTRAL LINE > 5 YRS .00 EA= .00 1 00031110 659.00
CENTRAL LINE .00 .00 2 00031220 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 36556 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890004 CENTRAL LINE FLUSH .00 EA= .00 1 00000000 222.00
CENTRAL LINE .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99211 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330500 CENTRAL LINE INSERTION .00 EA= .00 1 00000000 985.00
CENTRAL LINE .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36556 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890005 CENTRAL LINE REMOVAL .00 EA= .00 1 00000000 81.00
CENTRAL LINE .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36589 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 206
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1410101 CERVICAL OR VAGINAL CANCER SCRENING .00 EA= .00 1 00000000 119.00
CERVICAL OR V .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0101 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443760 CHANGE OF GASTOSTOMY TUBE PERCUTANIO .00 EA= .00 1 00000000 392.00
CHANGE OF GAS .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43760 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1417250 CHEMICAL CAUTERIZATION OF GRANULATIO .00 EA= .00 1 00000000 132.00
CHEMICAL CAUT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 17250 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1447562 CHOLECYSTECTOMY LAPARASCOPIC .00 EA= .00 1 00000000 3123.00
CHOLECYSTECTO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 47562 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1447600 CHOLECYSTECTOMY OPEN .00 EA= .00 1 00000000 3123.00
CHOLECYSTECTO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 47600 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1447563 CHOLECYSTECTOMY W/ CHOLANGIOGRAM .00 EA= .00 1 00000000 3331.00
CHOLECYSTECTO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 47563 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1447605 CHOLECYSTECTOMY W/ CHOLANGIOGRAPHY .00 EA= .00 1 00000000 3331.00
CHOLECYSTECTO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 47605 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 207
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1444626 CLOSURE OF ENTEROSTOMY W/ RESECTION .00 EA= .00 1 00000000 3715.00
CLOSURE OF EN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 44626 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444140 COLECTOMY PARTIAL .00 EA= .00 1 00000000 4413.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44140 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444204 COLECTOMY PARTIAL W/ ANASTOMOSIS .00 EA= .00 1 00000000 4877.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44204 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444207 COLECTOMY PARTIAL W/ ANASTOMOSIS W/ .00 EA= .00 1 00000000 6037.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44207 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444208 COLECTOMY PARTIAL W/ ANASTOMOSIS W/ .00 EA= .00 1 00000000 6271.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44208 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444146 COLECTOMY PARTIAL W/ COLOPROCTOSTOMY .00 EA= .00 1 00000000 6921.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44146 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444143 COLECTOMY PARTIAL W/ END COLOSTOMY A .00 EA= .00 1 00000000 4503.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44143 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 208
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1444160 COLECTOMY PARTIAL W/ REMOVAL OF TERM .00 EA= .00 1 00000000 4181.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44160 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444205 COLECTOMY PARTIAL W/REMOVAL TERMINAL .00 EA= .00 1 00000000 4645.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44205 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444211 COLECTOMY TOTAL ABDOMINAL W/ PROCTEC .00 EA= .00 1 00000000 8129.00
COLECTOMY TOT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44211 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445378 COLONOSCOPY .00 EA= .00 1 00000000 1049.00
COLONOSCOPY .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
------------------------------------------------------------------------------------------------------------------------------------
1445383 COLONOSCOPY FLEXIBLE TO SPLENIC FLEX .00 EA= .00 1 00000000 1424.00
COLONOSCOPY F .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 45383 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445382 COLONOSCOPY FLEXIBLE W/ CONTROL OF B .00 EA= .00 1 00000000 1340.00
COLONOSCOPY F .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 45382 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444394 COLONOSCOPY THROUGH STOMA W/ REMOVAL .00 EA= .00 1 00000000 1693.00
COLONOSCOPY T .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 44394 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 209
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1413132 COLONOSCOPY W/ BIOPSY .00 EA= .00 1 00000000 1591.00
COLONOSCOPY W .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 13132 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445380 COLONOSCOPY W/ BIOPSY .00 EA= .00 1 00000000 1154.00
COLONOSCOPY W .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 45380 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445386 COLONOSCOPY W/ DILATION BY BALLOON 1 .00 EA= .00 1 00000000 1165.00
COLONOSCOPY W .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 45386 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445381 COLONOSCOPY W/ DIRECTED SUBMUCOSAL I .00 EA= .00 1 00000000 1300.00
COLONOSCOPY W .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 45381 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445384 COLONOSCOPY W/BIOPSY BY HOT BIOSPY F .00 EA= .00 1 00000000 1486.00
COLONOSCOPY W .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 45384 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445385 COLONOSCOPY W/BIOPSY SNARE .00 EA= .00 1 00000000 1486.00
COLONOSCOPY W .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 45385 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410122 COLORECTAL CANCER SCREENING COLONOSC .00 EA= .00 1 00000000 1105.00
COLORECTAL CA .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0121 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 210
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1410328 COLORECTAL SCREENING WELCOME TO MEDI .00 EA= .00 1 00000000 80.00
COLORECTAL SC .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0328 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1480053 COMPREHENSIVE METABOLIC PANEL .00 EA= .00 1 00000000 61.00
COMPREHENSIVE .00 .00 2 00000000 .00
.......... 56(0301) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 80053 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499394 COMPREHENSIVE PHYSICAL 12-17 .00 EA= .00 1 00000000 175.00
COMPREHENSIVE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99394 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499395 COMPREHENSIVE PHYSICAL 18-39 .00 EA= .00 1 00000000 236.00
COMPREHENSIVE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99395 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499396 COMPREHENSIVE PHYSICAL 40-64 YRS .00 EA= .00 1 00000000 258.00
COMPREHENSIVE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99396 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499397 COMPREHENSIVE PHYSICAL >65 .00 EA= .00 1 00000000 292.00
COMPREHENSIVE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99397 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330502 CONSCIOUS SEDATION .00 EA= .00 1 00000000 525.00
CONSCIOUS SED .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99144 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 211
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
890006 CONSTIPATION REMOVAL .00 EA= .00 1 00000000 212.00
CONSTIPATION .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2113304 CONTRAST INJ VEN DEV .00 EA= .00 1 00000000 89.00
CONTRAST INJ .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36598 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1482570 CREATININE OTHER SOURCE .00 EA= .00 1 00000000 33.00
CREATININE OT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 82570 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330514 CRITICAL CARE 30-74 MIN .00 EA= .00 1 00000000 1969.00
CRITICAL CARE .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 9929125 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330515 CRITICAL CARE EACH ADDTL 30 MIN .00 EA= .00 1 00000000 525.00
CRITICAL CARE .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 9929225 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499292 CRITICAL CARE EVAL/MGT EA ADDITIONAL .00 EA= .00 1 00031110 302.00
CRITICAL CARE .00 .00 2 00031220 .00
SERVICE .......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99292 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499291 CRITICAL CARE EVAL/MGT FIRST 30-74 M .00 EA= .00 1 00031110 604.00
CRITICAL CARE .00 .00 2 00031220 .00
SERVICE .......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99291 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 212
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1417340 CRYO SURGERY-ACNE .00 EA= .00 1 00000000 104.00
CRYO SURGERY- .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 17340 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1487070 CULTURE BACTERIAL ANY OTHER SOURCE E .00 EA= .00 1 00000000 40.00
CULTURE BACTE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 87070 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890007 CYST DRAINAGE SIMPLE .00 EA= .00 1 00000000 231.00
CYST DRAINAGE .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 10080 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890008 CYST REMOVAL SIMPLE .00 EA= .00 1 00000000 263.00
CYST REMOVAL .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 10040 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411044 DEBRIDEMENT BONE FIRS 20 SQ CM OR LE .00 EA= .00 1 00000000 828.00
DEBRIDEMENT B .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 11044 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411043 DEBRIDEMENT MUSCLE AND/OR FASCIA FIR .00 EA= .00 1 00000000 497.00
DEBRIDEMENT M .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 11043 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411000 DEBRIDEMENT OF EXTENSIVE EZCEMATOUS .00 EA= .00 1 00000000 200.00
DEBRIDEMENT O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 11000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 213
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1411720 DEBRIDEMENT OF NAIL 1 TO 5 .00 EA= .00 1 00000000 92.00
DEBRIDEMENT O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11720 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411721 DEBRIDEMENT OF NAILS BY ANY METHOD 6 .00 EA= .00 1 00000000 125.00
DEBRIDEMENT O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11721 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411040 DEBRIDEMENT SKIN-PARTIAL THICKNESS .00 EA= .00 1 00000000 150.00
DEBRIDEMENT S .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 11040 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411042 DEBRIDEMENT SUBCUTANEOUS TISSUE FIRS .00 EA= .00 1 00000000 232.00
DEBRIDEMENT S .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 11042 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113273 DECLOT VAS ACC DEVIC .00 EA= .00 1 00000000 710.00
DECLOT VAS AC .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36593 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1429590 DENIS-BROWNE SPLNT-LEG SPLINT .00 EA= .00 1 00000000 145.00
DENIS-BROWNE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29590 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446924 DESTR OF LES ANUS EXTENSIVE (EX LASE .00 EA= .00 1 00000000 2013.00
DESTR OF LES .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 46924 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 214
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1417280 DESTRUCTION MALIGNANT LESION .00 EA= .00 1 00000000 287.00
DESTRUCTION M .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 17280 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1417260 DESTRUCTION MALIGNANT LESION < .5 CM .00 EA= .00 1 00000000 211.00
DESTRUCTION M .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 17260 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1417263 DESTRUCTION MALIGNANT LESION TRUNK/A .00 EA= .00 1 00000000 313.00
DESTRUCTION M .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 17263 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446900 DESTRUCTION OF LESION ANUS SIMPLE CH .00 EA= .00 1 00000000 607.00
DESTRUCTION O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 46900 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446922 DESTRUCTION OF LESION ANUS SIMPLE SU .00 EA= .00 1 00000000 1087.00
DESTRUCTION O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 46922 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1417000 DESTRUCTION PRMLGNT LESION (ACTINIC .00 EA= .00 1 00000000 183.00
DESTRUCTION P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 17000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1417003 DESTRUCTION PRMLGNT LESION 2-14 EACH .00 EA= .00 1 00000000 41.00
DESTRUCTION P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 17003 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 215
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1443450 DILATION OF ESOPHAGUS BY UNGUIDED SO .00 EA= .00 1 00000000 284.00
DILATION OF E .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43450 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490702 DIPHTERIA TETANUS TOXOIDS (DT) ADM T .00 EA= .00 1 00000000 45.00
DIPHTERIA TET .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90702 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490700 DIPHTHERIA TETANUS TOXOIDS/PERTUSSIS .00 EA= .00 1 00000000 56.00
DIPHTHERIA TE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90700 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890009 DIRECT ADMIT OBSERVA .00 EA= .00 1 00000000 162.00
DIRECT ADMIT .00 .00 2 00000000 .00
.......... EJ(0762) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0379 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499419 DRAINAGE OF PERITIONEAL ABSCESS OR L .00 EA= .00 1 00000000 3897.00
DRAINAGE OF P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 49020 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800008 DRESSINGS AND OR DEBRIEDEMENT OR PAR .00 EA= .00 1 00000000 192.00
DRESSINGS AND .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 16020 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1480100 DRUG SCREEN QUALITATIVE .00 EA= .00 1 00000000 135.00
DRUG SCREEN Q .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 80100 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 216
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1469210 EAR IRRIGATION (RMVL IMPACTED WAX) .00 EA= .00 1 00000000 127.00
EAR IRRIGATIO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 69210 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1493010 ECG ROUTINE INTERPRETATION AND REPOR .00 EA= .00 1 00000000 48.00
ECG ROUTINE I .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 93010 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499071 EDUCATIONAL SUPPLIES AND HANDOUTS .00 EA= .00 1 00000000 .00
EDUCATIONAL S .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99071 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443235 EGD UPPER GASTROINESTINAL EDOSCOPY D .00 EA= .00 1 00000000 779.00
EGD UPPER GAS .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43235 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443244 EGD WITH BAND LIGATION OF ESOPHAGEAL .00 EA= .00 1 00000000 1156.00
EGD WITH BAND .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43244 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443239 EGD WITH BIOPSY UPPER GASTROINTESTIN .00 EA= .00 1 00000000 903.00
EGD WITH BIOP .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43239 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443255 EGD WITH CONTROL OF BLEEDING ANY MET .00 EA= .00 1 00000000 1190.00
EGD WITH CONT .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43255 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 217
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1443246 EGD WITH PEG TUBE PLACEMENT .00 EA= .00 1 00000000 1558.00
EGD WITH PEG .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43246 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410405 EKG ROUNTINE INTERPRET/REPORT SCREEN .00 EA= .00 1 00000000 57.00
EKG ROUNTINE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0405 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410403 EKG WELCOME TO MEDICARE PHYSICAL .00 EA= .00 1 00000000 57.00
EKG WELCOME T .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0403 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1493000 EKG-ECG ROUTINE ECG W/AT LEAST 12 LD .00 EA= .00 1 00000000 101.00
EKG-ECG ROUTI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 93000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2310024 EMERGENCY ROOM LEVEL I .00 EA= .00 1 00000000 390.00
ER LEVEL I .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 9928125 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2310025 EMERGENCY ROOM LEVEL II .00 EA= .00 1 00000000 500.00
ER LEVEL II .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 9928225 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2310026 EMERGENCY ROOM LEVEL III .00 EA= .00 1 00000000 680.00
ER LEVEL III .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 9928325 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 218
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2310027 EMERGENCY ROOM LEVEL IV .00 EA= .00 1 00000000 925.00
ER LEVEL IV .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 9928425 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2310028 EMERGENCY ROOM LEVEL V .00 EA= .00 1 00000000 1250.00
ER LEVEL V .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 9928525 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499285 EMERGENCY ROOM VISIT HIGH COMPLEXITY .00 EA= .00 1 00000000 702.00
EMERGENCY ROO .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99285 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499284 EMERGENCY ROOM VISIT MEDIUM COMPLEXI .00 EA= .00 1 00000000 470.00
EMERGENCY ROO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99284 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499283 EMERGENCY ROOM VISIT MINIMUM COMPLEX .00 EA= .00 1 00000000 315.00
EMERGENCY ROO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99283 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113300 ENDOVENOUS ABLATION .00 EA= .00 1 00000000 710.00
ENDOVENOUS AB .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36478 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800003 ENTERECTOMY, RESECTION OR SMALL INTE .00 EA= .00 1 00000000 4204.00
ENTERECTOMY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 44120 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 219
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499409 ENTEROLYSIS FREEING OF INTESTINAL AD .00 EA= .00 1 00000000 2681.00
ENTEROLYSIS .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44005 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2310005 ER SCREENING FEE .00 EA= .00 1 00000000 54.00
ER SCREENING .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99281 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800007 ESCHAROTOMY INITAL INCISION .00 EA= .00 1 00000000 494.00
ESCHOROTOMY I .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 16035 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499211 ESTABLISHED PT LEVEL 1 (5 MINS-NURSE .00 EA= .00 1 00000000 61.00
ESTABLISHED P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99211 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499212 ESTABLISHED PT LEVEL 2 (10 MINS) .00 EA= .00 1 00000000 86.00
ESTABLISHED P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99212 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499213 ESTABLISHED PT LEVEL 3 (15 MINS) .00 EA= .00 1 00031110 110.00
ESTABLISHED P .00 .00 2 00031220 .00
SERVICE .......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99213 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499214 ESTABLISHED PT LEVEL 4 (25 MINS) .00 EA= .00 1 00000000 160.00
ESTABLISHED P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99214 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 220
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499215 ESTABLISHED PT LEVEL 5 (40 MINS) .00 EA= .00 1 00000000 256.00
ESTABLISHED P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99215 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411740 EVACUATION OF SUBUNGUAL HEMATOMA .00 EA= .00 1 00000000 153.00
EVACUATION OF .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11740 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411402 EXC B9 LES MRGN XCP SKT 1.1-2.0CM .00 EA= .00 1 00000000 364.00
EXC B9 LES MR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11402 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411403 EXC B9 LESIO MRGN 2.1-3.0 CM .00 EA= .00 1 00000000 467.00
EXC B9 LESIO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11403 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411400 EXC B9 LESION SCP SK TGS .5 CM< .00 EA= .00 1 00000000 239.00
EXC B9 LESION .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11400 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411422 EXC BENIGN LESION SCALP/NECK/HANDS/F .00 EA= .00 1 00000000 387.00
EXC BENIGN LE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11422 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411401 EXC BENIGN LESION TRUNK/ARMS/LESGS 0 .00 EA= .00 1 00000000 285.00
EXC BENIGN LE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11401 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 221
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1411606 EXC MAL LES W/MRGN T/A/L > 4.0 CM .00 EA= .00 1 00000000 852.00
EXC MAL LES W .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11606 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411621 EXC MALIGNANT LESION .5/CM .00 EA= .00 1 00000000 426.00
EXC MALIGNANT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11621 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411623 EXC MALIGNANT LESION 2.1 TO 3.0 CM S .00 EA= .00 1 00000000 639.00
EXC MALIGNANT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11623 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411600 EXC MALIGNANT LESION TRUNK/ARMS/LEGS .00 EA= .00 1 00000000 391.00
EXC MALIGNANT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11600 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411440 EXC OTHER BENIGN LESION INCL MARGINS .00 EA= .00 1 00000000 285.00
EXC OTHER BEN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11440 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113276 EXCH ART CATH .00 EA= .00 1 00000000 1242.00
EXCH ART CATH .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 37209 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499416 EXCISION BENIGN LESION INCLUDING MAR .00 EA= .00 1 00000000 266.00
EXCISION BENI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 11421 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 222
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2800005 EXCISION MALIGNANT LESION INCLUDING .00 EA= .00 1 00000000 423.00
EXCISION MALI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11640 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1419125 EXCISION OF BREAST LESION .00 EA= .00 1 00000000 1550.00
EXCISION OF B .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 19125 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1419120 EXCISION OF CYST OF BREAST .00 EA= .00 1 00000000 1292.00
EXCISION OF C .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 19120 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1425111 EXCISION OF GANGLION CYST WRIST .00 EA= .00 1 00000000 1427.00
EXCISION OF G .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 25111 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499412 EXCISION OF LESION OF TENDON SHEATH .00 EA= .00 1 00000000 892.00
EXCISION OF L .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 27630 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411750 EXCISION OF NAIL AND NAIL MATRIX PAR .00 EA= .00 1 00000000 690.00
EXCISION OF N .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11750 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411772 EXCISION OF PILONIDAL CYST COMPLICAT .00 EA= .00 1 00000000 2023.00
EXCISION OF P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11772 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 223
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1445171 EXCISION OF RECTAL TUMOR TRANSANAL A .00 EA= .00 1 00000000 2418.00
EXCISION OF R .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45171 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800010 EXCISION OF SKIN AND SUBCUTANEOUS TI .00 EA= .00 1 00000000 679.00
EXCISION OF S .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11470 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446320 EXCISION OF THROMBOSED HEMORRHOID EX .00 EA= .00 1 00000000 455.00
EXCISION OF T .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 46320 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499417 EXCISION OR DESTRUCTION OPEN INTRA A .00 EA= .00 1 00000000 2936.00
EXCISION OR D .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 49203 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1421930 EXCISION TUMOR SOFT TISSU OF BACK .00 EA= .00 1 00000000 1595.00
EXC TUM BACK .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 21930 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800014 EXCISION TUMOR SOFT TISSUE OF FACE S .00 EA= .00 1 00000000 1268.00
EXC TUM 2MM .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 21014 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499414 EXCISION TUMOR SOFT TISSUE OF PELVIS .00 EA= .00 1 00000000 1480.00
EXCISION TUMO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 27048 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 224
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2800009 EXCISION TUMOR SOFT TISSUE OF SHOULD .00 EA= .00 1 00000000 1013.00
EXCISION TUMO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 23071 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1424075 EXCISION TUMOR SOFT TISSUE OF UPPER .00 EA= .00 1 00000000 1759.00
EXC TUM UP AR .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 24075 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800004 EXPLORATORY LAPAROTOMY EXPLORATORY C .00 EA= .00 1 00000000 2640.00
EXPLORATORY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 49000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330518 EXTERNAL PACEMAKER .00 EA= .00 1 00000000 525.00
EXTERNAL PACE .00 .00 2 00000000 .00
.......... 7L(0482) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 92953 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
920027 FACILITY FEE MD .00 EA= .00 1 00000000 300.00
FAC FEE MD .00 .00 2 00000000 .00
.......... PQ(0914) INV.GL= EXP.GL= .00 .00 3 31300009 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0463 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446200 FISSURECTOMY INCLUDING SPHINCTEROTOM .00 EA= .00 1 00000000 1275.00
FISSURECTOMY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 46200 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445331 FLEX SIGMOID WITH BIOPSY SINGLE OR M .00 EA= .00 1 00000000 480.00
FLEX SIGMOID .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45331 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 225
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
4420130 FLUORO GUIDE FOR ASPIRATION OF S .00 EA= .00 1 00000000 340.00
FLUOROSCOPY G .00 .00 2 00000000 .00
.......... 77(0320) INV.GL= EXP.GL= .00 .00 3 31300044 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:N CHG @ ORD ENTRY:N AUTO COMP ORD:N VIEW UNVER ORD:Y PRT ORD SLIP:B CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 62270 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113321 FLUOROGUIDE FOR VEIN DEVICE .00 EA= .00 1 00000000 642.00
FLUOROGUIDE .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 77001 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330516 FOLEY CATH INSERTION .00 EA= .00 1 00000000 185.00
FOLEY CATH IN .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 51702 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
920030 FOLLOW UP 5 MINUTES .00 EA= .00 1 00000000 150.00
FOLLOW UP 5 M .00 .00 2 00000000 .00
.......... PQ(0914) INV.GL= EXP.GL= .00 .00 3 31300009 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99211 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890018 G TUBE INSERTION .00 EA= .00 1 00000000 160.00
G TUBE INSERT .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 43760 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490649 GARDASIL HPV VACCINE .00 EA= .00 1 00000000 282.00
GARDASIL HPV .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90649 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330505 GASTRIC INTUBATION LAVAGE .00 EA= .00 1 00000000 335.00
GASTRIC INTUB .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 43753 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 226
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1491110 GI TRACT IMAGING INTRALUMAL ESOPH TH .00 EA= .00 1 00000000 2107.00
GI TRACT IMAG .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 91110 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490470 H1N1 VACCINATION .00 EA= .00 1 00000000 49.00
H1N1 VACCINAT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90470 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1419141 H1N1 VACCINATION ADMINISTRATION .00 EA= .00 1 00000000 25.00
H1N1 VACCINAT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G9141 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1484703 HCG QUALITATIVE .00 EA= .00 1 00000000 71.00
HCG QUALITATI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 84703 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1492552 HEARING TEST-PURE TONE ADIOMETRY AIR .00 EA= .00 1 00000000 49.00
HEARING TEST- .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 92552 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1485018 HEMOGLOBIN (HGB) .00 EA= .00 1 00000000 19.00
HEMOGLOBIN (H .00 .00 2 00000000 .00
.......... 55(0300) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 85018 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1483036 HEMOGLOBIN A1C .00 EA= .00 1 00000000 68.00
HEMOGLOBIN A1 .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 83036 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 227
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1446221 HEMORRHOIDECTOMY INTERNAL BY RUBBER .00 EA= .00 1 00000000 546.00
HEMORRHOIDECT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 46221 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446947 HEMORRHOIDOPEXY BY STAPLING .00 EA= .00 1 00000000 1214.00
HEMORRHOIDOPE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 46947 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446260 HEMORROIDECTOMY COMPLEX .00 EA= .00 1 00000000 2276.00
HEMORROIDECTO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 46260 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1493233 HOLTER MONITOR .00 EA= .00 1 00000000 172.00
HOLTER MONITO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 93233 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499341 HOME VISIT INITIAL VISIT .00 EA= .00 1 00000000 197.00
HOME VISIT IN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99341 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499239 HOSPITAL DISCHARGE > 30 MINS .00 EA= .00 1 00000000 180.00
HOSPITAL DISC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300020 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99239 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499238 HOSPITAL DISCHARGE DAY MNGMT <30 MIN .00 EA= .00 1 00000000 144.00
HOSPITAL DISC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300020 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99238 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 228
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1410180 I & D COMPLEX POST OP WOUND INFECTIO .00 EA= .00 1 00000000 592.00
I & D COMPLEX .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10180 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410140 I & D OF HEMATOMA SEROMA OR FLUID CO .00 EA= .00 1 00000000 335.00
I & D OF HEMA .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10140 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410081 I & D OF PILONIDAL CYST COMPLICATED .00 EA= .00 1 00000000 619.00
I & D OF PILO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10081 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410080 I & D OF PILONIDAL CYST SIMPLE .00 EA= .00 1 00000000 347.00
I & D OF PILO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10080 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1456405 I & D OF VULVA AND PERINEAL ABSCESS .00 EA= .00 1 00000000 424.00
I & D OF VULV .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 56405 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410061 I&D COMPLICATED OR MULTIPLE .00 EA= .00 1 00000000 523.00
I&D COMPLICAT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10061 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890016 I&D HEMATOMA .00 EA= .00 1 00000000 213.00
I&D HEMATOMA .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 10140 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 229
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2113283 I&D HEMATOMA PERIGRA .00 EA= .00 1 00000000 89.00
I&D HEMATOMA .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 37799 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113281 I&D PERIGRAFT SEROMA .00 EA= .00 1 00000000 89.00
I&D PERIGRAFT .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 37799 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410060 I&D SIMPLE OR SINGLE .00 EA= .00 1 00000000 261.00
I&D SIMPLE OR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10060 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490460 IMMUNIZATION ADMINISTRATION THROUGH .00 EA= .00 1 00000000 49.00
IMMUNIZATION .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90460 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1449568 IMPLANTATION OF MESH/W INCISIONAL HE .00 EA= .00 1 00000000 876.00
IMPLANTATION .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 49568 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1449587 INCARCERATED UMBILICAL HERNIA .00 EA= .00 1 00000000 2103.00
INCARCERATED .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 49587 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800013 INCESION AND DRAINAGE SHOULDER AREA .00 EA= .00 1 00000000 865.00
INCESION AND .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 23030 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 230
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1446040 INCISION AND DRAINAGE OF ISCHIORECTA .00 EA= .00 1 00000000 2015.00
INCISION AND .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 46040 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800001 INCISION AND DRAINAGE OF SUBMUCOSAL .00 EA= .00 1 00000000 531.00
INC AND DRAIN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45005 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800002 INCISION AND DRAINAGE SHOULDER AREA .00 EA= .00 1 00000000 865.00
INC AND DRAIN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 10121 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410121 INCISION AND REMOVAL OF FOREIGN BODY .00 EA= .00 1 00000000 712.00
INCISION AND .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10121 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410120 INCISION AND REMOVAL OF FOREIGN BODY .00 EA= .00 1 00000000 311.00
INCISION AND .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10120 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446083 INCISION OF THROMBOSED HEMORRHOID EX .00 EA= .00 1 00000000 351.00
INCISION OF T .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 46083 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410008 INFLUENZA ADMINISTRATION (MEDICARE O .00 EA= .00 1 00000000 25.00
INFLUENZA ADM .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0008 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 231
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1402038 INFLUENZA VACCINE 3 YEARS AND OLDER .00 EA= .00 1 00000000 34.00
INFLUENZA VAC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: Q2038 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490658 INFLUENZA VACCINE AGE 3 YRS + .00 EA= .00 1 00000000 34.00
INFLUENZA VAC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90658 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490656 INFLUENZA VACCINE PRESERVATIVE FREE .00 EA= .00 1 00000000 33.00
INFLUENZA VAC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90656 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490662 INFLUENZA VIRUS VACCINE SPLIT VIRUS .00 EA= .00 1 00000000 80.00
INFLUENZA VIR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90662 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499382 INITIAL COMPREH PHYSICAL AGE 1 TO 4 .00 EA= .00 1 00000000 183.00
INITIAL COMPR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99382 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499384 INITIAL COMPREHENSIVE PHYSICAL 12-17 .00 EA= .00 1 00000000 210.00
INITIAL COMPR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99384 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499386 INITIAL COMPREHENSIVE PHYSICAL 40-64 .00 EA= .00 1 00000000 310.00
INITIAL COMPR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99386 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 232
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499387 INITIAL COMPREHENSIVE PHYSICAL > 65 .00 EA= .00 1 00000000 349.00
INITIAL COMPR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99387 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499383 INITIAL COMPREHENSIVE PHYSICAL AGE 5 .00 EA= .00 1 00000000 196.00
INITIAL COMPR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99383 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499381 INITIAL COMPREHENSIVE PHYSICAL- UNDE .00 EA= .00 1 00000000 170.00
INITIAL COMPR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99381 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499385 INITIAL COMPREHENSIVE PREVENTIVE PHY .00 EA= .00 1 00000000 284.00
INITIAL COMPR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99385 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499222 INITIAL HOSPITAL CARE 50 MINS .00 EA= .00 1 00000000 252.00
INITIAL HOSPI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99222 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499223 INITIAL HOSPITAL CARE HIGH COMPLEXIT .00 EA= .00 1 00000000 380.00
INITIAL HOSPI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99223 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499221 INITIAL HOSPITAL CARE PER DAY 30 MIN .00 EA= .00 1 00000000 187.00
INITIAL HOSPI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99221 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 233
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499303 INITIAL NURSING FACILITY CARE 25 MIN .00 EA= .00 1 00000000 216.00
INITIAL NURSI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99304SW FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499304 INITIAL NURSING FACILITY CARE 25 MIN .00 EA= .00 1 00000000 216.00
INITIAL NURSI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99304 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499305 INITIAL NURSING FACILITY PER DAY 35 .00 EA= .00 1 00000000 303.00
INITIAL NURSI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99305 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499311 INITIAL NURSING FACILITY PER DAY 35 .00 EA= .00 1 00000000 303.00
INITIAL NURSI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99305SW FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499306 INITIAL NURSING FACILITY PER DAY 45 .00 EA= .00 1 00000000 368.00
INITIAL NURSI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300020 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99306 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499312 INITIAL NURSING FACILITY PER DAY 45 .00 EA= .00 1 00000000 368.00
INITIAL NURSI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99306SW FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499218 INITIAL OBSERVATION CARE LOW SEVERIT .00 EA= .00 1 00000000 168.00
INITIAL OBSER .00 .00 2 00000000 .00
.......... EJ(0762) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99218 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 234
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499219 INITIAL OBSERVATION CARE MODERATE SE .00 EA= .00 1 00000000 229.00
INITIAL OBSER .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99219 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499220 INITIAL OBSERVATION CARE PER DAY .00 EA= .00 1 00000000 287.00
INITIAL OBSER .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99220 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410402 INITIAL PREVENTATIVE PHYSICAL WELCOM .00 EA= .00 1 00000000 399.00
INITIAL PREVE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0402 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113278 INJ EXT VENOGRAPHY .00 EA= .00 1 00000000 532.00
INJ EXT VENOG .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36005 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113306 INJ LUMBAR OR SACRAL .00 EA= .00 1 00000000 887.00
INJ LUMBAR OR .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36595 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420550 INJ SINGLE TENDON SHEATH OR LIGAMENT .00 EA= .00 1 00000000 163.00
INJ SINGLE TE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20550 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113279 INJECT ANTIOBOTIC IM .00 EA= .00 1 00000000 89.00
INJECT ANTIOB .00 .00 2 00000000 .00
.......... 3I(0260) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 235
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1420553 INJECT SINGLE/MULTIPLE TRIGGER POINT .00 EA= .00 1 00000000 198.00
INJECT SINGLE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20553 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420170 INJECTION ADRENALINE UP TO 1 ML AMPU .00 EA= .00 1 00000000 3.00
INJECTION ADR .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J0170 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1464413 INJECTION ANESTHETIC AGENT CERVICAL .00 EA= .00 1 00000000 649.00
INJECTION ANE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 64413 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1464412 INJECTION ANESTHETIC AGENT SPINAL AC .00 EA= .00 1 00000000 731.00
INJECTION ANE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 64412 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420702 INJECTION BETAMETHASONE SODIUM PHOSP .00 EA= .00 1 00000000 4.00
INJECTION BET .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J0702 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420704 INJECTION BETAMETHASONE SODIUM PHOSP .00 EA= .00 1 00000000 4.00
INJECTION BET .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J0704 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1421100 INJECTION DECADRON 1 MG .00 EA= .00 1 00000000 30.00
INJECTION DEC .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J1100 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 236
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1421000 INJECTION DEPO-ESTRADIOL UP TO 5MG .00 EA= .00 1 00000000 24.00
INJECTION DEP .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J1000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1421200 INJECTION DIPHENHYDRAMINE HCI UP TO .00 EA= .00 1 00000000 3.00
INJECTION DIP .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J1200 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1423410 INJECTION HYDROXYZINE HCL VISTARIL U .00 EA= .00 1 00000000 4.00
INJECTION HYD .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J3410 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1422001 INJECTION LIDOCAINE FOR INTRAVENOUS .00 EA= .00 1 00000000 50.00
INJECTION LID .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J2001 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1421055 INJECTION MEDROXYPROGESTERONE ACETAT .00 EA= .00 1 00000000 88.00
INJECTION MED .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J1055 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1422175 INJECTION MEPERIDINE PER 100 MG .00 EA= .00 1 00000000 7.00
INJECTION MEP .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J2175 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1421030 INJECTION METHYLPREDISOLONE ACETATE .00 EA= .00 1 00000000 12.00
INJECTION MET .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J1030 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 237
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1422300 INJECTION NALBUPHINE PER 10 MG .00 EA= .00 1 00000000 4.00
INJECTION NAL .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J2300 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1422550 INJECTION PHENERGEN PER 50 MG .00 EA= .00 1 00000000 6.00
INJECTION PHE .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J2550 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1421070 INJECTION TESTOSERONE CYPIONATE UP T .00 EA= .00 1 00000000 13.00
INJECTION TES .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J1070 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1421060 INJECTION TESTOSTERONE CYPIONATE AND .00 EA= .00 1 00000000 25.00
INJECTION TES .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J1060 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420526 INJECTION THERAPEUTIC CARPAL TUNNEL .00 EA= .00 1 00000000 219.00
INJECTION THE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20526 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420551 INJECTION(S) SINGLE TENDON ORIGIN/IN .00 EA= .00 1 00000000 168.00
INJECTION(S) .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20551 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499254 INPATIENT CONSULT COMPREHENSIVE .00 EA= .00 1 00000000 358.00
INPATIENT CON .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99254 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 238
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499253 INPATIENT CONSULT DETAILED .00 EA= .00 1 00000000 286.00
INPATIENT CON .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99253 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499252 INPATIENT CONSULT EXPANDED PROBLEM .00 EA= .00 1 00000000 232.00
INPATIENT CON .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99252 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499255 INPATIENT CONSULT HIGH COMPLEXITY .00 EA= .00 1 00000000 450.00
INPATIENT CON .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99255 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499251 INPATIENT CONSULT PROBLEM FOCUSED .00 EA= .00 1 00000000 153.00
INPATIENT CON .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99251 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113289 INSERT TUNNELED CVA .00 EA= .00 1 00000000 1775.00
INSERT TUNNEL .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36565 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113270 INSERT VEN ACC DEVIC .00 EA= .00 1 00000000 2662.00
INSERT VEN AC .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36558 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1493503 INSERTION AND PLACEMENT OF FLOW DIRE .00 EA= .00 1 00000000 707.00
INSERTION AND .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 93503 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 239
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1436558 INSERTION GROSHON/HICKMAN CENTRAL LI .00 EA= .00 1 00000000 2268.00
INSERTION GRO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36558 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113284 INSERTION PICC LINE .00 EA= .00 1 00000000 1331.00
INSERTION PIC .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36569 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1436561 INSERTION TUNNELED CENTRAL LINE/PORT .00 EA= .00 1 00000000 2062.00
INSERTION TUN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36561 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113292 INTER INF VENA CAVA .00 EA= .00 1 00000000 2662.00
INTER INF VEN .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 37620 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1474360 INTRALUM DILAT STRICTURES AND/OR OBS .00 EA= .00 1 00000000 203.00
INTRALUM DILA .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 74360 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113301 INTRO CATH AORTA .00 EA= .00 1 00000000 1730.00
INTRO CATH AO .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36200 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1731084 INTUBATION .00 EA= 1.00 1 31110017 750.00
INTUBATION .00 .00 2 31220017 .00
SERVICE .......z.. 84(0410) INV.GL= EXP.GL= .00 .00 3 31300017 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:N AUTO COMP ORD:N VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 31500 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 240
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2330517 INTUBATION BY PHYSICIAN .00 EA= .00 1 00000000 461.00
INTUBATION BY .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 31500 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1431500 INTUBATION ENDOTRACHEAL ER PROCEDURE .00 EA= .00 1 00000000 513.00
INTUBATION EN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 31500 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330493 IO PLACEMENT .00 EA= .00 1 00000000 417.00
IO PLACEMENT .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36680 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
90001598 IO PLACEMENT 00053 XX 305.00 EA=1EA .00 1 00000000 417.00
IO PLACEMENT 305.00 EA=1EA 1 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36680 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330504 IV HEPLOCK ONLY .00 EA= .00 1 00000000 57.00
IV HEPLOCK ON .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1423301 KENALOG INJECTION .00 EA= .00 1 00000000 6.00
KENALOG INJEC .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J3301 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1478708 KIDNEY IMAGING SINGLE STUDY WITH PHA .00 EA= .00 1 00000000 1064.00
KIDNEY IMAGIN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 78708 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 241
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1444970 LAPARASCOPIC APPENDECTOMY .00 EA= .00 1 00000000 2721.00
LAPARASCOPIC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44970 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499407 LAPAROSCOPY SURG WITH REMOVAL OF ADN .00 EA= .00 1 00000000 1612.00
LAPARO SURG W .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 58661 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444213 LAPAROSCOPY SURGICAL MOBILIZATION WI .00 EA= .00 1 00000000 696.00
LAPAROSCOPY S .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 44213 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1427614 LEVALBUTEROL INHAL SOL NONCOMPOUNDED .00 EA= .00 1 00000000 12.00
LEVALBUTEROL .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J7614 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113280 LIGATION AV FISTULA .00 EA= .00 1 00000000 2662.00
LIGATION AV F .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 37607 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1464445 LUMBAR INJECTION ANESTHETIC AGEN SCI .00 EA= .00 1 00000000 649.00
LUMBAR INJECT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 64445 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499411 LYSIS OF ADHESIONS SALPINGOLYSIS OVA .00 EA= .00 1 00000000 2181.00
LYSIS OF ADHE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 58740 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 242
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1419307 MASTECTOMY MODIFIED RADICAL .00 EA= .00 1 00000000 3620.00
MASTECTOMY MO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 19307 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1419301 MASTECTOMY PARTIAL LUMPECTOMY .00 EA= .00 1 00000000 1385.00
MASTECTOMY PA .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 19301 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113305 MECH REMOVAL OBS MAT .00 EA= .00 1 00000000 710.00
MECH REMOVAL .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36595 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1482043 MICROALBUMIN-QUANTITATIVE .00 EA= .00 1 00000000 64.00
MICROALBUMIN- .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 82043 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444139 MOBILIZATION OF SPLENIC FLEXURE .00 EA= .00 1 00000000 464.00
MOBILIZATION .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44139 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411730 NAIL AVULSION PARTIAL OR COMPLETE .00 EA= .00 1 00000000 332.00
NAIL AVULSION .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11730 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1497605 NEG PRESS WOUND THER <= 50 SQ CM .00 EA= .00 1 00000000 204.00
WND THER <=50 .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 97605 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 243
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1497606 NEG PRESS WOUND THER >50 SQ CM .00 EA= .00 1 00000000 220.00
WND THER >50 .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 97606 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499201 NEW PATIENT LEVEL 1 (10 MINS) .00 EA= .00 1 00000000 124.00
NEW PATIENT L .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99201 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499202 NEW PATIENT LEVEL 2 (20 MINS) .00 EA= .00 1 00000000 155.00
NEW PATIENT L .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99202 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499203 NEW PATIENT LEVEL 3 (30 MINS) .00 EA= .00 1 00000000 202.00
NEW PATIENT L .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99203 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499204 NEW PATIENT LEVEL 4 (45 MINS) .00 EA= .00 1 00000000 288.00
NEW PATIENT L .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99204 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499205 NEW PATIENT LEVEL 5 (60 MINS) .00 EA= .00 1 00000000 389.00
NEW PATIENT L .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99205 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499315 NURSING FACILITY DISCHARGE 30 MINS .00 EA= .00 1 00000000 225.00
NURSING FACIL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300020 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99315 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 244
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499318 NURSING FACILITY DISCHARGE 30 MINS .00 EA= .00 1 00000000 225.00
NURSING FACIL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99315SW FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499316 NURSING FACILITY DISCHARGE > 30 MINS .00 EA= .00 1 00000000 281.00
NURSING FACIL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300020 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99316 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499319 NURSING FACILITY DISCHARGE > 30 MINS .00 EA= .00 1 00000000 281.00
NURSING FACIL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99316SW FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2310007 OBSERVATION AUTO OBS .00 EA= .00 1 31110013 110.00
OBSERVATION R .00 .00 2 31220013 .00
.......... EJ(0762) INV.GL= EXP.GL= .00 .00 3 31300013 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99218 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499217 OBSERVATION CARE DISCHARGE .00 EA= .00 1 00000000 135.00
OBSERVATION C .00 .00 2 00000000 .00
.......... EJ(0762) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99217 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890010 OBSERVATION HOUR .00 EA= .00 1 31110013 36.00
OBSERVATION H .00 .00 2 31220013 .00
.......... EJ(0762) INV.GL= EXP.GL= .00 .00 3 31300013 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0378 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499235 OBSERVATION OR INPATIENT HOSPITAL CA .00 EA= .00 1 00000000 340.00
OBSERVATION O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99235 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 245
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499236 OBSERVATION OR INPATIENT HOSPITAL CA .00 EA= .00 1 00000000 438.00
OBSERVATION O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99236 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499234 OBSERVATION OR IP STAY INCLUDING ADM .00 EA= .00 1 00000000 241.00
OBSERVATION O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99234 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2310006 OBSERVATION ROOM RATE .00 EA= .00 1 00000000 36.00
OBSERVATION R .00 .00 2 00000000 .00
.......... EJ(0762) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99218 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499245 OFFICE CONSULT COMPREHENSIVE HIGH .00 EA= .00 1 00000000 485.00
OFFICE CONSUL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99245 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499244 OFFICE CONSULT COMPREHENSIVE-MODERAT .00 EA= .00 1 00000000 384.00
OFFICE CONSUL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99244 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499243 OFFICE CONSULT DETAILED .00 EA= .00 1 00000000 293.00
OFFICE CONSUL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99243 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499242 OFFICE CONSULT EXPANDED PROBLEM FOCU .00 EA= .00 1 00000000 230.00
OFFICE CONSUL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99242 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 246
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
9227005 OT APL LONG ARM SPLINT .00 EA= .00 1 31110092 176.00
OT APL LONG .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29105 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227016 OT APP FINGER SPLINT DY - 29131 .00 EA= 1.00 1 00000000 108.00
OT APP FINGER .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29131 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227006 OT APP FINGER SPLINT ST .00 EA= .00 1 31110092 84.00
OT APP FINGER .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29130 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227015 OT APP FINGER SPLINT ST - 29130 .00 EA= 1.00 1 00000000 84.00
OT APP FINGER .00 .00 2 00000000 .00
p......p.. 85(0420) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29130 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227021 OT APP LONG LEG SPLINT .00 EA= 1.00 1 00000000 155.00
OT APP LONG L .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29505 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227026 OT APP LONG LEG SPLINT .00 EA= .00 1 31110092 155.00
OT APP LONG L .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29505 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227003 OT APP SH ARM SPLINT DY .00 EA= .00 1 31110092 166.00
OT APP SH ARM .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29126 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 247
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
9227014 OT APP SH ARM SPLINT DY - 29126 .00 EA= 1.00 1 00000000 166.00
OT APP SH ARM .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29126 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227013 OT APP SH ARM SPLINT ST - 29125 .00 EA= 1.00 1 00000000 135.00
OT APP SH ARM .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29125 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227004 OT APP SH ARM ST .00 EA= .00 1 31110092 135.00
OT APP SH ARM .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29125 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227022 OT APP SHORT LEG SPLINT .00 EA= 1.00 1 00000000 136.00
OT APP SHORT .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 2
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29515 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227028 OT APP SHORT LEG SPLINT .00 EA= .00 1 31110092 135.00
OT AP SH LEG .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29515 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227012 OT APPL LONG ARM SPLINT .00 EA= 1.00 1 00000000 176.00
OT APPL LONG .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29105 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227011 OT STRAP HAND/FING .00 EA= .00 1 31110092 108.00
OT STRAP HAN .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29280 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 248
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
9227019 OT STRAPPING ELBO/WRIS .00 EA= 1.00 1 00000000 108.00
OT STRAPPING .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29260 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227010 OT STRAPPING ELBOW WRIST .00 EA= .00 1 31110092 108.00
OT STRAP ELB .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29260 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227020 OT STRAPPING HAND/FING .00 EA= 1.00 1 00000000 108.00
OT STRAPPING .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29280 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227023 OT STRAPPING HIP .00 EA= 1.00 1 00000000 128.00
OT STRAPPING .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 3
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29520 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227027 OT STRAPPING HIP .00 EA= .00 1 31110092 128.00
OT STRAP HIP .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29520 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227008 OT STRAPPING LOW BACK .00 EA= .00 1 31110092 116.00
OT STRAP LOW .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
9227017 OT STRAPPING LOW BACK .00 EA= 1.00 1 00000000 116.00
OT STRAPPING .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29799 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 249
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
9227001 OT STRAPPING OF ANKLE .00 EA= .00 1 31110092 89.00
OT STRAPPING .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29540 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227025 OT STRAPPING OF ANKLE .00 EA= 1.00 1 00000000 89.00
OT STRAPPING .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 5
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29540 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227002 OT STRAPPING OF KNEE .00 EA= .00 1 31110092 116.00
OT STRAPPING .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29530 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227024 OT STRAPPING OF KNEE .00 EA= 1.00 1 00000000 116.00
OT STRAPPING .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 4
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29530 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227009 OT STRAPPING SHOULDER .00 EA= .00 1 31110092 136.00
OT STRAPPING .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29240 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227018 OT STRAPPING SHOULDER .00 EA= 1.00 1 00000000 136.00
OT STRAPPING .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29240 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227041 OT STRAPPING THORAX .00 EA= 1.00 1 00000000 128.00
OT STRAPPING .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29200 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 250
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
9227007 OTAPP FINGER SPLINT DY .00 EA= .00 1 31110092 108.00
OT APP FINGER .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29131 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800016 OVARIAN CYSTECTOMY UNILATERAL OR BIL .00 EA= .00 1 00000000 1846.00
OVAR CYST UB .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 58925 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1400091 PAP SMEAR OBTAINING PREPARING AND CO .00 EA= .00 1 00000000 137.00
PAP SMEAR OBT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: Q0091 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1488150 PAP SMEAR-CYTOPATHOLOGY SLIDES CERVI .00 EA= .00 1 00000000 80.00
PAP SMEAR-CYT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 88150 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330519 PARACENTESIS .00 EA= .00 1 00000000 473.00
PARACENTESIS .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 49080 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411056 PARING/CUTTING B9 KERATOTIC LES 2-4 .00 EA= .00 1 00000000 126.00
PARING/CUTTIN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11056 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411055 PARING/CUTTING KERATOTIC LESION 1 .00 EA= .00 1 00000000 101.00
PARING/CUTTIN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11055 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 251
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1460220 PARTIAL REMOVAL OF THYROID .00 EA= .00 1 00000000 1741.00
PARTIAL REMOV .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 60220 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113277 PARTIAL REPLACE VAD .00 EA= .00 1 00000000 1331.00
PARTIAL REPLA .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36578 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499392 PERIODIC COMPREHENSIVE PHYSICAL EARL .00 EA= .00 1 00000000 148.00
PERIODIC COMP .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99392 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499391 PERIODIC COMPREHENSIVE PHYSICAL INFA .00 EA= .00 1 00000000 140.00
PERIODIC COMP .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99391 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499393 PERIODIC COMPREHENSIVE PHYSICAL-LATE .00 EA= .00 1 00000000 162.00
PERIODIC COMP .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99393 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410250 PHY REVIEW INTERPRET AND PT MGMT OF .00 EA= .00 1 00000000 55.00
PHY REVIEW IN .00 .00 2 00000000 .00
.......... CY(0000) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0250 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499374 PHYS SUPERVISION OF A PATIENT UNDER .00 EA= .00 1 00000000 164.00
PHYS SUPERVIS .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99374 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 252
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1410181 PHYSICIAN CERTIFICATION FOR MEDICARE .00 EA= .00 1 00000000 152.00
PHYSICIAN CER .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0180 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410179 PHYSICIAN RECERTIFICATION FOR MEDICA .00 EA= .00 1 00000000 115.00
PHYSICIAN REC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0179 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499378 PHYSICIAN SUPER HOSPICE PT 30 MIN OR .00 EA= .00 1 00000000 346.00
PHYSICIAN SUP .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99378 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499379 PHYSICIAN SUPER NURSING FACILITY PT .00 EA= .00 1 00000000 173.00
PHYSICIAN SUP .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99379 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499375 PHYSICIAN SUPER PT UNDER CARE OF HOM .00 EA= .00 1 00000000 303.00
PHYSICIAN SUP .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99375 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499380 PHYSICIAN SUPERVISION OF A NURSING F .00 EA= .00 1 00000000 272.00
PHYSICIAN SUP .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99380 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490732 PNEUMOCOCCAL VACCINE AGE 2YRS+ .00 EA= .00 1 00000000 72.00
PNEUMOCOCCAL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90732 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 253
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2330495 PORT-A-CATH BLOOD DRAW .00 EA= .00 1 00000000 51.00
PORT-A-CATH B .00 .00 2 00000000 .00
.......... 56(0301) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36591 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499024 POST OP .00 EA= .00 1 00000000 .00
POST OP .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99024 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499210 PREOP COLON OFFICE VISIT .00 EA= .00 1 00000000 .00
PREOP COLON O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99211N FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445300 PROCTOSIGMOIDOSCOPY FIGID DIAGNOSTIC .00 EA= .00 1 00000000 202.00
PROCTOSIGMOID .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45300 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1484153 PROSTATE SPECIFIC ANTIGEN-PSA TOTAL .00 EA= .00 1 00000000 107.00
PROSTATE SPEC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 84153 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445110 PROTECTOMY COMPLETE COMBINED ABDOMIN .00 EA= .00 1 00000000 6386.00
PROTECTOMY CO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45110 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1485610 PROTHROMBIN TIME (PT) .00 EA= .00 1 00000000 27.00
PROTHROMBIN T .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 85610 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 254
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
9127004 PT FUNCTIONAL EVALUATIO .00 EA= 1.00 1 00000000 86.00
PT FUNCTIONAL .00 .00 2 00000000 .00
p......p.. 85(0420) INV.GL= EXP.GL= .00 .00 3 31300091 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 4
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99203 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9121013 PT TENS INITIAL SET UP .00 EA= 1.00 1 00000000 108.00
PT TENS INITI .00 .00 2 00000000 .00
p......p.. 85(0420) INV.GL= EXP.GL= .00 .00 3 31300091 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 64550GP FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9127040 PT UNNA BOOT APPLICATIO .00 EA= 1.00 1 00000000 116.00
PT UNNA BOOT .00 .00 2 00000000 .00
p......p.. 85(0420) INV.GL= EXP.GL= .00 .00 3 31300091 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29580 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1494760 PULSE OX-NONINVASIVE EAR OR PULSE OX .00 EA= .00 1 00000000 41.00
PULSE OX-NONI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 94760 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410160 PUNCTURE ASPIRATION OF ABSCESS HEMAT .00 EA= .00 1 00000000 232.00
PUNCTURE ASPI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 10160 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1419000 PUNCTURE ASPIRATION OF CYST OF BREAS .00 EA= .00 1 00000000 226.00
PUNCTURE ASPI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 19000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499377 PYSICIAN SUPER OF A HOSPICE PT 15-29 .00 EA= .00 1 00000000 195.00
PYSICIAN SUPE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99377 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 255
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1487880 RAPID STREPT A .00 EA= .00 1 00000000 54.00
RAPID STREPT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 87880 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113322 REM TUNNELED CVAD W PORT/PUMP .00 EA= .00 1 00000000 3001.00
REM TUNN CVAD .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36590 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113290 REMOVAL FOREIGN BODY .00 EA= .00 1 00000000 355.00
REMOVAL FOREI .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20520 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1424200 REMOVAL FOREIGN BODY UPPER ARM .00 EA= .00 1 00000000 248.00
REMOVAL FOREI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 24200 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1465220 REMOVAL OF FOREIGN BODY EXTERNAL EYE .00 EA= .00 1 00000000 351.00
REMOVAL OF FO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 65220 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411200 REMOVAL OF SKIN TAGS UP TO 15 .00 EA= .00 1 00000000 161.00
REMOVAL OF SK .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11200 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113272 REMOVE VEN ACC DEVIC .00 EA= .00 1 00000000 1331.00
REMOVE VEN AC .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36589 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 256
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499418 REOPENING OF RECENT LAPAROTOMY .00 EA= .00 1 00000000 2567.00
REOPENING OF .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 49002 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113297 REP BLD VESS W/GRAFT .00 EA= .00 1 00000000 2129.00
REP BLD VESS .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 35266 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113296 REPAIR ANEURYSM .00 EA= .00 1 00000000 2662.00
REPAIR ANEURY .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 35011 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
280017 REPAIR INCARCERATED INGUINAL HERNIA .00 EA= .00 1 00000000 1424.00
REP INC ING 5 .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 49507 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499413 REPAIR INITAL INCISIONAL OR VENTRAL .00 EA= .00 1 00000000 2273.00
REPAIR INITAL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 49561 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1449560 REPAIR INITIAL INCISIONAL OF VENTRAL .00 EA= .00 1 00000000 2409.00
REPAIR INITIA .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 49560 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1449505 REPAIR INITIAL INGUINAL HERNIA AGE 5 .00 EA= .00 1 00000000 1817.00
REPAIR INITIA .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 49505 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 257
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1449565 REPAIR RECURRENT INCISIONAL OR VENTR .00 EA= .00 1 00000000 2629.00
REPAIR RECURR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 49565 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1449585 REPAIR UMBILICAL HERNIA AGE 5 YRS OR .00 EA= .00 1 00000000 1884.00
REPAIR UMBILI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 49585 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113298 REV ART BYPASS W/O .00 EA= .00 1 00000000 1775.00
REV ART BYPAS .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 35881 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113271 REVISE VEN ACC DEVIC .00 EA= .00 1 00000000 1331.00
REVISE VEN AC .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36581 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113288 REVISION AV FISTULA .00 EA= .00 1 00000000 1242.00
REVISION AV F .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36010 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420696 ROCEPHIN ANTIBIOTIC INJECTION PER 25 .00 EA= .00 1 00000000 4.00
ROCEPHIN ANTI .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J0696 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499410 SALPINGO-OOHORECTOMY COMPLETE OR PAR .00 EA= .00 1 00000000 1807.00
SALPINGO OOHO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 58720 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 258
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1410105 SCREENING COLONOSCOPY/HIGH RISK .00 EA= .00 1 00000000 1206.00
SCREENING COL .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0105 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410104 SCREENING FLEX SIGMOIDOSCOPY .00 EA= .00 1 00000000 380.00
SCREENING FLE .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0104 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
4560043 SENTINEL NODE INJECTION .00 EA= 2.00 1 00000000 200.00
SENT NODE INJ .00 .00 2 00000000 .00
n......n.P 42(0360) INV.GL= EXP.GL= .00 .00 3 31300045 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:N AUTO COMP ORD:N VIEW UNVER ORD:Y PRT ORD SLIP:B CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 38792 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411301 SHAVING OF DERMAL LESION SINGLE TRUN .00 EA= .00 1 00000000 192.00
SHAVING OF DE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11301 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411300 SHAVING OF EPIDERMAL /DERMAL LESION .00 EA= .00 1 00000000 156.00
SHAVING OF EP .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11300 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113285 SHUNT ARTERY TO VEIN .00 EA= .00 1 00000000 3549.00
SHUNT ARTERY .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36145 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445338 SIGMOIDOSCOPY FLEX DX W/REMOVALTUMOR .00 EA= .00 1 00000000 1040.00
SIGMOIDOSCOPY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45338 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 259
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1445531 SIGMOIDOSCOPY FLEX W/ BIOPSY SINGLE .00 EA= .00 1 00000000 480.00
SIGMOIDOSCOPY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45531 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445330 SIGMOIDOSCOPY FLEXIBLE DIAGNOSTIC .00 EA= .00 1 00000000 392.00
SIGMOIDOSCOPY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45330 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1412002 SIMPLE REPAIR OF SUPERFICIAL WOUND 7 .00 EA= .00 1 00000000 544.00
SIMPLE REPAIR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 12002 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1412001 SIMPLE REPAIR SUPERFICIAL WOUND .00 EA= .00 1 00000000 450.00
SIMPLE REPAIR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 12001 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1486580 SKN TEST-PPD .00 EA= .00 1 00000000 33.00
SKN TEST-PPD .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 86580 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499406 SMOKING AND TOBACCO CESSATION .00 EA= .00 1 00000000 44.00
SMOKING AND T .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99406 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410436 SMOKING AND TOBACCO CESSATON .00 EA= .00 1 00000000 44.00
SMOKING AND T .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0436 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 260
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499080 SPECIAL REPORTS MEDICAL RECORDS INSU .00 EA= .00 1 00000000 .00
SPECIAL REPOR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99080 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330520 SPINAL TAP .00 EA= .00 1 00000000 525.00
SPINAL TAP .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 62272 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890020 SPINAL/LUMBAR PUNCTU .00 EA= .00 1 00000000 525.00
SPINAL/LUMBAR .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 62270 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1494010 SPIROMETRY PLAIN .00 EA= .00 1 00000000 140.00
SPIROMETRY PL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 94010 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1438100 SPLENECTOMY TOTAL .00 EA= .00 1 00000000 6702.00
SPLENECTOMY T .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 38100 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499401 SPORTS PHYSICAL .00 EA= .00 1 00000000 25.00
SPORTS PHYSIC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99401F FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1487430 STREP GROUP A .00 EA= .00 1 00000000 41.00
STREP GROUP A .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 87430 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 261
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499231 SUBSEQUENT HOSPITAL CARE 15 MINS .00 EA= .00 1 00000000 102.00
SUBSEQUENT HO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99231 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499232 SUBSEQUENT HOSPITAL CARE PER DAY 25 .00 EA= .00 1 00000000 139.00
SUBSEQUENT HO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300020 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99232 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499233 SUBSEQUENT HOSPITAL VISIT .00 EA= .00 1 00000000 259.00
SUBSEQUENT HO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99233 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499308 SUBSEQUENT NURSING CARE 15 MINS .00 EA= .00 1 00000000 164.00
SUBSEQUENT NU .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99308 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499314 SUBSEQUENT NURSING CARE 15 MINS .00 EA= .00 1 00000000 164.00
SUBSEQUENT NU .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99308SW FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499309 SUBSEQUENT NURSING CARE 25 MINUTES .00 EA= .00 1 00000000 238.00
SUBSEQUENT NU .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300020 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99309 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499317 SUBSEQUENT NURSING CARE 25 MINUTES .00 EA= .00 1 00000000 238.00
SUBSEQUENT NU .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99309SW FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 262
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499310 SUBSEQUENT NURSING FACILITY CARE 35 .00 EA= .00 1 00000000 324.00
SUBSEQUENT NU .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300020 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99310 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499307 SUBSEQUENT NURSING HOME CARE .00 EA= .00 1 00000000 121.00
SUBSEQUENT NU .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99307 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499313 SUBSEQUENT NURSING HOME CARE .00 EA= .00 1 00000000 121.00
SUBSEQUENT NU .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99307SW FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499224 SUBSEQUENT OBSERVATION CARE 15 MINS .00 EA= .00 1 00000000 66.00
SUBSEQUENT OB .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99224 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499225 SUBSEQUENT OBSERVATION CARE 25 MINS .00 EA= .00 1 00000000 132.00
SUBSEQUENT OB .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99225 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499226 SUBSEQUENT OBSERVATION CARE 35 MINS .00 EA= .00 1 00000000 184.00
SUBSEQUENT OB .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99226 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1731068 SUCTION .00 EA= 1.00 1 31110017 79.00
SUCTION .00 .00 2 31220017 .00
.......z.. 84(0410) INV.GL= EXP.GL= .00 .00 3 31300017 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:N AUTO COMP ORD:N VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 31720 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 263
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1446270 SURGICAL TREATMENT OF ANAL FISTULA .00 EA= .00 1 00000000 1502.00
SURGICAL TREA .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 46270 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420670 SUTURE REMOVAL .00 EA= .00 1 00000000 1031.00
SUTURE REMOVA .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20670 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113287 SVC OR IVC PLACEMENT .00 EA= .00 1 00000000 1775.00
SVC OR IVC PL .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36010 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490715 TDAP > 7YRS IM .00 EA= .00 1 00000000 36.00
TDAP > 7YRS I .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90715 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
8041843 TEMPERAL ARTERY BIOPSY .00 EA= .00 1 00000000 512.00
TEMPERAL ARTE .00 .00 2 00000000 .00
.......... 65(0370) INV.GL= EXP.GL= .00 .00 3 31300080 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 37609 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1421080 TESTOSTERONE INJECTION .00 EA= .00 1 00000000 18.00
TESTOSTERONE .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J1080 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490703 TETANUS SHOT .00 EA= .00 1 00000000 48.00
TETANUS SHOT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90703 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 264
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1490718 TETANUS/DIPHTHERIA TOXOIDS (TD) ADM .00 EA= .00 1 00000000 44.00
TETANUS/DIPHT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90718 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1496372 THERAPEUTIC PROPHYLACTIC INJECTION .00 EA= .00 1 00031110 50.00
THERAPEUTIC P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96372 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330521 THORACENTESIS FOR ASPIRATION .00 EA= .00 1 00000000 499.00
THORACENTESIS .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 32421 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330522 THORACENTESIS W/WATER SEAL .00 EA= .00 1 00000000 525.00
THORACENTESIS .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 32422 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113269 THROMBECT AV FISTULA .00 EA= .00 1 00000000 3549.00
THROMBECT AV .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36870 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113314 THROMBECTOMY .00 EA= .00 1 00000000 24126.00
THROMBECTOMY .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36904 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113315 THROMBECTOMY W/ BALLOON .00 EA= .00 1 00000000 48762.00
THROMB W/ BAL .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36905 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 265
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2113316 THROMBECTOMY W/ STENT .00 EA= .00 1 00000000 73910.00
THROMB W/ STN .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36906 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1484443 THYROID STIMULATING HORMONE .00 EA= .00 1 00000000 97.00
THYROID STIMU .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 84443 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499408 THYROIDECTOMY, REMOVAL OF ALL REMAIN .00 EA= .00 1 00000000 2696.00
THROIDECTOMY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 60260 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1484436 THYROXINE TOTAL .00 EA= .00 1 00000000 39.00
THYROXINE TOT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 84436 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1421885 TORADOL KETOROLAC PER 15 MG .00 EA= .00 1 00000000 6.00
TORADOL KETOR .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J1885 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1731081 TRACH CARE .00 EA= 1.00 1 31110017 113.00
TRACH CARE .00 .00 2 31220017 .00
.......z.. 84(0410) INV.GL= EXP.GL= .00 .00 3 31300017 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:N AUTO COMP ORD:N VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 31720 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1431600 TRACHEOSTOMY PLANNED .00 EA= .00 1 00000000 1554.00
TRACHEOSTOMY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 31600 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 266
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2113274 TRANSCATH PLACE STEN .00 EA= .00 1 00000000 3549.00
TRANSCATH PLA .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 37205 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113293 TRANSCATH RETR FB .00 EA= .00 1 00000000 1730.00
TRANSCATH RET .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 37203 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113318 TRANSCATH STENT PLACEMENT .00 EA= .00 1 00000000 4336.00
TRANSCTH STNT .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36908 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1484460 TRANSFERASE ALANINE AMINO (ALT)(SGPT .00 EA= .00 1 00000000 27.00
TRANSFERASE A .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 84460 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890021 TRIGGER POINT INJECT .00 EA= .00 1 00000000 296.00
TRIGGER POINT .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20552 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420552 TRIGGER PT INJECTION .00 EA= .00 1 00000000 169.00
TRIGGER PT IN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20552 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1432551 TUBE THORACOSTOMY INCLUDES WATER SEA .00 EA= .00 1 00000000 661.00
TUBE THORACOS .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 32551 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 267
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
4560041 ULTRASOUND GUIDANCE NEEDLE WIRE IN B .00 EA= .00 1 00000000 559.00
US GUID NEED .00 .00 2 00000000 .00
u......u.P 42(0360) INV.GL= EXP.GL= .00 .00 3 31300045 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:N AUTO COMP ORD:N VIEW UNVER ORD:Y PRT ORD SLIP:B CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 19290 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1429580 UNNA BOOT .00 EA= .00 1 00000000 116.00
UNNA BOOT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29580 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443248 UP GI ENDO W/ INSERT GUIDE WIRE THEN .00 EA= .00 1 00000000 901.00
UP GI ENDO W/ .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43248 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443245 UP GI ENDO W/DILAT GASTRIC OUT OBSTR .00 EA= .00 1 00000000 928.00
UP GI ENDO W/ .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43245 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443251 UP GI ENDOSCOPY WITH REMOVAL OF TUMO .00 EA= .00 1 00000000 1122.00
UP GI ENDOSCO .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43251 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443247 UPPER GASTROINTESTINAL ENDOSCOPY WIT .00 EA= .00 1 00000000 928.00
UPPER GASTROI .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43247 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443249 UPPER GI ENDOSCOPY WITH BALLOON DILA .00 EA= .00 1 00000000 986.00
UPPER GI ENDO .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43249 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 268
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1481002 URINALYIS BY DIPSTICK OR TABLE NON-A .00 EA= .00 1 00000000 24.00
URINALYIS BY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 81002 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1481001 URINALYSIS BY DIPSTICK OR TABLET REA .00 EA= .00 1 00000000 31.00
URINALYSIS BY .00 .00 2 00000000 .00
.......... 58(0307) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 81001 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1481003 URINALYSIS DIP STICK/TABLET RGNT/AUT .00 EA= .00 1 00000000 25.00
URINALYSIS DI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 81003 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490472 VACCINE ADMINISTRATION EACH ADDITION .00 EA= .00 1 00000000 26.00
VACCINE ADMIN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90472 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490471 VACCINE ADMINISTRATION FIRST SHOT .00 EA= .00 1 00000000 49.00
VACCINE ADMIN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90471 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113319 VEIN EMBOLIZATION .00 EA= .00 1 00000000 4336.00
VEIN EMBOLIZA .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36909 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
4111020 VENI PUNCTURE .00 EA= .00 1 00000000 28.00
VENI PUNCTURE .00 .00 2 00000000 .00
.......... 55(0300) INV.GL= EXP.GL= .00 .00 3 31300041 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36415 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 269
TIME: 08:24 ITEM MASTER LIST DEPT# 004 O/P CLINIC PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1436415 VENIPUNCTURE .00 EA= .00 1 00000000 21.00
VENIPUNCTURE .00 .00 2 00000000 .00
.......... 55(0300) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36415 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113320 VENOGRAPHY .00 EA= .00 1 00000000 3420.00
VENOGRAPHY .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 75827 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113295 VESSEL MAPPING DIALY .00 EA= .00 1 00000000 887.00
VESSEL MAPPIN .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0365 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499172 VISUAL FUNCTION SCREENING .00 EA= .00 1 00000000 62.00
VISUAL FUNCTI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99172 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411765 WEDGE EXCOF SKIN NAIL FOLD (INGROWN .00 EA= .00 1 00000000 409.00
WEDGE EXCOF S .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11765 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1487210 WET PREP-SMR PRIM SRC WET MOUNT NFCT .00 EA= .00 1 00000000 27.00
WET PREP-SMR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 87210 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490736 ZOSTER SHINGLES VACCINE LIVE SUBCUTA .00 EA= .00 1 00000000 356.00
ZOSTER SHINGL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90736 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 270
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2113291 A/V ANASTOMOSIS OPEN .00 EA= .00 1 00000000 1775.00
A/V ANASTOMOS .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36818 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890000 ABSCESS I&D .00 EA= .00 1 00000000 337.00
ABSCESS I&D .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 10061 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113302 ACCESS AV DIAL GRAFT .00 EA= .00 1 00000000 4336.00
ACCESS AV DIA .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36147 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113311 ACCESS AV FISTULOGRAM .00 EA= .00 1 00000000 4336.00
AV FISTULOGRA .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36901 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113275 ADDTL STENT PLACEMEN .00 EA= .00 1 00000000 3106.00
ADDTL STENT P .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 37206 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800006 ADJACENT TISSUE TRANSFER OR REARRANG .00 EA= .00 1 00000000 1467.00
ADJACENT TISS .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 14000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800011 ADJACENT TISSUE TRANSFER OR REARRANG .00 EA= .00 1 00000000 1211.00
ADJACENT TISS .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 14000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 271
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1410009 ADMIN PNEUMOCOCCAL VACCINE (MEDICARE .00 EA= .00 1 00000000 25.00
ADMIN PNEUMOC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0009 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1415734 ADVANCEMENT FLAPS TRUNK .00 EA= .00 1 00000000 6260.00
ADVANCEMENT F .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 15734 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1427613 ALBUTEROL INHALATION SOLUTION .00 EA= .00 1 00000000 12.00
ALBUTEROL INH .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J7613 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1495117 ALLERGY MULTIPLE- PROF SVS ALLERGY I .00 EA= .00 1 00000000 42.00
ALLERGY MULTI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 95117 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1495115 ALLERGY SINGLE- PROFESSIONAL SERVICE .00 EA= .00 1 00000000 28.00
ALLERGY SINGL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 95115 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
8040009 ANESTHESIA SERVICES .00 EA= .00 1 00000000 18.00
ANESTHESIA SE .00 .00 2 00000000 .00
.......... 65(0370) INV.GL= EXP.GL= .00 .00 3 31300080 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45384 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
8040010 ANESTHESIA UNITS .00 EA= .00 1 00000000 18.00
ANESTHESIA UN .00 .00 2 00000000 .00
.......... 65(0370) INV.GL= EXP.GL= .00 .00 3 31300080 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45384 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 272
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2113267 ANGIOPLASTY ART BLKG .00 EA= .00 1 00000000 2662.00
ANGIOPLASTY A .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 35475 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113299 ANGIOPLASTY FEM-POP .00 EA= .00 1 00000000 2574.00
ANGIOPLASTY F .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 35474 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113312 ANGIOPLASTY NO STENT .00 EA= .00 1 00000000 20385.50
ANGIOPLAS W/O .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36902 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113313 ANGIOPLASTY W/ STENT .00 EA= .00 1 00000000 41202.05
ANGIOPLASTY W .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36903 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410438 ANNUAL WELLNESS VISIT INITIAL VISIT .00 EA= .00 1 00000000 468.00
ANNUAL WELLNE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0438 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446600 ANOSCOPY DX W OR W/OUT SPECIMEN COLL .00 EA= .00 1 00000000 204.00
ANOSCOPY DX W .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 46600 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444950 APPENDECTOMY .00 EA= .00 1 00000000 2221.00
APPENDECTOMY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44950 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 273
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1444960 APPENDECTOMY RUPTURED OPEN .00 EA= .00 1 00000000 2776.00
APPENDECTOMY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44960 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1429130 APPLICATION OF FINGER SPLINT STATIC .00 EA= .00 1 00000000 120.00
APPLICATION O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29130 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1429125 APPLICATION OF SHORT ARM SPLINT (FOR .00 EA= .00 1 00000000 180.00
APPLICATION O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29125 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113286 ART EXT-ARM .00 EA= .00 1 00000000 1775.00
ART EXT-ARM .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36120 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420600 ARTHROCENTESIS ASPIRATION AND/OR INJ .00 EA= .00 1 00000000 168.00
ARTHROCENTESI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20600 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420605 ARTHROCENTESIS ASPIRATION AND/OR INJ .00 EA= .00 1 00000000 174.00
ARTHROCENTESI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20605 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420610 ARTHROCENTESIS ASPIRATION OR INJECTI .00 EA= .00 1 00000000 206.00
ARTHROCENTESI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20610 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 274
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1427644 ATROVENT NONCOMPOUNDED UNIT DOSE FOR .00 EA= .00 1 00000000 12.00
ATROVENT NONC .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J7644 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113303 AV GRAFT DIAL PROC .00 EA= .00 1 00000000 2129.00
AV GRAFT DIAL .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36148 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1423420 B-12 INJECTION UP TO 1000 MCG .00 EA= .00 1 00000000 7.50
B-12 INJECTIO .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J3420 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113317 BALLOON ANGIOPLASTY .00 EA= .00 1 00000000 4336.00
BALLOON ANGIO .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36907 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
4111334 BB TRANSFUSE BLOOD PRODUCT .00 EA= 1.00 1 00000000 1063.00
TRANSFUSE BLD .00 .00 2 00000000 .00
....P..... 6B(0391) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36430 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411101 BIOPSY OF SKIN SUBQ (INCLUDING SIMPL .00 EA= .00 1 00000000 87.00
BIOPSY OF SKI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11101 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411100 BIOPSY OF SKIN SUBQ TISSUE (INCLUDIN .00 EA= .00 1 00000000 174.00
BIOPSY OF SKI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11100 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 275
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2800015 BIOPSY OR EXCISION OF LYMPH NODE OPE .00 EA= .00 1 00000000 617.00
BIO EXC LYMPH .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 38500 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499415 BIOPSY SOFT TISSUE OF NECK OR THORAX .00 EA= .00 1 00000000 382.00
BIOPSY SOFT T .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 21550 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800012 BIOPSY SOFT TISSUE OF THIGH OR KNEE .00 EA= .00 1 00000000 430.00
BIOPSY SOFT O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 27323 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1482272 BLOOD OCCULT PERFORMED FOR OTHER THA .00 EA= .00 1 00000000 23.00
BLOOD OCCULT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 82272 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1494664 BREATHING TREATMENT-DEMONSTRATION AN .00 EA= .00 1 00000000 69.00
BREATHING TRE .00 .00 2 00000000 .00
.......... 7D(0460) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 94664 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890001 BRIEF OUTPATIENT VIS .00 EA= .00 1 00000000 148.00
BRIEF OUTPATI .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99211 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330496 BURN DRESSING WITH SILVADENE .00 EA= .00 1 00000000 102.00
BURN DRESSING .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 16000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 276
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2113282 CANNULATION OF GRAFT .00 EA= .00 1 00000000 3194.00
CANNULATION O .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36800 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113294 CATH ART PLACEMENT .00 EA= .00 1 00000000 1775.00
CATH ART PLAC .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36246 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1485025 CBC .00 EA= .00 1 00000000 39.00
CBC .00 .00 2 00000000 .00
.......... 55(0300) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 85025 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1436556 CENTRAL LINE > 5 YRS .00 EA= .00 1 00031110 659.00
CENTRAL LINE .00 .00 2 00031220 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 36556 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890004 CENTRAL LINE FLUSH .00 EA= .00 1 00000000 222.00
CENTRAL LINE .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99211 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330500 CENTRAL LINE INSERTION .00 EA= .00 1 00000000 985.00
CENTRAL LINE .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36556 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890005 CENTRAL LINE REMOVAL .00 EA= .00 1 00000000 81.00
CENTRAL LINE .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36589 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 277
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1410101 CERVICAL OR VAGINAL CANCER SCRENING .00 EA= .00 1 00000000 119.00
CERVICAL OR V .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0101 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443760 CHANGE OF GASTOSTOMY TUBE PERCUTANIO .00 EA= .00 1 00000000 392.00
CHANGE OF GAS .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43760 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1417250 CHEMICAL CAUTERIZATION OF GRANULATIO .00 EA= .00 1 00000000 132.00
CHEMICAL CAUT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 17250 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1447562 CHOLECYSTECTOMY LAPARASCOPIC .00 EA= .00 1 00000000 3123.00
CHOLECYSTECTO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 47562 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1447600 CHOLECYSTECTOMY OPEN .00 EA= .00 1 00000000 3123.00
CHOLECYSTECTO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 47600 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1447563 CHOLECYSTECTOMY W/ CHOLANGIOGRAM .00 EA= .00 1 00000000 3331.00
CHOLECYSTECTO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 47563 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1447605 CHOLECYSTECTOMY W/ CHOLANGIOGRAPHY .00 EA= .00 1 00000000 3331.00
CHOLECYSTECTO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 47605 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 278
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1444626 CLOSURE OF ENTEROSTOMY W/ RESECTION .00 EA= .00 1 00000000 3715.00
CLOSURE OF EN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 44626 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444140 COLECTOMY PARTIAL .00 EA= .00 1 00000000 4413.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44140 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444204 COLECTOMY PARTIAL W/ ANASTOMOSIS .00 EA= .00 1 00000000 4877.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44204 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444207 COLECTOMY PARTIAL W/ ANASTOMOSIS W/ .00 EA= .00 1 00000000 6037.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44207 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444208 COLECTOMY PARTIAL W/ ANASTOMOSIS W/ .00 EA= .00 1 00000000 6271.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44208 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444146 COLECTOMY PARTIAL W/ COLOPROCTOSTOMY .00 EA= .00 1 00000000 6921.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44146 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444143 COLECTOMY PARTIAL W/ END COLOSTOMY A .00 EA= .00 1 00000000 4503.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44143 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 279
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1444160 COLECTOMY PARTIAL W/ REMOVAL OF TERM .00 EA= .00 1 00000000 4181.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44160 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444205 COLECTOMY PARTIAL W/REMOVAL TERMINAL .00 EA= .00 1 00000000 4645.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44205 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444211 COLECTOMY TOTAL ABDOMINAL W/ PROCTEC .00 EA= .00 1 00000000 8129.00
COLECTOMY TOT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44211 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445378 COLONOSCOPY .00 EA= .00 1 00000000 1049.00
COLONOSCOPY .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
------------------------------------------------------------------------------------------------------------------------------------
1445383 COLONOSCOPY FLEXIBLE TO SPLENIC FLEX .00 EA= .00 1 00000000 1424.00
COLONOSCOPY F .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 45383 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445382 COLONOSCOPY FLEXIBLE W/ CONTROL OF B .00 EA= .00 1 00000000 1340.00
COLONOSCOPY F .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 45382 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444394 COLONOSCOPY THROUGH STOMA W/ REMOVAL .00 EA= .00 1 00000000 1693.00
COLONOSCOPY T .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 44394 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 280
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1413132 COLONOSCOPY W/ BIOPSY .00 EA= .00 1 00000000 1591.00
COLONOSCOPY W .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 13132 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445380 COLONOSCOPY W/ BIOPSY .00 EA= .00 1 00000000 1154.00
COLONOSCOPY W .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 45380 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445386 COLONOSCOPY W/ DILATION BY BALLOON 1 .00 EA= .00 1 00000000 1165.00
COLONOSCOPY W .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 45386 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445381 COLONOSCOPY W/ DIRECTED SUBMUCOSAL I .00 EA= .00 1 00000000 1300.00
COLONOSCOPY W .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 45381 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445384 COLONOSCOPY W/BIOPSY BY HOT BIOSPY F .00 EA= .00 1 00000000 1486.00
COLONOSCOPY W .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 45384 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445385 COLONOSCOPY W/BIOPSY SNARE .00 EA= .00 1 00000000 1486.00
COLONOSCOPY W .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 45385 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410122 COLORECTAL CANCER SCREENING COLONOSC .00 EA= .00 1 00000000 1105.00
COLORECTAL CA .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0121 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 281
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1410328 COLORECTAL SCREENING WELCOME TO MEDI .00 EA= .00 1 00000000 80.00
COLORECTAL SC .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0328 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1480053 COMPREHENSIVE METABOLIC PANEL .00 EA= .00 1 00000000 61.00
COMPREHENSIVE .00 .00 2 00000000 .00
.......... 56(0301) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 80053 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499394 COMPREHENSIVE PHYSICAL 12-17 .00 EA= .00 1 00000000 175.00
COMPREHENSIVE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99394 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499395 COMPREHENSIVE PHYSICAL 18-39 .00 EA= .00 1 00000000 236.00
COMPREHENSIVE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99395 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499396 COMPREHENSIVE PHYSICAL 40-64 YRS .00 EA= .00 1 00000000 258.00
COMPREHENSIVE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99396 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499397 COMPREHENSIVE PHYSICAL >65 .00 EA= .00 1 00000000 292.00
COMPREHENSIVE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99397 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330502 CONSCIOUS SEDATION .00 EA= .00 1 00000000 525.00
CONSCIOUS SED .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99144 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 282
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
890006 CONSTIPATION REMOVAL .00 EA= .00 1 00000000 212.00
CONSTIPATION .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2113304 CONTRAST INJ VEN DEV .00 EA= .00 1 00000000 89.00
CONTRAST INJ .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36598 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1482570 CREATININE OTHER SOURCE .00 EA= .00 1 00000000 33.00
CREATININE OT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 82570 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330514 CRITICAL CARE 30-74 MIN .00 EA= .00 1 00000000 1969.00
CRITICAL CARE .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 9929125 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330515 CRITICAL CARE EACH ADDTL 30 MIN .00 EA= .00 1 00000000 525.00
CRITICAL CARE .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 9929225 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499292 CRITICAL CARE EVAL/MGT EA ADDITIONAL .00 EA= .00 1 00031110 302.00
CRITICAL CARE .00 .00 2 00031220 .00
SERVICE .......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99292 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499291 CRITICAL CARE EVAL/MGT FIRST 30-74 M .00 EA= .00 1 00031110 604.00
CRITICAL CARE .00 .00 2 00031220 .00
SERVICE .......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99291 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 283
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1417340 CRYO SURGERY-ACNE .00 EA= .00 1 00000000 104.00
CRYO SURGERY- .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 17340 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1487070 CULTURE BACTERIAL ANY OTHER SOURCE E .00 EA= .00 1 00000000 40.00
CULTURE BACTE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 87070 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890007 CYST DRAINAGE SIMPLE .00 EA= .00 1 00000000 231.00
CYST DRAINAGE .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 10080 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890008 CYST REMOVAL SIMPLE .00 EA= .00 1 00000000 263.00
CYST REMOVAL .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 10040 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411044 DEBRIDEMENT BONE FIRS 20 SQ CM OR LE .00 EA= .00 1 00000000 828.00
DEBRIDEMENT B .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 11044 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411043 DEBRIDEMENT MUSCLE AND/OR FASCIA FIR .00 EA= .00 1 00000000 497.00
DEBRIDEMENT M .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 11043 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411000 DEBRIDEMENT OF EXTENSIVE EZCEMATOUS .00 EA= .00 1 00000000 200.00
DEBRIDEMENT O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 11000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 284
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1411720 DEBRIDEMENT OF NAIL 1 TO 5 .00 EA= .00 1 00000000 92.00
DEBRIDEMENT O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11720 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411721 DEBRIDEMENT OF NAILS BY ANY METHOD 6 .00 EA= .00 1 00000000 125.00
DEBRIDEMENT O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11721 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411040 DEBRIDEMENT SKIN-PARTIAL THICKNESS .00 EA= .00 1 00000000 150.00
DEBRIDEMENT S .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 11040 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411042 DEBRIDEMENT SUBCUTANEOUS TISSUE FIRS .00 EA= .00 1 00000000 232.00
DEBRIDEMENT S .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 11042 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113273 DECLOT VAS ACC DEVIC .00 EA= .00 1 00000000 710.00
DECLOT VAS AC .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36593 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1429590 DENIS-BROWNE SPLNT-LEG SPLINT .00 EA= .00 1 00000000 145.00
DENIS-BROWNE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29590 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446924 DESTR OF LES ANUS EXTENSIVE (EX LASE .00 EA= .00 1 00000000 2013.00
DESTR OF LES .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 46924 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 285
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1417280 DESTRUCTION MALIGNANT LESION .00 EA= .00 1 00000000 287.00
DESTRUCTION M .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 17280 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1417260 DESTRUCTION MALIGNANT LESION < .5 CM .00 EA= .00 1 00000000 211.00
DESTRUCTION M .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 17260 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1417263 DESTRUCTION MALIGNANT LESION TRUNK/A .00 EA= .00 1 00000000 313.00
DESTRUCTION M .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 17263 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446900 DESTRUCTION OF LESION ANUS SIMPLE CH .00 EA= .00 1 00000000 607.00
DESTRUCTION O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 46900 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446922 DESTRUCTION OF LESION ANUS SIMPLE SU .00 EA= .00 1 00000000 1087.00
DESTRUCTION O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 46922 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1417000 DESTRUCTION PRMLGNT LESION (ACTINIC .00 EA= .00 1 00000000 183.00
DESTRUCTION P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 17000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1417003 DESTRUCTION PRMLGNT LESION 2-14 EACH .00 EA= .00 1 00000000 41.00
DESTRUCTION P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 17003 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 286
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1443450 DILATION OF ESOPHAGUS BY UNGUIDED SO .00 EA= .00 1 00000000 284.00
DILATION OF E .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43450 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490702 DIPHTERIA TETANUS TOXOIDS (DT) ADM T .00 EA= .00 1 00000000 45.00
DIPHTERIA TET .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90702 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490700 DIPHTHERIA TETANUS TOXOIDS/PERTUSSIS .00 EA= .00 1 00000000 56.00
DIPHTHERIA TE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90700 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890009 DIRECT ADMIT OBSERVA .00 EA= .00 1 00000000 162.00
DIRECT ADMIT .00 .00 2 00000000 .00
.......... EJ(0762) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0379 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499419 DRAINAGE OF PERITIONEAL ABSCESS OR L .00 EA= .00 1 00000000 3897.00
DRAINAGE OF P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 49020 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800008 DRESSINGS AND OR DEBRIEDEMENT OR PAR .00 EA= .00 1 00000000 192.00
DRESSINGS AND .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 16020 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1480100 DRUG SCREEN QUALITATIVE .00 EA= .00 1 00000000 135.00
DRUG SCREEN Q .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 80100 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 287
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1469210 EAR IRRIGATION (RMVL IMPACTED WAX) .00 EA= .00 1 00000000 127.00
EAR IRRIGATIO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 69210 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1493010 ECG ROUTINE INTERPRETATION AND REPOR .00 EA= .00 1 00000000 48.00
ECG ROUTINE I .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 93010 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499071 EDUCATIONAL SUPPLIES AND HANDOUTS .00 EA= .00 1 00000000 .00
EDUCATIONAL S .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99071 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443235 EGD UPPER GASTROINESTINAL EDOSCOPY D .00 EA= .00 1 00000000 779.00
EGD UPPER GAS .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43235 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443244 EGD WITH BAND LIGATION OF ESOPHAGEAL .00 EA= .00 1 00000000 1156.00
EGD WITH BAND .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43244 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443239 EGD WITH BIOPSY UPPER GASTROINTESTIN .00 EA= .00 1 00000000 903.00
EGD WITH BIOP .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43239 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443255 EGD WITH CONTROL OF BLEEDING ANY MET .00 EA= .00 1 00000000 1190.00
EGD WITH CONT .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43255 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 288
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1443246 EGD WITH PEG TUBE PLACEMENT .00 EA= .00 1 00000000 1558.00
EGD WITH PEG .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43246 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410405 EKG ROUNTINE INTERPRET/REPORT SCREEN .00 EA= .00 1 00000000 57.00
EKG ROUNTINE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0405 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410403 EKG WELCOME TO MEDICARE PHYSICAL .00 EA= .00 1 00000000 57.00
EKG WELCOME T .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0403 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1493000 EKG-ECG ROUTINE ECG W/AT LEAST 12 LD .00 EA= .00 1 00000000 101.00
EKG-ECG ROUTI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 93000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2310024 EMERGENCY ROOM LEVEL I .00 EA= .00 1 00000000 390.00
ER LEVEL I .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 9928125 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2310025 EMERGENCY ROOM LEVEL II .00 EA= .00 1 00000000 500.00
ER LEVEL II .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 9928225 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2310026 EMERGENCY ROOM LEVEL III .00 EA= .00 1 00000000 680.00
ER LEVEL III .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 9928325 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 289
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2310027 EMERGENCY ROOM LEVEL IV .00 EA= .00 1 00000000 925.00
ER LEVEL IV .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 9928425 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2310028 EMERGENCY ROOM LEVEL V .00 EA= .00 1 00000000 1250.00
ER LEVEL V .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 9928525 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499285 EMERGENCY ROOM VISIT HIGH COMPLEXITY .00 EA= .00 1 00000000 702.00
EMERGENCY ROO .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99285 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499284 EMERGENCY ROOM VISIT MEDIUM COMPLEXI .00 EA= .00 1 00000000 470.00
EMERGENCY ROO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99284 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499283 EMERGENCY ROOM VISIT MINIMUM COMPLEX .00 EA= .00 1 00000000 315.00
EMERGENCY ROO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99283 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113300 ENDOVENOUS ABLATION .00 EA= .00 1 00000000 710.00
ENDOVENOUS AB .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36478 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800003 ENTERECTOMY, RESECTION OR SMALL INTE .00 EA= .00 1 00000000 4204.00
ENTERECTOMY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 44120 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 290
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499409 ENTEROLYSIS FREEING OF INTESTINAL AD .00 EA= .00 1 00000000 2681.00
ENTEROLYSIS .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44005 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2310005 ER SCREENING FEE .00 EA= .00 1 00000000 54.00
ER SCREENING .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99281 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800007 ESCHAROTOMY INITAL INCISION .00 EA= .00 1 00000000 494.00
ESCHOROTOMY I .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 16035 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499211 ESTABLISHED PT LEVEL 1 (5 MINS-NURSE .00 EA= .00 1 00000000 61.00
ESTABLISHED P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99211 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499212 ESTABLISHED PT LEVEL 2 (10 MINS) .00 EA= .00 1 00000000 86.00
ESTABLISHED P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99212 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499213 ESTABLISHED PT LEVEL 3 (15 MINS) .00 EA= .00 1 00031110 110.00
ESTABLISHED P .00 .00 2 00031220 .00
SERVICE .......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99213 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499214 ESTABLISHED PT LEVEL 4 (25 MINS) .00 EA= .00 1 00000000 160.00
ESTABLISHED P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99214 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 291
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499215 ESTABLISHED PT LEVEL 5 (40 MINS) .00 EA= .00 1 00000000 256.00
ESTABLISHED P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99215 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411740 EVACUATION OF SUBUNGUAL HEMATOMA .00 EA= .00 1 00000000 153.00
EVACUATION OF .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11740 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411402 EXC B9 LES MRGN XCP SKT 1.1-2.0CM .00 EA= .00 1 00000000 364.00
EXC B9 LES MR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11402 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411403 EXC B9 LESIO MRGN 2.1-3.0 CM .00 EA= .00 1 00000000 467.00
EXC B9 LESIO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11403 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411400 EXC B9 LESION SCP SK TGS .5 CM< .00 EA= .00 1 00000000 239.00
EXC B9 LESION .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11400 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411422 EXC BENIGN LESION SCALP/NECK/HANDS/F .00 EA= .00 1 00000000 387.00
EXC BENIGN LE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11422 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411401 EXC BENIGN LESION TRUNK/ARMS/LESGS 0 .00 EA= .00 1 00000000 285.00
EXC BENIGN LE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11401 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 292
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1411606 EXC MAL LES W/MRGN T/A/L > 4.0 CM .00 EA= .00 1 00000000 852.00
EXC MAL LES W .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11606 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411621 EXC MALIGNANT LESION .5/CM .00 EA= .00 1 00000000 426.00
EXC MALIGNANT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11621 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411623 EXC MALIGNANT LESION 2.1 TO 3.0 CM S .00 EA= .00 1 00000000 639.00
EXC MALIGNANT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11623 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411600 EXC MALIGNANT LESION TRUNK/ARMS/LEGS .00 EA= .00 1 00000000 391.00
EXC MALIGNANT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11600 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411440 EXC OTHER BENIGN LESION INCL MARGINS .00 EA= .00 1 00000000 285.00
EXC OTHER BEN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11440 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113276 EXCH ART CATH .00 EA= .00 1 00000000 1242.00
EXCH ART CATH .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 37209 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499416 EXCISION BENIGN LESION INCLUDING MAR .00 EA= .00 1 00000000 266.00
EXCISION BENI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 11421 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 293
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2800005 EXCISION MALIGNANT LESION INCLUDING .00 EA= .00 1 00000000 423.00
EXCISION MALI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11640 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1419125 EXCISION OF BREAST LESION .00 EA= .00 1 00000000 1550.00
EXCISION OF B .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 19125 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1419120 EXCISION OF CYST OF BREAST .00 EA= .00 1 00000000 1292.00
EXCISION OF C .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 19120 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1425111 EXCISION OF GANGLION CYST WRIST .00 EA= .00 1 00000000 1427.00
EXCISION OF G .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 25111 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499412 EXCISION OF LESION OF TENDON SHEATH .00 EA= .00 1 00000000 892.00
EXCISION OF L .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 27630 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411750 EXCISION OF NAIL AND NAIL MATRIX PAR .00 EA= .00 1 00000000 690.00
EXCISION OF N .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11750 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411772 EXCISION OF PILONIDAL CYST COMPLICAT .00 EA= .00 1 00000000 2023.00
EXCISION OF P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11772 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 294
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1445171 EXCISION OF RECTAL TUMOR TRANSANAL A .00 EA= .00 1 00000000 2418.00
EXCISION OF R .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45171 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800010 EXCISION OF SKIN AND SUBCUTANEOUS TI .00 EA= .00 1 00000000 679.00
EXCISION OF S .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11470 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446320 EXCISION OF THROMBOSED HEMORRHOID EX .00 EA= .00 1 00000000 455.00
EXCISION OF T .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 46320 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499417 EXCISION OR DESTRUCTION OPEN INTRA A .00 EA= .00 1 00000000 2936.00
EXCISION OR D .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 49203 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1421930 EXCISION TUMOR SOFT TISSU OF BACK .00 EA= .00 1 00000000 1595.00
EXC TUM BACK .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 21930 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800014 EXCISION TUMOR SOFT TISSUE OF FACE S .00 EA= .00 1 00000000 1268.00
EXC TUM 2MM .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 21014 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499414 EXCISION TUMOR SOFT TISSUE OF PELVIS .00 EA= .00 1 00000000 1480.00
EXCISION TUMO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 27048 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 295
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2800009 EXCISION TUMOR SOFT TISSUE OF SHOULD .00 EA= .00 1 00000000 1013.00
EXCISION TUMO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 23071 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1424075 EXCISION TUMOR SOFT TISSUE OF UPPER .00 EA= .00 1 00000000 1759.00
EXC TUM UP AR .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 24075 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800004 EXPLORATORY LAPAROTOMY EXPLORATORY C .00 EA= .00 1 00000000 2640.00
EXPLORATORY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 49000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330518 EXTERNAL PACEMAKER .00 EA= .00 1 00000000 525.00
EXTERNAL PACE .00 .00 2 00000000 .00
.......... 7L(0482) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 92953 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
920027 FACILITY FEE MD .00 EA= .00 1 00000000 300.00
FAC FEE MD .00 .00 2 00000000 .00
.......... PQ(0914) INV.GL= EXP.GL= .00 .00 3 31300009 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0463 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446200 FISSURECTOMY INCLUDING SPHINCTEROTOM .00 EA= .00 1 00000000 1275.00
FISSURECTOMY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 46200 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445331 FLEX SIGMOID WITH BIOPSY SINGLE OR M .00 EA= .00 1 00000000 480.00
FLEX SIGMOID .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45331 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 296
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
4420130 FLUORO GUIDE FOR ASPIRATION OF S .00 EA= .00 1 00000000 340.00
FLUOROSCOPY G .00 .00 2 00000000 .00
.......... 77(0320) INV.GL= EXP.GL= .00 .00 3 31300044 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:N CHG @ ORD ENTRY:N AUTO COMP ORD:N VIEW UNVER ORD:Y PRT ORD SLIP:B CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 62270 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113321 FLUOROGUIDE FOR VEIN DEVICE .00 EA= .00 1 00000000 642.00
FLUOROGUIDE .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 77001 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330516 FOLEY CATH INSERTION .00 EA= .00 1 00000000 185.00
FOLEY CATH IN .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 51702 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
920030 FOLLOW UP 5 MINUTES .00 EA= .00 1 00000000 150.00
FOLLOW UP 5 M .00 .00 2 00000000 .00
.......... PQ(0914) INV.GL= EXP.GL= .00 .00 3 31300009 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99211 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890018 G TUBE INSERTION .00 EA= .00 1 00000000 160.00
G TUBE INSERT .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 43760 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490649 GARDASIL HPV VACCINE .00 EA= .00 1 00000000 282.00
GARDASIL HPV .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90649 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330505 GASTRIC INTUBATION LAVAGE .00 EA= .00 1 00000000 335.00
GASTRIC INTUB .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 43753 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 297
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1491110 GI TRACT IMAGING INTRALUMAL ESOPH TH .00 EA= .00 1 00000000 2107.00
GI TRACT IMAG .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 91110 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490470 H1N1 VACCINATION .00 EA= .00 1 00000000 49.00
H1N1 VACCINAT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90470 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1419141 H1N1 VACCINATION ADMINISTRATION .00 EA= .00 1 00000000 25.00
H1N1 VACCINAT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G9141 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1484703 HCG QUALITATIVE .00 EA= .00 1 00000000 71.00
HCG QUALITATI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 84703 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1492552 HEARING TEST-PURE TONE ADIOMETRY AIR .00 EA= .00 1 00000000 49.00
HEARING TEST- .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 92552 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1485018 HEMOGLOBIN (HGB) .00 EA= .00 1 00000000 19.00
HEMOGLOBIN (H .00 .00 2 00000000 .00
.......... 55(0300) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 85018 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1483036 HEMOGLOBIN A1C .00 EA= .00 1 00000000 68.00
HEMOGLOBIN A1 .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 83036 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 298
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1446221 HEMORRHOIDECTOMY INTERNAL BY RUBBER .00 EA= .00 1 00000000 546.00
HEMORRHOIDECT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 46221 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446947 HEMORRHOIDOPEXY BY STAPLING .00 EA= .00 1 00000000 1214.00
HEMORRHOIDOPE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 46947 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446260 HEMORROIDECTOMY COMPLEX .00 EA= .00 1 00000000 2276.00
HEMORROIDECTO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 46260 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1493233 HOLTER MONITOR .00 EA= .00 1 00000000 172.00
HOLTER MONITO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 93233 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499341 HOME VISIT INITIAL VISIT .00 EA= .00 1 00000000 197.00
HOME VISIT IN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99341 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499239 HOSPITAL DISCHARGE > 30 MINS .00 EA= .00 1 00000000 180.00
HOSPITAL DISC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300020 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99239 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499238 HOSPITAL DISCHARGE DAY MNGMT <30 MIN .00 EA= .00 1 00000000 144.00
HOSPITAL DISC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300020 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99238 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 299
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1410180 I & D COMPLEX POST OP WOUND INFECTIO .00 EA= .00 1 00000000 592.00
I & D COMPLEX .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10180 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410140 I & D OF HEMATOMA SEROMA OR FLUID CO .00 EA= .00 1 00000000 335.00
I & D OF HEMA .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10140 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410081 I & D OF PILONIDAL CYST COMPLICATED .00 EA= .00 1 00000000 619.00
I & D OF PILO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10081 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410080 I & D OF PILONIDAL CYST SIMPLE .00 EA= .00 1 00000000 347.00
I & D OF PILO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10080 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1456405 I & D OF VULVA AND PERINEAL ABSCESS .00 EA= .00 1 00000000 424.00
I & D OF VULV .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 56405 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410061 I&D COMPLICATED OR MULTIPLE .00 EA= .00 1 00000000 523.00
I&D COMPLICAT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10061 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890016 I&D HEMATOMA .00 EA= .00 1 00000000 213.00
I&D HEMATOMA .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 10140 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 300
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2113283 I&D HEMATOMA PERIGRA .00 EA= .00 1 00000000 89.00
I&D HEMATOMA .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 37799 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113281 I&D PERIGRAFT SEROMA .00 EA= .00 1 00000000 89.00
I&D PERIGRAFT .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 37799 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410060 I&D SIMPLE OR SINGLE .00 EA= .00 1 00000000 261.00
I&D SIMPLE OR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10060 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490460 IMMUNIZATION ADMINISTRATION THROUGH .00 EA= .00 1 00000000 49.00
IMMUNIZATION .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90460 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1449568 IMPLANTATION OF MESH/W INCISIONAL HE .00 EA= .00 1 00000000 876.00
IMPLANTATION .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 49568 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1449587 INCARCERATED UMBILICAL HERNIA .00 EA= .00 1 00000000 2103.00
INCARCERATED .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 49587 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800013 INCESION AND DRAINAGE SHOULDER AREA .00 EA= .00 1 00000000 865.00
INCESION AND .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 23030 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 301
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1446040 INCISION AND DRAINAGE OF ISCHIORECTA .00 EA= .00 1 00000000 2015.00
INCISION AND .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 46040 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800001 INCISION AND DRAINAGE OF SUBMUCOSAL .00 EA= .00 1 00000000 531.00
INC AND DRAIN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45005 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800002 INCISION AND DRAINAGE SHOULDER AREA .00 EA= .00 1 00000000 865.00
INC AND DRAIN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 10121 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410121 INCISION AND REMOVAL OF FOREIGN BODY .00 EA= .00 1 00000000 712.00
INCISION AND .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10121 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410120 INCISION AND REMOVAL OF FOREIGN BODY .00 EA= .00 1 00000000 311.00
INCISION AND .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10120 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446083 INCISION OF THROMBOSED HEMORRHOID EX .00 EA= .00 1 00000000 351.00
INCISION OF T .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 46083 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410008 INFLUENZA ADMINISTRATION (MEDICARE O .00 EA= .00 1 00000000 25.00
INFLUENZA ADM .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0008 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 302
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1402038 INFLUENZA VACCINE 3 YEARS AND OLDER .00 EA= .00 1 00000000 34.00
INFLUENZA VAC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: Q2038 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490658 INFLUENZA VACCINE AGE 3 YRS + .00 EA= .00 1 00000000 34.00
INFLUENZA VAC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90658 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490656 INFLUENZA VACCINE PRESERVATIVE FREE .00 EA= .00 1 00000000 33.00
INFLUENZA VAC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90656 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490662 INFLUENZA VIRUS VACCINE SPLIT VIRUS .00 EA= .00 1 00000000 80.00
INFLUENZA VIR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90662 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499382 INITIAL COMPREH PHYSICAL AGE 1 TO 4 .00 EA= .00 1 00000000 183.00
INITIAL COMPR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99382 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499384 INITIAL COMPREHENSIVE PHYSICAL 12-17 .00 EA= .00 1 00000000 210.00
INITIAL COMPR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99384 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499386 INITIAL COMPREHENSIVE PHYSICAL 40-64 .00 EA= .00 1 00000000 310.00
INITIAL COMPR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99386 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 303
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499387 INITIAL COMPREHENSIVE PHYSICAL > 65 .00 EA= .00 1 00000000 349.00
INITIAL COMPR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99387 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499383 INITIAL COMPREHENSIVE PHYSICAL AGE 5 .00 EA= .00 1 00000000 196.00
INITIAL COMPR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99383 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499381 INITIAL COMPREHENSIVE PHYSICAL- UNDE .00 EA= .00 1 00000000 170.00
INITIAL COMPR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99381 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499385 INITIAL COMPREHENSIVE PREVENTIVE PHY .00 EA= .00 1 00000000 284.00
INITIAL COMPR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99385 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499222 INITIAL HOSPITAL CARE 50 MINS .00 EA= .00 1 00000000 252.00
INITIAL HOSPI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99222 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499223 INITIAL HOSPITAL CARE HIGH COMPLEXIT .00 EA= .00 1 00000000 380.00
INITIAL HOSPI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99223 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499221 INITIAL HOSPITAL CARE PER DAY 30 MIN .00 EA= .00 1 00000000 187.00
INITIAL HOSPI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99221 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 304
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499303 INITIAL NURSING FACILITY CARE 25 MIN .00 EA= .00 1 00000000 216.00
INITIAL NURSI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99304SW FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499304 INITIAL NURSING FACILITY CARE 25 MIN .00 EA= .00 1 00000000 216.00
INITIAL NURSI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99304 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499305 INITIAL NURSING FACILITY PER DAY 35 .00 EA= .00 1 00000000 303.00
INITIAL NURSI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99305 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499311 INITIAL NURSING FACILITY PER DAY 35 .00 EA= .00 1 00000000 303.00
INITIAL NURSI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99305SW FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499306 INITIAL NURSING FACILITY PER DAY 45 .00 EA= .00 1 00000000 368.00
INITIAL NURSI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300020 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99306 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499312 INITIAL NURSING FACILITY PER DAY 45 .00 EA= .00 1 00000000 368.00
INITIAL NURSI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99306SW FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499218 INITIAL OBSERVATION CARE LOW SEVERIT .00 EA= .00 1 00000000 168.00
INITIAL OBSER .00 .00 2 00000000 .00
.......... EJ(0762) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99218 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 305
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499219 INITIAL OBSERVATION CARE MODERATE SE .00 EA= .00 1 00000000 229.00
INITIAL OBSER .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99219 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499220 INITIAL OBSERVATION CARE PER DAY .00 EA= .00 1 00000000 287.00
INITIAL OBSER .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99220 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410402 INITIAL PREVENTATIVE PHYSICAL WELCOM .00 EA= .00 1 00000000 399.00
INITIAL PREVE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0402 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113278 INJ EXT VENOGRAPHY .00 EA= .00 1 00000000 532.00
INJ EXT VENOG .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36005 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113306 INJ LUMBAR OR SACRAL .00 EA= .00 1 00000000 887.00
INJ LUMBAR OR .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36595 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420550 INJ SINGLE TENDON SHEATH OR LIGAMENT .00 EA= .00 1 00000000 163.00
INJ SINGLE TE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20550 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113279 INJECT ANTIOBOTIC IM .00 EA= .00 1 00000000 89.00
INJECT ANTIOB .00 .00 2 00000000 .00
.......... 3I(0260) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 306
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1420553 INJECT SINGLE/MULTIPLE TRIGGER POINT .00 EA= .00 1 00000000 198.00
INJECT SINGLE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20553 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420170 INJECTION ADRENALINE UP TO 1 ML AMPU .00 EA= .00 1 00000000 3.00
INJECTION ADR .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J0170 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1464413 INJECTION ANESTHETIC AGENT CERVICAL .00 EA= .00 1 00000000 649.00
INJECTION ANE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 64413 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1464412 INJECTION ANESTHETIC AGENT SPINAL AC .00 EA= .00 1 00000000 731.00
INJECTION ANE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 64412 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420702 INJECTION BETAMETHASONE SODIUM PHOSP .00 EA= .00 1 00000000 4.00
INJECTION BET .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J0702 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420704 INJECTION BETAMETHASONE SODIUM PHOSP .00 EA= .00 1 00000000 4.00
INJECTION BET .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J0704 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1421100 INJECTION DECADRON 1 MG .00 EA= .00 1 00000000 30.00
INJECTION DEC .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J1100 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 307
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1421000 INJECTION DEPO-ESTRADIOL UP TO 5MG .00 EA= .00 1 00000000 24.00
INJECTION DEP .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J1000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1421200 INJECTION DIPHENHYDRAMINE HCI UP TO .00 EA= .00 1 00000000 3.00
INJECTION DIP .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J1200 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1423410 INJECTION HYDROXYZINE HCL VISTARIL U .00 EA= .00 1 00000000 4.00
INJECTION HYD .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J3410 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1422001 INJECTION LIDOCAINE FOR INTRAVENOUS .00 EA= .00 1 00000000 50.00
INJECTION LID .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J2001 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1421055 INJECTION MEDROXYPROGESTERONE ACETAT .00 EA= .00 1 00000000 88.00
INJECTION MED .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J1055 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1422175 INJECTION MEPERIDINE PER 100 MG .00 EA= .00 1 00000000 7.00
INJECTION MEP .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J2175 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1421030 INJECTION METHYLPREDISOLONE ACETATE .00 EA= .00 1 00000000 12.00
INJECTION MET .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J1030 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 308
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1422300 INJECTION NALBUPHINE PER 10 MG .00 EA= .00 1 00000000 4.00
INJECTION NAL .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J2300 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1422550 INJECTION PHENERGEN PER 50 MG .00 EA= .00 1 00000000 6.00
INJECTION PHE .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J2550 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1421070 INJECTION TESTOSERONE CYPIONATE UP T .00 EA= .00 1 00000000 13.00
INJECTION TES .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J1070 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1421060 INJECTION TESTOSTERONE CYPIONATE AND .00 EA= .00 1 00000000 25.00
INJECTION TES .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J1060 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420526 INJECTION THERAPEUTIC CARPAL TUNNEL .00 EA= .00 1 00000000 219.00
INJECTION THE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20526 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420551 INJECTION(S) SINGLE TENDON ORIGIN/IN .00 EA= .00 1 00000000 168.00
INJECTION(S) .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20551 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499254 INPATIENT CONSULT COMPREHENSIVE .00 EA= .00 1 00000000 358.00
INPATIENT CON .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99254 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 309
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499253 INPATIENT CONSULT DETAILED .00 EA= .00 1 00000000 286.00
INPATIENT CON .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99253 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499252 INPATIENT CONSULT EXPANDED PROBLEM .00 EA= .00 1 00000000 232.00
INPATIENT CON .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99252 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499255 INPATIENT CONSULT HIGH COMPLEXITY .00 EA= .00 1 00000000 450.00
INPATIENT CON .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99255 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499251 INPATIENT CONSULT PROBLEM FOCUSED .00 EA= .00 1 00000000 153.00
INPATIENT CON .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99251 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113289 INSERT TUNNELED CVA .00 EA= .00 1 00000000 1775.00
INSERT TUNNEL .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36565 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113270 INSERT VEN ACC DEVIC .00 EA= .00 1 00000000 2662.00
INSERT VEN AC .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36558 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1493503 INSERTION AND PLACEMENT OF FLOW DIRE .00 EA= .00 1 00000000 707.00
INSERTION AND .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 93503 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 310
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1436558 INSERTION GROSHON/HICKMAN CENTRAL LI .00 EA= .00 1 00000000 2268.00
INSERTION GRO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36558 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113284 INSERTION PICC LINE .00 EA= .00 1 00000000 1331.00
INSERTION PIC .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36569 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1436561 INSERTION TUNNELED CENTRAL LINE/PORT .00 EA= .00 1 00000000 2062.00
INSERTION TUN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36561 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113292 INTER INF VENA CAVA .00 EA= .00 1 00000000 2662.00
INTER INF VEN .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 37620 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1474360 INTRALUM DILAT STRICTURES AND/OR OBS .00 EA= .00 1 00000000 203.00
INTRALUM DILA .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 74360 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113301 INTRO CATH AORTA .00 EA= .00 1 00000000 1730.00
INTRO CATH AO .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36200 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1731084 INTUBATION .00 EA= 1.00 1 31110017 750.00
INTUBATION .00 .00 2 31220017 .00
SERVICE .......z.. 84(0410) INV.GL= EXP.GL= .00 .00 3 31300017 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:N AUTO COMP ORD:N VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 31500 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 311
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2330517 INTUBATION BY PHYSICIAN .00 EA= .00 1 00000000 461.00
INTUBATION BY .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 31500 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1431500 INTUBATION ENDOTRACHEAL ER PROCEDURE .00 EA= .00 1 00000000 513.00
INTUBATION EN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 31500 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330493 IO PLACEMENT .00 EA= .00 1 00000000 417.00
IO PLACEMENT .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36680 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
90001598 IO PLACEMENT 00053 XX 305.00 EA=1EA .00 1 00000000 417.00
IO PLACEMENT 305.00 EA=1EA 1 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36680 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330504 IV HEPLOCK ONLY .00 EA= .00 1 00000000 57.00
IV HEPLOCK ON .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1423301 KENALOG INJECTION .00 EA= .00 1 00000000 6.00
KENALOG INJEC .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J3301 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1478708 KIDNEY IMAGING SINGLE STUDY WITH PHA .00 EA= .00 1 00000000 1064.00
KIDNEY IMAGIN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 78708 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 312
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001711 LAB LABEL SMALL 8604 00107 8604 44.00 RL=1ROL .00 1 00000000 .00
LAB LABEL SMA 44.00 RL=1RL 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 44.00 1 .00 3 00000000 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1444970 LAPARASCOPIC APPENDECTOMY .00 EA= .00 1 00000000 2721.00
LAPARASCOPIC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44970 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499407 LAPAROSCOPY SURG WITH REMOVAL OF ADN .00 EA= .00 1 00000000 1612.00
LAPARO SURG W .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 58661 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444213 LAPAROSCOPY SURGICAL MOBILIZATION WI .00 EA= .00 1 00000000 696.00
LAPAROSCOPY S .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 44213 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1427614 LEVALBUTEROL INHAL SOL NONCOMPOUNDED .00 EA= .00 1 00000000 12.00
LEVALBUTEROL .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J7614 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113280 LIGATION AV FISTULA .00 EA= .00 1 00000000 2662.00
LIGATION AV F .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 37607 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1464445 LUMBAR INJECTION ANESTHETIC AGEN SCI .00 EA= .00 1 00000000 649.00
LUMBAR INJECT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 64445 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 313
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499411 LYSIS OF ADHESIONS SALPINGOLYSIS OVA .00 EA= .00 1 00000000 2181.00
LYSIS OF ADHE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 58740 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1419307 MASTECTOMY MODIFIED RADICAL .00 EA= .00 1 00000000 3620.00
MASTECTOMY MO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 19307 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1419301 MASTECTOMY PARTIAL LUMPECTOMY .00 EA= .00 1 00000000 1385.00
MASTECTOMY PA .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 19301 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113305 MECH REMOVAL OBS MAT .00 EA= .00 1 00000000 710.00
MECH REMOVAL .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36595 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1482043 MICROALBUMIN-QUANTITATIVE .00 EA= .00 1 00000000 64.00
MICROALBUMIN- .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 82043 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444139 MOBILIZATION OF SPLENIC FLEXURE .00 EA= .00 1 00000000 464.00
MOBILIZATION .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44139 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411730 NAIL AVULSION PARTIAL OR COMPLETE .00 EA= .00 1 00000000 332.00
NAIL AVULSION .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11730 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 314
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1497605 NEG PRESS WOUND THER <= 50 SQ CM .00 EA= .00 1 00000000 204.00
WND THER <=50 .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 97605 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1497606 NEG PRESS WOUND THER >50 SQ CM .00 EA= .00 1 00000000 220.00
WND THER >50 .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 97606 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499201 NEW PATIENT LEVEL 1 (10 MINS) .00 EA= .00 1 00000000 124.00
NEW PATIENT L .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99201 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499202 NEW PATIENT LEVEL 2 (20 MINS) .00 EA= .00 1 00000000 155.00
NEW PATIENT L .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99202 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499203 NEW PATIENT LEVEL 3 (30 MINS) .00 EA= .00 1 00000000 202.00
NEW PATIENT L .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99203 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499204 NEW PATIENT LEVEL 4 (45 MINS) .00 EA= .00 1 00000000 288.00
NEW PATIENT L .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99204 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499205 NEW PATIENT LEVEL 5 (60 MINS) .00 EA= .00 1 00000000 389.00
NEW PATIENT L .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99205 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 315
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499315 NURSING FACILITY DISCHARGE 30 MINS .00 EA= .00 1 00000000 225.00
NURSING FACIL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300020 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99315 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499318 NURSING FACILITY DISCHARGE 30 MINS .00 EA= .00 1 00000000 225.00
NURSING FACIL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99315SW FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499316 NURSING FACILITY DISCHARGE > 30 MINS .00 EA= .00 1 00000000 281.00
NURSING FACIL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300020 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99316 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499319 NURSING FACILITY DISCHARGE > 30 MINS .00 EA= .00 1 00000000 281.00
NURSING FACIL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99316SW FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2310007 OBSERVATION AUTO OBS .00 EA= .00 1 31110013 110.00
OBSERVATION R .00 .00 2 31220013 .00
.......... EJ(0762) INV.GL= EXP.GL= .00 .00 3 31300013 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99218 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499217 OBSERVATION CARE DISCHARGE .00 EA= .00 1 00000000 135.00
OBSERVATION C .00 .00 2 00000000 .00
.......... EJ(0762) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99217 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890010 OBSERVATION HOUR .00 EA= .00 1 31110013 36.00
OBSERVATION H .00 .00 2 31220013 .00
.......... EJ(0762) INV.GL= EXP.GL= .00 .00 3 31300013 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0378 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 316
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499235 OBSERVATION OR INPATIENT HOSPITAL CA .00 EA= .00 1 00000000 340.00
OBSERVATION O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99235 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499236 OBSERVATION OR INPATIENT HOSPITAL CA .00 EA= .00 1 00000000 438.00
OBSERVATION O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99236 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499234 OBSERVATION OR IP STAY INCLUDING ADM .00 EA= .00 1 00000000 241.00
OBSERVATION O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99234 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2310006 OBSERVATION ROOM RATE .00 EA= .00 1 00000000 36.00
OBSERVATION R .00 .00 2 00000000 .00
.......... EJ(0762) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99218 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499245 OFFICE CONSULT COMPREHENSIVE HIGH .00 EA= .00 1 00000000 485.00
OFFICE CONSUL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99245 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499244 OFFICE CONSULT COMPREHENSIVE-MODERAT .00 EA= .00 1 00000000 384.00
OFFICE CONSUL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99244 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499243 OFFICE CONSULT DETAILED .00 EA= .00 1 00000000 293.00
OFFICE CONSUL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99243 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 317
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499242 OFFICE CONSULT EXPANDED PROBLEM FOCU .00 EA= .00 1 00000000 230.00
OFFICE CONSUL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99242 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227005 OT APL LONG ARM SPLINT .00 EA= .00 1 31110092 176.00
OT APL LONG .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29105 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227016 OT APP FINGER SPLINT DY - 29131 .00 EA= 1.00 1 00000000 108.00
OT APP FINGER .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29131 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227006 OT APP FINGER SPLINT ST .00 EA= .00 1 31110092 84.00
OT APP FINGER .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29130 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227015 OT APP FINGER SPLINT ST - 29130 .00 EA= 1.00 1 00000000 84.00
OT APP FINGER .00 .00 2 00000000 .00
p......p.. 85(0420) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29130 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227021 OT APP LONG LEG SPLINT .00 EA= 1.00 1 00000000 155.00
OT APP LONG L .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29505 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227026 OT APP LONG LEG SPLINT .00 EA= .00 1 31110092 155.00
OT APP LONG L .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29505 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 318
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
9227003 OT APP SH ARM SPLINT DY .00 EA= .00 1 31110092 166.00
OT APP SH ARM .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29126 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227014 OT APP SH ARM SPLINT DY - 29126 .00 EA= 1.00 1 00000000 166.00
OT APP SH ARM .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29126 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227013 OT APP SH ARM SPLINT ST - 29125 .00 EA= 1.00 1 00000000 135.00
OT APP SH ARM .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29125 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227004 OT APP SH ARM ST .00 EA= .00 1 31110092 135.00
OT APP SH ARM .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29125 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227022 OT APP SHORT LEG SPLINT .00 EA= 1.00 1 00000000 136.00
OT APP SHORT .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 2
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29515 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227028 OT APP SHORT LEG SPLINT .00 EA= .00 1 31110092 135.00
OT AP SH LEG .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29515 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227012 OT APPL LONG ARM SPLINT .00 EA= 1.00 1 00000000 176.00
OT APPL LONG .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29105 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 319
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
9227011 OT STRAP HAND/FING .00 EA= .00 1 31110092 108.00
OT STRAP HAN .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29280 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227019 OT STRAPPING ELBO/WRIS .00 EA= 1.00 1 00000000 108.00
OT STRAPPING .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29260 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227010 OT STRAPPING ELBOW WRIST .00 EA= .00 1 31110092 108.00
OT STRAP ELB .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29260 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227020 OT STRAPPING HAND/FING .00 EA= 1.00 1 00000000 108.00
OT STRAPPING .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29280 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227023 OT STRAPPING HIP .00 EA= 1.00 1 00000000 128.00
OT STRAPPING .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 3
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29520 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227027 OT STRAPPING HIP .00 EA= .00 1 31110092 128.00
OT STRAP HIP .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29520 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227008 OT STRAPPING LOW BACK .00 EA= .00 1 31110092 116.00
OT STRAP LOW .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 320
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
9227017 OT STRAPPING LOW BACK .00 EA= 1.00 1 00000000 116.00
OT STRAPPING .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29799 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227001 OT STRAPPING OF ANKLE .00 EA= .00 1 31110092 89.00
OT STRAPPING .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29540 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227025 OT STRAPPING OF ANKLE .00 EA= 1.00 1 00000000 89.00
OT STRAPPING .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 5
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29540 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227002 OT STRAPPING OF KNEE .00 EA= .00 1 31110092 116.00
OT STRAPPING .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29530 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227024 OT STRAPPING OF KNEE .00 EA= 1.00 1 00000000 116.00
OT STRAPPING .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 4
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29530 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227009 OT STRAPPING SHOULDER .00 EA= .00 1 31110092 136.00
OT STRAPPING .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29240 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227018 OT STRAPPING SHOULDER .00 EA= 1.00 1 00000000 136.00
OT STRAPPING .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29240 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 321
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
9227041 OT STRAPPING THORAX .00 EA= 1.00 1 00000000 128.00
OT STRAPPING .00 .00 2 00000000 .00
p......p.. 6P(0430) INV.GL= EXP.GL= .00 .00 3 31300092 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29200 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9227007 OTAPP FINGER SPLINT DY .00 EA= .00 1 31110092 108.00
OT APP FINGER .00 1 .00 2 31220092 .00
.......... 6P(0430) INV.GL= EXP.GL= .00 1 .00 3 31300092 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29131 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800016 OVARIAN CYSTECTOMY UNILATERAL OR BIL .00 EA= .00 1 00000000 1846.00
OVAR CYST UB .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 58925 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1400091 PAP SMEAR OBTAINING PREPARING AND CO .00 EA= .00 1 00000000 137.00
PAP SMEAR OBT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: Q0091 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1488150 PAP SMEAR-CYTOPATHOLOGY SLIDES CERVI .00 EA= .00 1 00000000 80.00
PAP SMEAR-CYT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 88150 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330519 PARACENTESIS .00 EA= .00 1 00000000 473.00
PARACENTESIS .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 49080 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411056 PARING/CUTTING B9 KERATOTIC LES 2-4 .00 EA= .00 1 00000000 126.00
PARING/CUTTIN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11056 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 322
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1411055 PARING/CUTTING KERATOTIC LESION 1 .00 EA= .00 1 00000000 101.00
PARING/CUTTIN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11055 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1460220 PARTIAL REMOVAL OF THYROID .00 EA= .00 1 00000000 1741.00
PARTIAL REMOV .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 60220 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113277 PARTIAL REPLACE VAD .00 EA= .00 1 00000000 1331.00
PARTIAL REPLA .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36578 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499392 PERIODIC COMPREHENSIVE PHYSICAL EARL .00 EA= .00 1 00000000 148.00
PERIODIC COMP .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99392 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499391 PERIODIC COMPREHENSIVE PHYSICAL INFA .00 EA= .00 1 00000000 140.00
PERIODIC COMP .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99391 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499393 PERIODIC COMPREHENSIVE PHYSICAL-LATE .00 EA= .00 1 00000000 162.00
PERIODIC COMP .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99393 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410250 PHY REVIEW INTERPRET AND PT MGMT OF .00 EA= .00 1 00000000 55.00
PHY REVIEW IN .00 .00 2 00000000 .00
.......... CY(0000) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0250 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 323
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499374 PHYS SUPERVISION OF A PATIENT UNDER .00 EA= .00 1 00000000 164.00
PHYS SUPERVIS .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99374 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410181 PHYSICIAN CERTIFICATION FOR MEDICARE .00 EA= .00 1 00000000 152.00
PHYSICIAN CER .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0180 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410179 PHYSICIAN RECERTIFICATION FOR MEDICA .00 EA= .00 1 00000000 115.00
PHYSICIAN REC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0179 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499378 PHYSICIAN SUPER HOSPICE PT 30 MIN OR .00 EA= .00 1 00000000 346.00
PHYSICIAN SUP .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99378 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499379 PHYSICIAN SUPER NURSING FACILITY PT .00 EA= .00 1 00000000 173.00
PHYSICIAN SUP .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99379 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499375 PHYSICIAN SUPER PT UNDER CARE OF HOM .00 EA= .00 1 00000000 303.00
PHYSICIAN SUP .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99375 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499380 PHYSICIAN SUPERVISION OF A NURSING F .00 EA= .00 1 00000000 272.00
PHYSICIAN SUP .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99380 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 324
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1490732 PNEUMOCOCCAL VACCINE AGE 2YRS+ .00 EA= .00 1 00000000 72.00
PNEUMOCOCCAL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90732 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330495 PORT-A-CATH BLOOD DRAW .00 EA= .00 1 00000000 51.00
PORT-A-CATH B .00 .00 2 00000000 .00
.......... 56(0301) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36591 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499024 POST OP .00 EA= .00 1 00000000 .00
POST OP .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99024 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499210 PREOP COLON OFFICE VISIT .00 EA= .00 1 00000000 .00
PREOP COLON O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99211N FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445300 PROCTOSIGMOIDOSCOPY FIGID DIAGNOSTIC .00 EA= .00 1 00000000 202.00
PROCTOSIGMOID .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45300 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1484153 PROSTATE SPECIFIC ANTIGEN-PSA TOTAL .00 EA= .00 1 00000000 107.00
PROSTATE SPEC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 84153 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445110 PROTECTOMY COMPLETE COMBINED ABDOMIN .00 EA= .00 1 00000000 6386.00
PROTECTOMY CO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45110 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 325
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1485610 PROTHROMBIN TIME (PT) .00 EA= .00 1 00000000 27.00
PROTHROMBIN T .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 85610 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9127004 PT FUNCTIONAL EVALUATIO .00 EA= 1.00 1 00000000 86.00
PT FUNCTIONAL .00 .00 2 00000000 .00
p......p.. 85(0420) INV.GL= EXP.GL= .00 .00 3 31300091 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 4
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99203 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9121013 PT TENS INITIAL SET UP .00 EA= 1.00 1 00000000 108.00
PT TENS INITI .00 .00 2 00000000 .00
p......p.. 85(0420) INV.GL= EXP.GL= .00 .00 3 31300091 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 64550GP FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
9127040 PT UNNA BOOT APPLICATIO .00 EA= 1.00 1 00000000 116.00
PT UNNA BOOT .00 .00 2 00000000 .00
p......p.. 85(0420) INV.GL= EXP.GL= .00 .00 3 31300091 .00
MULT QTY:N MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29580 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1494760 PULSE OX-NONINVASIVE EAR OR PULSE OX .00 EA= .00 1 00000000 41.00
PULSE OX-NONI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 94760 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410160 PUNCTURE ASPIRATION OF ABSCESS HEMAT .00 EA= .00 1 00000000 232.00
PUNCTURE ASPI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 10160 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1419000 PUNCTURE ASPIRATION OF CYST OF BREAS .00 EA= .00 1 00000000 226.00
PUNCTURE ASPI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 19000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 326
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499377 PYSICIAN SUPER OF A HOSPICE PT 15-29 .00 EA= .00 1 00000000 195.00
PYSICIAN SUPE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99377 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1487880 RAPID STREPT A .00 EA= .00 1 00000000 54.00
RAPID STREPT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 87880 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113322 REM TUNNELED CVAD W PORT/PUMP .00 EA= .00 1 00000000 3001.00
REM TUNN CVAD .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36590 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113290 REMOVAL FOREIGN BODY .00 EA= .00 1 00000000 355.00
REMOVAL FOREI .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20520 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1424200 REMOVAL FOREIGN BODY UPPER ARM .00 EA= .00 1 00000000 248.00
REMOVAL FOREI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 24200 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1465220 REMOVAL OF FOREIGN BODY EXTERNAL EYE .00 EA= .00 1 00000000 351.00
REMOVAL OF FO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 65220 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411200 REMOVAL OF SKIN TAGS UP TO 15 .00 EA= .00 1 00000000 161.00
REMOVAL OF SK .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11200 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 327
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2113272 REMOVE VEN ACC DEVIC .00 EA= .00 1 00000000 1331.00
REMOVE VEN AC .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36589 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499418 REOPENING OF RECENT LAPAROTOMY .00 EA= .00 1 00000000 2567.00
REOPENING OF .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 49002 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113297 REP BLD VESS W/GRAFT .00 EA= .00 1 00000000 2129.00
REP BLD VESS .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 35266 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113296 REPAIR ANEURYSM .00 EA= .00 1 00000000 2662.00
REPAIR ANEURY .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 35011 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
280017 REPAIR INCARCERATED INGUINAL HERNIA .00 EA= .00 1 00000000 1424.00
REP INC ING 5 .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 49507 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499413 REPAIR INITAL INCISIONAL OR VENTRAL .00 EA= .00 1 00000000 2273.00
REPAIR INITAL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 49561 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1449560 REPAIR INITIAL INCISIONAL OF VENTRAL .00 EA= .00 1 00000000 2409.00
REPAIR INITIA .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 49560 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 328
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1449505 REPAIR INITIAL INGUINAL HERNIA AGE 5 .00 EA= .00 1 00000000 1817.00
REPAIR INITIA .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 49505 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1449565 REPAIR RECURRENT INCISIONAL OR VENTR .00 EA= .00 1 00000000 2629.00
REPAIR RECURR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 49565 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1449585 REPAIR UMBILICAL HERNIA AGE 5 YRS OR .00 EA= .00 1 00000000 1884.00
REPAIR UMBILI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 49585 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113298 REV ART BYPASS W/O .00 EA= .00 1 00000000 1775.00
REV ART BYPAS .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 35881 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113271 REVISE VEN ACC DEVIC .00 EA= .00 1 00000000 1331.00
REVISE VEN AC .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36581 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113288 REVISION AV FISTULA .00 EA= .00 1 00000000 1242.00
REVISION AV F .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36010 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420696 ROCEPHIN ANTIBIOTIC INJECTION PER 25 .00 EA= .00 1 00000000 4.00
ROCEPHIN ANTI .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J0696 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 329
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499410 SALPINGO-OOHORECTOMY COMPLETE OR PAR .00 EA= .00 1 00000000 1807.00
SALPINGO OOHO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 58720 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410105 SCREENING COLONOSCOPY/HIGH RISK .00 EA= .00 1 00000000 1206.00
SCREENING COL .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0105 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410104 SCREENING FLEX SIGMOIDOSCOPY .00 EA= .00 1 00000000 380.00
SCREENING FLE .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0104 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
4560043 SENTINEL NODE INJECTION .00 EA= 2.00 1 00000000 200.00
SENT NODE INJ .00 .00 2 00000000 .00
n......n.P 42(0360) INV.GL= EXP.GL= .00 .00 3 31300045 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:N AUTO COMP ORD:N VIEW UNVER ORD:Y PRT ORD SLIP:B CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 38792 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411301 SHAVING OF DERMAL LESION SINGLE TRUN .00 EA= .00 1 00000000 192.00
SHAVING OF DE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11301 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411300 SHAVING OF EPIDERMAL /DERMAL LESION .00 EA= .00 1 00000000 156.00
SHAVING OF EP .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11300 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113285 SHUNT ARTERY TO VEIN .00 EA= .00 1 00000000 3549.00
SHUNT ARTERY .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36145 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 330
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1445338 SIGMOIDOSCOPY FLEX DX W/REMOVALTUMOR .00 EA= .00 1 00000000 1040.00
SIGMOIDOSCOPY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45338 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445531 SIGMOIDOSCOPY FLEX W/ BIOPSY SINGLE .00 EA= .00 1 00000000 480.00
SIGMOIDOSCOPY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45531 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445330 SIGMOIDOSCOPY FLEXIBLE DIAGNOSTIC .00 EA= .00 1 00000000 392.00
SIGMOIDOSCOPY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45330 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1412002 SIMPLE REPAIR OF SUPERFICIAL WOUND 7 .00 EA= .00 1 00000000 544.00
SIMPLE REPAIR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 12002 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1412001 SIMPLE REPAIR SUPERFICIAL WOUND .00 EA= .00 1 00000000 450.00
SIMPLE REPAIR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 12001 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1486580 SKN TEST-PPD .00 EA= .00 1 00000000 33.00
SKN TEST-PPD .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 86580 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499406 SMOKING AND TOBACCO CESSATION .00 EA= .00 1 00000000 44.00
SMOKING AND T .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99406 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 331
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1410436 SMOKING AND TOBACCO CESSATON .00 EA= .00 1 00000000 44.00
SMOKING AND T .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0436 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499080 SPECIAL REPORTS MEDICAL RECORDS INSU .00 EA= .00 1 00000000 .00
SPECIAL REPOR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99080 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330520 SPINAL TAP .00 EA= .00 1 00000000 525.00
SPINAL TAP .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 62272 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890020 SPINAL/LUMBAR PUNCTU .00 EA= .00 1 00000000 525.00
SPINAL/LUMBAR .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 62270 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1494010 SPIROMETRY PLAIN .00 EA= .00 1 00000000 140.00
SPIROMETRY PL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 94010 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1438100 SPLENECTOMY TOTAL .00 EA= .00 1 00000000 6702.00
SPLENECTOMY T .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 38100 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499401 SPORTS PHYSICAL .00 EA= .00 1 00000000 25.00
SPORTS PHYSIC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99401F FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 332
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1487430 STREP GROUP A .00 EA= .00 1 00000000 41.00
STREP GROUP A .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 87430 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499231 SUBSEQUENT HOSPITAL CARE 15 MINS .00 EA= .00 1 00000000 102.00
SUBSEQUENT HO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99231 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499232 SUBSEQUENT HOSPITAL CARE PER DAY 25 .00 EA= .00 1 00000000 139.00
SUBSEQUENT HO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300020 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99232 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499233 SUBSEQUENT HOSPITAL VISIT .00 EA= .00 1 00000000 259.00
SUBSEQUENT HO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99233 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499308 SUBSEQUENT NURSING CARE 15 MINS .00 EA= .00 1 00000000 164.00
SUBSEQUENT NU .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99308 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499314 SUBSEQUENT NURSING CARE 15 MINS .00 EA= .00 1 00000000 164.00
SUBSEQUENT NU .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99308SW FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499309 SUBSEQUENT NURSING CARE 25 MINUTES .00 EA= .00 1 00000000 238.00
SUBSEQUENT NU .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300020 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99309 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 333
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499317 SUBSEQUENT NURSING CARE 25 MINUTES .00 EA= .00 1 00000000 238.00
SUBSEQUENT NU .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99309SW FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499310 SUBSEQUENT NURSING FACILITY CARE 35 .00 EA= .00 1 00000000 324.00
SUBSEQUENT NU .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300020 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99310 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499307 SUBSEQUENT NURSING HOME CARE .00 EA= .00 1 00000000 121.00
SUBSEQUENT NU .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99307 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499313 SUBSEQUENT NURSING HOME CARE .00 EA= .00 1 00000000 121.00
SUBSEQUENT NU .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99307SW FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499224 SUBSEQUENT OBSERVATION CARE 15 MINS .00 EA= .00 1 00000000 66.00
SUBSEQUENT OB .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99224 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499225 SUBSEQUENT OBSERVATION CARE 25 MINS .00 EA= .00 1 00000000 132.00
SUBSEQUENT OB .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99225 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499226 SUBSEQUENT OBSERVATION CARE 35 MINS .00 EA= .00 1 00000000 184.00
SUBSEQUENT OB .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99226 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 334
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1731068 SUCTION .00 EA= 1.00 1 31110017 79.00
SUCTION .00 .00 2 31220017 .00
.......z.. 84(0410) INV.GL= EXP.GL= .00 .00 3 31300017 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:N AUTO COMP ORD:N VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 31720 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446270 SURGICAL TREATMENT OF ANAL FISTULA .00 EA= .00 1 00000000 1502.00
SURGICAL TREA .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 46270 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420670 SUTURE REMOVAL .00 EA= .00 1 00000000 1031.00
SUTURE REMOVA .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20670 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113287 SVC OR IVC PLACEMENT .00 EA= .00 1 00000000 1775.00
SVC OR IVC PL .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36010 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490715 TDAP > 7YRS IM .00 EA= .00 1 00000000 36.00
TDAP > 7YRS I .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90715 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
8041843 TEMPERAL ARTERY BIOPSY .00 EA= .00 1 00000000 512.00
TEMPERAL ARTE .00 .00 2 00000000 .00
.......... 65(0370) INV.GL= EXP.GL= .00 .00 3 31300080 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 37609 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1421080 TESTOSTERONE INJECTION .00 EA= .00 1 00000000 18.00
TESTOSTERONE .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J1080 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 335
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1490703 TETANUS SHOT .00 EA= .00 1 00000000 48.00
TETANUS SHOT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90703 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490718 TETANUS/DIPHTHERIA TOXOIDS (TD) ADM .00 EA= .00 1 00000000 44.00
TETANUS/DIPHT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90718 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1496372 THERAPEUTIC PROPHYLACTIC INJECTION .00 EA= .00 1 00031110 50.00
THERAPEUTIC P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96372 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330521 THORACENTESIS FOR ASPIRATION .00 EA= .00 1 00000000 499.00
THORACENTESIS .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 32421 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330522 THORACENTESIS W/WATER SEAL .00 EA= .00 1 00000000 525.00
THORACENTESIS .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 32422 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113269 THROMBECT AV FISTULA .00 EA= .00 1 00000000 3549.00
THROMBECT AV .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36870 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113314 THROMBECTOMY .00 EA= .00 1 00000000 24126.00
THROMBECTOMY .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36904 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 336
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2113315 THROMBECTOMY W/ BALLOON .00 EA= .00 1 00000000 48762.00
THROMB W/ BAL .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36905 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113316 THROMBECTOMY W/ STENT .00 EA= .00 1 00000000 73910.00
THROMB W/ STN .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36906 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1484443 THYROID STIMULATING HORMONE .00 EA= .00 1 00000000 97.00
THYROID STIMU .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 84443 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499408 THYROIDECTOMY, REMOVAL OF ALL REMAIN .00 EA= .00 1 00000000 2696.00
THROIDECTOMY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 60260 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1484436 THYROXINE TOTAL .00 EA= .00 1 00000000 39.00
THYROXINE TOT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 84436 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1421885 TORADOL KETOROLAC PER 15 MG .00 EA= .00 1 00000000 6.00
TORADOL KETOR .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J1885 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1731081 TRACH CARE .00 EA= 1.00 1 31110017 113.00
TRACH CARE .00 .00 2 31220017 .00
.......z.. 84(0410) INV.GL= EXP.GL= .00 .00 3 31300017 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:N AUTO COMP ORD:N VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 31720 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 337
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1431600 TRACHEOSTOMY PLANNED .00 EA= .00 1 00000000 1554.00
TRACHEOSTOMY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 31600 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113274 TRANSCATH PLACE STEN .00 EA= .00 1 00000000 3549.00
TRANSCATH PLA .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 37205 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113293 TRANSCATH RETR FB .00 EA= .00 1 00000000 1730.00
TRANSCATH RET .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 37203 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113318 TRANSCATH STENT PLACEMENT .00 EA= .00 1 00000000 4336.00
TRANSCTH STNT .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36908 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1484460 TRANSFERASE ALANINE AMINO (ALT)(SGPT .00 EA= .00 1 00000000 27.00
TRANSFERASE A .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 84460 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890021 TRIGGER POINT INJECT .00 EA= .00 1 00000000 296.00
TRIGGER POINT .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20552 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420552 TRIGGER PT INJECTION .00 EA= .00 1 00000000 169.00
TRIGGER PT IN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20552 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 338
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1432551 TUBE THORACOSTOMY INCLUDES WATER SEA .00 EA= .00 1 00000000 661.00
TUBE THORACOS .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 32551 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
4560041 ULTRASOUND GUIDANCE NEEDLE WIRE IN B .00 EA= .00 1 00000000 559.00
US GUID NEED .00 .00 2 00000000 .00
u......u.P 42(0360) INV.GL= EXP.GL= .00 .00 3 31300045 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:N AUTO COMP ORD:N VIEW UNVER ORD:Y PRT ORD SLIP:B CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 19290 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1429580 UNNA BOOT .00 EA= .00 1 00000000 116.00
UNNA BOOT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29580 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443248 UP GI ENDO W/ INSERT GUIDE WIRE THEN .00 EA= .00 1 00000000 901.00
UP GI ENDO W/ .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43248 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443245 UP GI ENDO W/DILAT GASTRIC OUT OBSTR .00 EA= .00 1 00000000 928.00
UP GI ENDO W/ .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43245 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443251 UP GI ENDOSCOPY WITH REMOVAL OF TUMO .00 EA= .00 1 00000000 1122.00
UP GI ENDOSCO .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43251 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443247 UPPER GASTROINTESTINAL ENDOSCOPY WIT .00 EA= .00 1 00000000 928.00
UPPER GASTROI .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43247 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 339
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1443249 UPPER GI ENDOSCOPY WITH BALLOON DILA .00 EA= .00 1 00000000 986.00
UPPER GI ENDO .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43249 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1481002 URINALYIS BY DIPSTICK OR TABLE NON-A .00 EA= .00 1 00000000 24.00
URINALYIS BY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 81002 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1481001 URINALYSIS BY DIPSTICK OR TABLET REA .00 EA= .00 1 00000000 31.00
URINALYSIS BY .00 .00 2 00000000 .00
.......... 58(0307) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 81001 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1481003 URINALYSIS DIP STICK/TABLET RGNT/AUT .00 EA= .00 1 00000000 25.00
URINALYSIS DI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 81003 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490472 VACCINE ADMINISTRATION EACH ADDITION .00 EA= .00 1 00000000 26.00
VACCINE ADMIN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90472 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490471 VACCINE ADMINISTRATION FIRST SHOT .00 EA= .00 1 00000000 49.00
VACCINE ADMIN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90471 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113319 VEIN EMBOLIZATION .00 EA= .00 1 00000000 4336.00
VEIN EMBOLIZA .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36909 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 340
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
4111020 VENI PUNCTURE .00 EA= .00 1 00000000 28.00
VENI PUNCTURE .00 .00 2 00000000 .00
.......... 55(0300) INV.GL= EXP.GL= .00 .00 3 31300041 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36415 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1436415 VENIPUNCTURE .00 EA= .00 1 00000000 21.00
VENIPUNCTURE .00 .00 2 00000000 .00
.......... 55(0300) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36415 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113320 VENOGRAPHY .00 EA= .00 1 00000000 3420.00
VENOGRAPHY .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 75827 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2113295 VESSEL MAPPING DIALY .00 EA= .00 1 00000000 887.00
VESSEL MAPPIN .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300021 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0365 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499172 VISUAL FUNCTION SCREENING .00 EA= .00 1 00000000 62.00
VISUAL FUNCTI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99172 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411765 WEDGE EXCOF SKIN NAIL FOLD (INGROWN .00 EA= .00 1 00000000 409.00
WEDGE EXCOF S .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11765 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1487210 WET PREP-SMR PRIM SRC WET MOUNT NFCT .00 EA= .00 1 00000000 27.00
WET PREP-SMR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 87210 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 341
TIME: 08:24 ITEM MASTER LIST DEPT# 005 ER CLINIC/PHY H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1490736 ZOSTER SHINGLES VACCINE LIVE SUBCUTA .00 EA= .00 1 00000000 356.00
ZOSTER SHINGL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90736 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 342
TIME: 08:24 ITEM MASTER LIST DEPT# 007 SLEEP LAB H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
730000 MAINTENANCE OF WAKEFULNESS TEST .00 EA= .00 1 00000000 3471.00
MAINTENANCE O .00 .00 2 00000000 .00
.......... EA(0740) INV.GL= EXP.GL= .00 .00 3 31300007 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 95805 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
730001 MULTIPLE SLEEP LATENCY TEST .00 EA= .00 1 00000000 3465.00
MULTIPLE SLEE .00 .00 2 00000000 .00
.......... EA(0740) INV.GL= EXP.GL= .00 .00 3 31300007 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 95805 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
730009 PAP NAP .00 EA= .00 1 00000000 551.00
PAP NAP .00 .00 2 00000000 .00
.......... EA(0740) INV.GL= EXP.GL= .00 .00 3 31300007 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 95807 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
730003 POLYSOMNOGRAPHY P >4 INIT CPAP .00 EA= .00 1 00000000 4305.00
POLYSOMNOGRAP .00 .00 2 00000000 .00
.......... EA(0740) INV.GL= EXP.GL= .00 .00 3 31300007 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 95811 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
730002 POLYSOMNOGRAPHY P>4 ATTEND TECH .00 EA= .00 1 00000000 3410.00
POLYSOMNOGRAP .00 .00 2 00000000 .00
.......... EA(0740) INV.GL= EXP.GL= .00 .00 3 31300007 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 95810 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
730004 SLEEP STUDY UNATTENDED .00 EA= .00 1 00000000 683.00
SLEEP STUDY U .00 .00 2 00000000 .00
.......... EA(0740) INV.GL= EXP.GL= .00 .00 3 31300007 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 95806 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
730008 TERMINATD SLEEP STUDY 3-4 HR .00 EA= .00 1 00000000 1870.00
TERMINATD SLE .00 .00 2 00000000 .00
.......... EA(0740) INV.GL= EXP.GL= .00 .00 3 31300007 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 95810 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 343
TIME: 08:24 ITEM MASTER LIST DEPT# 007 SLEEP LAB H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
730005 TERMINATED CPAP 3-4 HR .00 EA= .00 1 00000000 2619.00
TERMINATED CP .00 .00 2 00000000 .00
.......... EA(0740) INV.GL= EXP.GL= .00 .00 3 31300007 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 95811 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
730006 TERMINATED CPAP STUDY 1-2 HR .00 EA= .00 1 00000000 1372.00
TERMINATED CP .00 .00 2 00000000 .00
.......... EA(0740) INV.GL= EXP.GL= .00 .00 3 31300007 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 95811 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
730007 TERMINATED SLEEP STUDY 1-2 HR .00 EA= .00 1 00000000 998.00
TERMINATED SL .00 .00 2 00000000 .00
.......... EA(0740) INV.GL= EXP.GL= .00 .00 3 31300007 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 95810 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 344
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501040 ARM SLING L 00432 1796-13-10 3.72 EA=1EA .00 1 00000000 65.00
ARM SLING L 37.16 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000615 1 X 2 5/8 WHITE LABLES 816 00499 UNV80201 9.99 PK=1PK .00 1 00000000 .00
1 X 2 5/8 WHI 9.99 PK=1PK/PK 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000614 1"X 2 5/8 CLEAR LABELS 866 00499 AVE8660 23.99 PK=1PK .00 1 00000000 .00
1"X 2 5/8 CLE 23.99 PK=1PK/PK 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000739 1.2 GAL CAP ROOM HUMIDIFIE 01304 4714100HF 31.91 EA=1EA .00 1 00000000 93.00
1.2 GAL CAP R 31.91 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000754 100FT ROLL-SEG 6"-COR TUB 01304 301150 11.70 EA=1EA .00 1 00000000 69.00
100FT ROLL-SE 11.70 RL=1EA/RL 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500512 2WAY CATH 12FR. FOLEY 5CC 00249 S512 4.3092 EA=1EA .00 1 00000000 44.00
2WAY CATH 12F 51.71 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500513 2WAY CATH 14FR 5CC BALLON 00249 DYND11501 4.3092 EA=1EA .00 1 00000000 44.00
2WAY CATH 14F 51.71 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500514 2WAY CATH 16FR 5CC BALLON 00249 DYND11502 4.3092 EA=1EA .00 1 00000000 44.00
2WAY CATH 16F 51.71 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 345
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500499 2WAY CATH 16FR FOLEY 30CC 00249 S186 4.91 EA=1EA .00 1 00000000 35.00
2WAY CATH 16F 58.89 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500515 2WAY CATH 18FR 5CC BALLON 00249 DYND11503 4.3092 EA=1EA .00 1 00000000 44.00
2WAY CATH 18F 51.71 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500500 2WAY CATH 18FR FOLEY 30CC 00249 S618 4.91 EA=1EA .00 1 00000000 35.00
2WAY CATH 18F 58.89 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500516 2WAY CATH 20FR 5CC BALLON 00249 S520 1.31 EA=1EA .00 1 00000000 44.00
2WAY CATH 20F 15.66 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500501 2WAY CATH 20FR FOLEY 30CC 00249 S620 4.91 EA=1EA .00 1 00000000 35.00
2WAY CATH 20F 58.89 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500517 2WAY CATH 22FR 5CC BALLON 00249 DYND11504 4.3092 EA=1EA .00 1 00000000 44.00
2WAY CATH 22F 51.71 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500502 2WAY CATH 22FR FOLEY 30CC 00249 S622 1.18 EA=1EA .00 1 00000000 35.00
2WAY CATH 22F 14.13 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500518 2WAY CATH 24FR 5CC BALLON 00249 S524 1.31 EA=1EA .00 1 00000000 44.00
2WAY CATH 24F 15.66 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 346
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500503 2WAY CATH 24FR FOLEY 30CC 00249 S624 1.18 EA=1EA .00 1 00000000 35.00
2WAY CATH 24F 14.13 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500519 2WAY CATH 26FR 5CC BALLON 00249 S526 1.31 EA=1EA .00 1 00000000 44.00
2WAY CATH 26F 15.66 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500520 2WAY CATH 28FR 5CC BALLON 00249 S528 .28 EA=1EA .00 1 00000000 44.00
2WAY CATH 28F 3.40 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500504 2WAY CATH 28FR FOLEY 30CC 00249 S628 .28 EA=1EA .00 1 00000000 35.00
2WAY CATH 28F 3.40 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500521 2WAY CATH 30FR 5CC BALLON 00249 265730 .28 EA=1EA .00 1 00000000 44.00
2WAY CATH 30F 3.40 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500505 2WAY CATH 30FR FOLEY 30CC 00249 S630 1.21 EA=1EA .00 1 00000000 35.00
2WAY CATH 30F 14.49 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001016 3-0 VICRYL J416H 00257 23000J416H 44.995 BX=1BX .00 1 00000000 .00
3-0 VICRYL J4 44.995 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000759 340 ML HUMIDIFIER W/ ADAPT 01304 36-003-40 1.01 EA=1EA .00 1 00000000 12.00
340 ML HUMIDI 20.12 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 347
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500506 3WAY CATH 16FR 30CC 00249 DYND11572 7.3233 EA=1EA .00 1 00000000 63.00
3WAY CATH 16F 87.88 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500507 3WAY CATH 18FR 30CC 00249 DYND11573 7.3233 EA=1EA .00 1 00000000 63.00
3WAY CATH 18F 87.88 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500508 3WAY CATH 20FR 00249 PS720 3.70 EA=1EA .00 1 00000000 63.00
3WAY CATH 20F 44.37 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500509 3WAY CATH 22FR 30CC 00249 DYND11575 7.3233 EA=1EA .00 1 00000000 63.00
3WAY CATH 22F 87.88 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500510 3WAY CATH 24FR 00249 06200167L24 8.82 EA=1EA .00 1 00000000 63.00
3WAY CATH 24F 105.78 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500511 3WAY CATH 26FR 00249 2D2655 2.85 EA=1EA .00 1 00000000 63.00
3WAY CATH 26F 34.20 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000764 760ML NEB W/ADAPTER (HUMI 01304 04-3D0808 3.29 EA=1EA .00 1 00000000 78.00
760ML NEB W/ 39.51 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
890000 ABSCESS I&D .00 EA= .00 1 00000000 337.00
ABSCESS I&D .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 10061 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 348
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500985 ACUDYNE SWABSTICKS 00249 MDS093901ZZ .2044 EA=1EA .00 1 00000000 .00
ACUDYNE SWABS 10.22 BX=50/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501001 ADAPTIC 3X3 00249 CUR250330Z .2074 EA=1EA .00 1 00000000 8.00
ADAPTIC 3X3 10.37 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501002 ADAPTIC 3X8 00249 CUR250381Z .5342 EA=1EA .00 1 00000000 32.00
ADAPTIC 3X8 12.82 BX=24EA/BX 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:Y MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000326 ADHERENT DRAPE 92-0500 2.22 EA=1EA .00 1 00000000 .00
ADHERENT DRAP 55.51 BX=25EA/BX 25 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001228 ADHESIVE MEDICAL SPRAY 00257 3158007730 11.41 EA=1EA .00 1 00000000 .00
ADHESIVE MEDI 45.62 BX=4EA/BX 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000762 ADULT AEROSOL MASK 00396 301-170EA .4968 EA=1EA .00 1 00031110 49.00
ADULT AEROSOL 00249 HCS4630B 24.84 CS=50EA/CS 50 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000763 ADULT NASAL CANNULA 7’ 00396 301-100EA .4694 EA=1EA .00 1 00031110 35.00
ADULT NASAL C 00249 HCS4514 23.47 CS=50EA/CS 50 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000760 ADULT NON-REBREATHER 01304 301181 .7226 EA=1EA .00 1 00031110 69.00
ADULT NON-REB 36.13 CS=50EA/CS 50 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 349
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501339 ADULT SLIPPERS XXL 00249 MDT211218XXLI 1.0215 EA=1EA .00 1 00031110 7.50
ADULT SLIPPER 00304 6239LG 49.03 CS=48EA/CS 48 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500039 ADULT WIPES 00249 MSC263810 1.5171 EA=1EA .00 1 00031110 16.00
ADULT WIPES 00062 10-710 36.41 CS=24EA/CS 24 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501021 AIRCAST LEFT 00123 02BLK 25.41 EA=1EA .00 1 00000000 425.00
AIRCAST LEFT 00249 ARC02BLK 25.41 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501022 AIRCAST RIGHT 00123 02BRK 31.46 EA=1EA .00 1 00000000 425.00
AIRCAST RIGHT 00249 ARC02BRK 31.46 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000209 ALCOHOL 00249 MDS098003Z .9875 EA=1EA .00 1 00000000 .00
ALCOHOL 11.85 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000001 ALCOHOL PREP 00249 KDL5750 1.0175 BX=1BX .00 1 00000000 .00
ALCOHOL PREP 00074 KC5033 20.35 CS=20BX/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000367 ALLERGIC TO LABEL 00783 59704578 48.06 BX=1BX .00 1 00000000 .00
ALLERGIC TO L 48.06 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501526 ALOE VESTA BODY WASH &SHAM 00249 MSC095348 .3583 EA=1EA .00 1 00000000 .00
ALOE VESTA BO 00062 82-0994 17.20 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 350
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001432 AMPLATZ WIRE 00058 46-525 40.654 EA=1EA .00 1 00000000 102.00
AMPLATZ WIRE 203.27 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500374 ANKLE BRACE LG 00420 176705 15.18 EA=1EA .00 1 00000000 161.00
ANKLE BRACE L 15.18 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500373 ANKLE BRACE MED 00420 176704 15.66 EA=1EA .00 1 00000000 161.00
ANKLE BRACE M 15.66 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001185 AQUACEL AG 4X4 00257 1638177902 10.39 EA=1EA .00 1 00000000 14.00
AQUACEL AG 4X 103.86 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501038 ARM SLING CHILD 00249 ORT11400SD 5.86 BX=1BX .00 1 00000000 65.00
ARM SLING S 23.44 BX=4EA/BX 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500071 ARMBOARD 18" 00249 NON24291H 1.42 EA=1EA .00 1 00000000 20.00
ARMBOARD 18" 1.42 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500070 ARMBOARD 9" 00249 5189450010 .39 EA=1EA .00 1 00000000 20.00
ARMBOARD 9" 39.00 CS=100EA/CS 100 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500038 ART LINE ARM BD 00249 18686010 6.00 EA=1EA .00 1 00000000 45.00
ART LINE ARM 120.06 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 351
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90000736 ASMAPLANT STAND PEAK FLOW 01304 26111300 10.00 EA=1EA .00 1 00000000 48.00
ASMAPLANT STA 100.00 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001028 ATRAC-TAIN CREAM 5OZ TUBE 00249 COL1814 5.1238 EA=1EA .00 1 00000000 25.00
ATRAC-TAIN CR 61.485 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500404 BANDAGE ACE 2" 00249 MDS046002 .2944 EA=1EA .00 1 00000000 5.00
BANDAGE ACE 2 14.72 BX=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500405 BANDAGE ACE 3" 00249 MDS046003 .3758 EA=1EA .00 1 00000000 7.00
BANDAGE ACE 3 18.79 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500406 BANDAGE ACE 4" 00249 MDS087004LF .4236 EA=1EA .00 1 00000000 9.00
BANDAGE ACE 4 21.18 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500407 BANDAGE ACE 6" 00249 MDS046006 .7446 EA=1EA .00 1 00000000 14.00
BANDAGE ACE 6 37.23 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001277 BANDAID 1" 00249 NON25600 1.10 BX=1BX .00 1 00000000 .00
BANDAID 1" 13.20 CS=12BX/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001678 BANDAID 2" 00249 NON25504 2.3242 BX=1BX .00 1 00000000 .00
BANDAID 2" 27.89 CS=12BX/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 352
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001176 BARALYME 00299 32-55-001-0006 94.75 CS=1CS .00 1 00000000 .00
BARALYME 94.75 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001179 BARRIER WIPES 00257 1638037439 5.79 BX=1BX .00 1 00000000 .00
BARRIER WIPES 5.79 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500150 BASIN 7QT 00249 DYND80347 .2964 EA=1EA .00 1 00000000 14.00
BASIN 7QT 00062 93-H36210 14.82 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001093 BATTERY 9V 00249 DRCPC1604Z .6988 EA=1EA .00 1 00000000 .00
BATTERY 9V 00361 810694 8.386 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001092 BATTERY AAA 00249 DRCPC2400Z .1982 EA=1EA .00 1 00000000 .00
BATTERY AAA 4.756 BX=24EA/BX 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001309 BATTERY C 00249 DRCPC1400Z .4588 EA=1EA .00 1 00000000 .00
BATTERY C 5.505 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001310 BATTERY D 00249 DRCPC1300Z .605 EA=1EA .00 1 00000000 .00
BATTERY D 7.26 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001020 BATTERY-AA 00249 DRCPC1500 .1963 EA=1EA .00 1 00000000 .00
BATTERY-AA 00052 EVEE91SBP36H 28.26 CS=144EA/CS 144 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 353
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
4111334 BB TRANSFUSE BLOOD PRODUCT .00 EA= 1.00 1 00000000 1063.00
TRANSFUSE BLD .00 .00 2 00000000 .00
....P..... 6B(0391) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36430 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2500003 BEDPAN 00249 DYND80245 .4694 EA=1EA .00 1 00000000 36.00
BEDPAN 00062 541-5072-0000 23.47 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500004 BEDPAN FRACTURE 00249 DYNC8521 .5696 EA=1EA .00 1 00000000 39.00
BEDPAN FRACTU 13.67 CS=24EA/CS 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500556 BENSON WIRE 180CM 00104 G01431 11.50 EA=1EA .00 1 00000000 128.00
BENSON WIRE 1 00058 49-147 11.50 EA=1EA/EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000072 BIO-HAZ BAG 6X9 00249 DYND30261 4.715 PK=1PK .00 1 00000000 .00
BIO-HAZ BAG 6 00084 SB69BZ 47.15 CS=10PK/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000339 BIOHAZARD BAG 17X17 00249 NON151717 56.12 CS=1CS .00 1 00000000 .00
BIOHAZARD BAG 56.12 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000340 BIOHAZARD BAG 40X46 00249 HTBA8046ZR 55.20 CS=1CS .00 1 00000000 .00
BIOHAZARD BAG 00146 14-828-89 55.20 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 354
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001332 BIOHAZARD BAGS 24X33 00249 NON122433 5.748 RL=1RL .00 1 00000000 .00
BIOHAZARD BAG 57.48 CS=10RL/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001345 BIOPSY SKIN PUNCH 2MM 00285 DD-2MM 25.00 BX=1BX .00 1 00000000 20.00
BIOPSY SKIN P 25.00 BX=1BX 1 .00 2 00000000 .00
.......... 44(0272) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001344 BIOPSY SKIN PUNCH 4MM 00285 DD-4MM 25.00 BX=1BX .00 1 00000000 20.00
BIOPSY SKIN P 25.00 BX=1BX 1 .00 2 00000000 .00
.......... 44(0272) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001404 BLOOD GAS CARTRIDGE 00316 945-713 807.84 EA=1EA .00 1 00000000 .00
BLOOD GAS CAR 807.84 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001459 BLUNT FILL NEEDLE 00249 B-D305180 6.601 BX=1BX .00 1 00000000 .00
BLUNT FILL NE 66.01 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001638 BLUNT FILTER NEEDLE 00249 B-D305211Z 19.90 BX=1BX .00 1 00000000 .00
BLUNT FILTER 19.90 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500073 BONE MARROW NEEDLE 00249 0707DIN1515X 11.03 EA=1EA .00 1 00000000 135.00
BONE MARROW N 110.30 CS=10EA/CS 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001503 BP CUFF ISOLATION 00328 39203 3.82 EA=1EA .00 1 00000000 .00
BP CUFF ISOLA 76.32 BX=20EA/BX 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 355
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
890001 BRIEF OUTPATIENT VIS .00 EA= .00 1 00000000 148.00
BRIEF OUTPATI .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99211 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2500033 BUTTERFLY 19GA X7/8 00249 45900101 .54 EA=1EA .00 1 00000000 16.00
BUTTERFLY 19G 26.95 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500034 BUTTERFLY 25GA X1/2 00249 B-D367298Z .5814 EA=1EA .00 1 00000000 36.00
BUTTERFLY 25G 29.07 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501518 BUTTERFLY SETS 21GA. 00249 723367296 .59 EA=1EA .00 1 00000000 16.00
BUTTERFLY SET 29.67 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2146226 C-QUR/TACSHIELD MESH 4X6 00249 BAR9001C0212 .00 EA=1EA .00 1 00000000 2325.00
CQURTASMESH4X 00043 9001C0212 .00 BX=10EA/BX 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: C1781 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
80000653 CALCULATOR TAPE-2 1/4 00499 UNV35715 .9992 EA=1EA .00 1 00000000 .00
CALCULATOR TA 11.99 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2330498 CARDIAC MONITORING .00 EA= .00 1 00000000 361.00
CARDIAC MONIT .00 .00 2 00000000 .00
.......... CP(0730) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 93041 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 356
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500056 CARRA-KLENZ 00249 CRR102060 2.7892 EA=1EA .00 1 00000000 144.00
CARRA-KLENZ 33.47 CS=12EA/CS 12 .00 2 00000000 .00
.......... 78(0250) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500408 CAST PADDING 2" 00420 889002 .60 EA=1EA .00 1 00000000 9.00
CAST PADDING 12.00 BG=20EA/BG 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500409 CAST PADDING 3" 00249 MDS067003Z 1.5917 BG=1BG .00 1 00000000 12.00
CAST PADDING 19.10 BG=12/BG 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500410 CAST PADDING 4" 00249 MDS067004Z 1.8808 EA=1EA .00 1 00000000 20.00
CAST PADDING 22.57 BG=12EA/BG 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500411 CAST PADDING 5" 00420 889005 3.29 EA=1EA .00 1 00000000 24.00
CAST PADDING 65.79 BG=20EA/BG 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000974 CASTILE SOAP 00249 MDS001005H .76 EA=1EA. .00 1 00000000 .00
CASTILE SOAP .76 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501223 CATH 10FR PED 00249 DYND11710 3.65 EA=1EA .00 1 00031110 44.00
CATH 10FR PED 43.77 BX=12EA/BX 12 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500531 CATH 16FR 5CC COUDE 00249 DYND11216 4.2158 EA=1EA .00 1 00000000 49.00
CATH 16FR 5CC 50.59 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: C1758 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 357
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500529 CATH 22FR 30CC TELFON 3WA 00249 0167V22S 12.77 EA=1EA .00 1 00000000 44.00
CATH 22FR 30 153.20 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500532 CATH 22FR 5CC COUDE 00249 0168L22 1.22 EA=1EA .00 1 00000000 49.00
CATH 22FR 5CC 14.69 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: C1758 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2500530 CATH 24FR 30CC TEFLON 3WAY 00249 0167V24 12.77 EA=1EA .00 1 00000000 63.00
CATH 24FR 30C 153.20 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501222 CATH 8FR PED 00249 DYND11708 3.18 EA=1EA .00 1 00031110 44.00
CATH 8FR PED 38.14 BX=12EA/BX 12 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501014 CATH FOLEY 2WAY 26 FR 00249 5626 1.21 EA=1EA .00 1 00000000 35.00
CATH FOLEY 2W 14.49 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500526 CATH FOLEY 2WAY 30FR 30CC 00249 0166SI30 10.65 EA=1EA .00 1 00000000 35.00
CATH FOLEY 2W 127.80 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500522 CATH FOLEY 30CC 16FR SILVE 00249 06200166S116 11.22 EA=1EA .00 1 00000000 35.00
CATH FOLEY 30 134.61 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 358
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500523 CATH FOLEY 30CC 18FR SILVE 00249 06200166S118 11.22 EA=1EA .00 1 00000000 35.00
CATH FOLEY 30 134.61 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500524 CATH FOLEY 30CC 20FR SILVE 00249 06200166S120 11.22 EA=1EA .00 1 00000000 35.00
CATH FOLEY 30 134.61 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500525 CATH FOLEY 30CC 22FR SILVE 00249 06200166S122 11.51 EA=1EA .00 1 00000000 35.00
CATH FOLEY 30 138.07 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500528 CATH FOLEY 30CC 30FR SILVE 00249 016SS128 10.65 EA=1EA .00 1 00000000 44.00
CATH FOLEY 30 127.80 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500527 CATH FOLEY 5CC 28FR SILVER 00249 01655I30 10.65 EA=1EA .00 1 00000000 44.00
CATH FOLEY 5C 127.80 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500095 CATH MALE LG TEXAS 00249 RCH33304 .816 EA=1EA .00 1 00000000 39.00
CATH MALE LG 24.48 BX=30EA/BX 30 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500094 CATH MALE MED TEXAS 00249 DYND12302 .6288 EA=1EA .00 1 00000000 39.00
CATH MALE MED 15.72 CS=25EA/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500976 CATH PLUG 00249 76 .32 EA=1EA .00 1 00000000 6.00
CATH PLUG 80.24 CS=250EA/CS 250 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 359
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000977 CATH STRIP 00249 DERCS50Z 1.4352 EA=1EA .00 1 00000000 .00
CATH STRIP 71.76 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500996 CATH TRAY ADD-A FOLEY 00249 DYND11020 8.696 EA=1EA .00 1 00000000 288.00
CATH TRAY ADD 86.96 CS=10EA/CS 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501114 CATH. PED. 6FR. 00249 DYND11706 3.18 EA=1EA .00 1 00000000 44.00
CATH. PED. 6F 38.14 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001523 CAVICIDE 00249 MAP131150 5.5956 EA=1EA .00 1 00000000 .00
CAVICIDE 67.1466 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
890004 CENTRAL LINE FLUSH .00 EA= .00 1 00000000 222.00
CENTRAL LINE .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99211 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330500 CENTRAL LINE INSERTION .00 EA= .00 1 00000000 985.00
CENTRAL LINE .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36556 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890005 CENTRAL LINE REMOVAL .00 EA= .00 1 00000000 81.00
CENTRAL LINE .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36589 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 360
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500050 CENTRAL VENOUS SET 00310 CS04300 21.50 EA=1EA .00 1 00000000 232.00
CENTRAL VENOU 107.48 CS=5EA/CS 5 .00 2 00000000 .00
.......... 50(0278) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: C1751 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2501423 CHLORAPREP 26ML. 00249 MDF260815 5.6012 EA=1EA .00 1 00000000 122.00
CHLORAPREP 26 140.03 CS=25EA/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001493 CHLORASCRUB SWABS 00249 NPKB10800z 10.43 BX=1BX .00 1 00000000 .00
CHLORASCRUB S 10.43 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500426 CLAVICAL SPL. S 00420 73512 6.03 BX=1BX .00 1 00000000 49.00
CLAVICAL SPL. 6.03 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500428 CLAVICLE SPL.LG 00249 SDJ7985007 6.18 BX=1BX .00 1 00000000 49.00
CLAVICLE SPL. 6.18 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500427 CLAVICLE SPL.MD 00420 73513 6.60 BX=1BX .00 1 00000000 49.00
CLAVICLE SPL. 6.60 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500429 CLAVICLE SPL.XL 00420 73515 8.27 BX=1BX .00 1 00000000 49.00
CLAVICLE SPL. 8.27 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 361
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500393 COBAN 1" 00249 4509001581 .51 EA=1EA .00 1 00031110 12.00
COBAN 1" 3.04 CS=6EA/CS 6 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501420 COBAN 2 COMPRESSION SYSTEM 00249 4509002094 13.00 BX=1BX .00 1 00000000 40.00
COBAN 2 COMPR 104.02 CS=8BX/CS 8 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501585 COBAN 2" 00249 MDS089002 1.3964 EA=1EA .00 1 00000000 35.00
COBAN 2" 50.27 CS=36EA/CS 36 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:Y MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500395 COBAN 3" 00249 MDS089003 1.8392 EA=1EA .00 1 00031110 59.00
COBAN 3" 44.14 CS=24EA/CS 24 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:Y MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500396 COBAN 4" 00249 MDS089004 2.3061 EA=1EA .00 1 00031110 79.00
COBAN 4" 41.51 CS=18EA/CS 18 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:Y MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500886 COBAN STERILE 4" 00249 MMM1584S 1.6194 EA=1EA .00 1 00000000 35.00
COBAN STERILE 29.15 CS=18EA/CS 18 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500423 COLLAR LG 00249 ORT13100L 3.45 BX=1BX .00 1 00000000 99.00
COLLAR LG 3.45 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500422 COLLAR MD 00249 ORT13100M 2.58 BX=1BX .00 1 00000000 223.00
COLLAR MD 2.58 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 362
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500421 COLLAR SM 00249 ORT13100S 3.22 BX=1BX .00 1 00000000 99.00
COLLAR SM 3.22 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500424 COLLAR UNIVERSAL 00420 73705 3.50 BX=1BX .00 1 00000000 99.00
COLLAR UNIVER 3.50 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500425 COLLAR X-LONG 00420 73706 3.50 BX=1BX .00 1 00000000 99.00
COLLAR X-LONG 3.50 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001362 COLLES FOREARM SMALL LEFT 00249 ORT33300LS 6.06 EA=1EA .00 1 00000000 18.00
COLLES FOREAR 6.06 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500158 COMBINE DRESSING SURGIPAD 00249 NON21453 .083 EA=1EA .00 1 00000000 2.00
COMBINE DRESS 19.92 CS=240EA/CS 240 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2330513 COMPLEX PROCEDURE .00 EA= .00 1 00000000 985.00
COMPLEX PROCE .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001521 COMPLY 3983MM 00249 3983MM 106.71 BX=1BX .00 1 00000000 .00
COMPLY 3983M 106.71 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
890006 CONSTIPATION REMOVAL .00 EA= .00 1 00000000 212.00
CONSTIPATION .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 363
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000352 COPY PAPER 00118 4COPY 3.45 RM=1RM .00 1 00000000 .00
COPY PAPER 00361 135848 34.50 CS=10RM/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000569 COPY PAPER-14" 00499 HAM10329-01 12.99 RM=1RM .00 1 00000000 .00
COPY PAPER-14 12.99 RM=1RM/RM 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000573 COPY PAPER-BLUE 00052 UNV11202 12.99 RM=1RM .00 1 00000000 .00
COPY PAPER-BL 12.99 RM=1RM/RM 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000570 COPY PAPER-GOLDENROD 00499 UNV11205 5.44 RM=1RM .00 1 00000000 .00
COPY PAPER-GO 5.44 RM=1RM/RM 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000575 COPY PAPER-GREEN 00499 UNV11203 10.49 RM=1RM .00 1 00000000 .00
COPY PAPER-GR 10.49 RM=1RM/RM 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000576 COPY PAPER-PINK 00499 UNV11204 4.03 RM=1RM .00 1 00000000 .00
COPY PAPER-PI 4.03 RM=1RM/RM 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000572 COPY PAPER-YELLOW 00499 UNV11201 12.99 RM=1RM .00 1 00000000 .00
COPY PAPER-YE 12.99 RM=1RM/RM 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000571 COPY PAPRER-BUFF 00499 UNV11206 5.27 RM=1RM .00 1 00000000 .00
COPY PAPRER-B 5.27 RM=1RM/RM 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 364
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001076 CORRECTION TAPE 00118 BICWOETP21 3.145 EA=1EA .00 1 00000000 .00
CORRECTION TA 6.29 EA=2EA/EA 2 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000975 COTTON TIP 6" STERILE 00249 MDS202000 1.666 BX=1BX .00 1 00000000 .00
COTTON TIP 6" 16.66 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000007 COTTONBALLS 00249 MDS21461 1.0015 BG=1BG .00 1 00000000 .00
COTTONBALLS 00062 13-3170 20.03 CS=20BG/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001023 CRITIKON PAPER ER 00760 E9050JC 25.00 BX=1BX .00 1 00000000 .00
CRITIKON PAPE 25.00 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001140 CRITIKON PAPER OR 00760 E9050K 25.00 BX=1BX .00 1 00000000 .00
CRITIKON PAPE 25.00 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001550 CUFF 1 TUBE L ADULT LG.972 00328 99872 5.21 EA=1EA .00 1 00000000 .00
CUFF 1 TUBE L 104.20 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001627 CUFF ADULT SINGLE MDS9723D 00249 MDS9723DM 5.01 EA=1EA .00 1 00000000 .00
CUFF ADULT SI 25.07 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001626 CUFF CHILD SINGLE MDS9721D 00249 MDS9911HP 3.554 EA=1EA .00 1 00000000 .00
CUFF CHILD SI 17.77 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 365
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001552 CUFF DUAL ADULT LONG 3929 00328 39294 3.75 EA=1EA .00 1 00000000 .00
CUFF DUAL ADU 75.00 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001621 CUFF DUAL ADULT MDS9713DM 00249 MDS9713DM 3.82 EA=1EA .00 1 00000000 .00
CUFF DUAL ADU 19.08 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001581 CUFF DUAL ADULT MDS9713HP 00328 99593 5.52 EA=1EA .00 1 00000000 .00
CUFF DUAL ADU 110.48 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001554 CUFF DUAL CHILD 39296 00328 39296 4.14 EA=1EA .00 1 00000000 .00
CUFF DUAL CHI 82.80 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001624 CUFF DUAL CHILD MDS9711CM 00249 MDS9711DM 3.75 EA=1EA .00 1 00000000 .00
CUFF DUAL CHI 18.76 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001623 CUFF DUAL INFANT MDS9710DM 00249 MDS9710DM 3.23 EA=1EA .00 1 00000000 .00
CUFF DUAL INF 16.15 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001553 CUFF DUAL L.ADULT MDS9714H 00328 39291 5.05 EA=1EA .00 1 00000000 .00
CUFF DUAL L.A 101.04 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001622 CUFF DUAL LG ADULT MDS9714 00249 MDS9714DM 4.11 EA=1EA .00 1 00000000 .00
CUFF DUAL LG 20.53 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 366
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001625 CUFF INFANT SINGLE MDS9720 00249 MDS9720DM 4.83 EA=1EA .00 1 00000000 .00
CUFF INFANT S 24.17 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001628 CUFF LG.ADULT SING.MDS9724 00249 MDS9724DM 5.53 EA=1EA .00 1 00000000 .00
CUFF LG.ADULT 27.65 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001551 CUFF S.ADULT LONG MDS9723H 00249 MDS9723HPL 5.108 EA=1EA .00 1 00000000 .00
CUFF S.ADULT 25.54 PK=5EA/PK 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001546 CUFF SINGLE ADULT MDS9913HP 00249 MDS9913HP 2.954 EA=1EA .00 1 00000000 .00
CUFF SINGLE A 14.77 PK=5EA/PK 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001548 CUFF SINGLE CHILD MDS9911HP 00249 MDS9911HP 3.558 EA=1EA .00 1 00000000 .00
CUFF SINGLE C 17.79 PK=5EA/PK 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001549 CUFF SINGLE INFANT MDS9720 00249 MDS9720HP 3.23 EA=1EA .00 1 00000000 .00
CUFF SINGLE I 16.15 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001545 CUFF SINGLE L.ADULT MDS9914HP 00249 MDS9914HP 4.272 EA=1EA .00 1 00000000 .00
CUFF SINGLE L 21.36 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001547 CUFF SINGLE SM.ADULT MDS9912HP 00249 MDS9912HP 3.904 EA=1EA .00 1 00000000 .00
CUFF SINGLE S 19.52 CS=5EA/CS 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 367
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500002 CULTURE SWAB 00249 B-D220109 1.1872 EA=1EA .00 1 00031110 18.00
CULTURE SWAB 00146 220109 59.36 BG=50EA/BG 50 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001341 CUP 16OZ. 00692 2373 40.77 CS=1CS .00 1 00000000 .00
CUP 16OZ. 40.77 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000343 CUP SOUFFLE 00249 NON024220 1.53 PK=1PK .00 1 00000000 .00
CUP SOUFFLE 30.60 CS=20PK/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000345 CUPS 5OZ 00249 NON03005 1.9224 PK=1PK .00 1 00000000 .00
CUPS 5OZ 00062 63-0351 48.06 CS=25PK/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000344 CUPS MED PLASTIC 00249 DYND80000 .523 PK=1PK .00 1 00000000 .00
CUPS MED PLAS 26.15 CS=50PK/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000187 CURAD CLOTH TAPE 2" 00249 1538-2 5.40 BX=1BX .00 1 00000000 .00
DURAPORE TAPE 64.79 CS=12BX/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001424 CUSTOM CD 00089 XX 1.05 BX=1BX .00 1 00000000 .00
CUSTOM CD 1.05 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001487 CUSTOM HOLTER KITS 00111 S0A2R5ABKW 4.35 EA=1EA .00 1 00000000 .00
CUSTOM HOLTER 4.35 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 368
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501403 CVP DRESSING TRAY 00249 DYND75223 2.7213 EA=1EA .00 1 00000000 169.00
CVP DRESSING 108.85 CS=40EA/CS 40 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 31300025 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
890007 CYST DRAINAGE SIMPLE .00 EA= .00 1 00000000 231.00
CYST DRAINAGE .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 10080 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890008 CYST REMOVAL SIMPLE .00 EA= .00 1 00000000 263.00
CYST REMOVAL .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 10040 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
80000100 CYSTO BLADDER 00249 07062C4040 3.31 EA=1EA .00 1 00000000 .00
CYSTO BLADDER 159.05 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501575 CYTOLOGY BRUSH 00756 158R 11.50 EA=1EA .00 1 00000000 79.00
CYTOLOGY BRUS 230.00 BX=20BX/BX 20 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000101 DEFIB PAD 00249 4509-02346N 4.00 EA=1EA .00 1 00000000 .00
DEFIB PAD 39.95 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001261 DEFOAMER 00522 3238 13.99 BT=1BT .00 1 00000000 .00
DEFOAMER 13.99 BT=1BT 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 369
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000979 DENTIPS 00249 MDS096502 32.75 BX=1BX .00 1 00000000 .00
DENTIPS 65.50 CS=2BX/CS 2 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000181 DENTURE CUPS 00249 DYND70293 .9024 PK=1PK .00 1 00000000 .00
DENTURE CUPS 22.56 CS=25PK/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501202 DEODRANT 00249 MSC095010 .2293 EA=1EA .00 1 00000000 .00
DEODRANT 00062 D82-752 22.01 CS=96EA/CS 96 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001096 DESK CALENDAR PD/WALL BK 00499 7.99 EA=1EA .00 1 00000000 .00
DESK CALENDAR 7.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000630 DESK STAPLER 00118 UNV43119 5.99 EA=1EA .00 1 00000000 .00
DESK STAPLER 5.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500009 DIAPER ADULT 00249 FITULTRALG 7.175 BG=1BG .00 1 00000000 70.00
DIAPER ADULT 00062 10-VB013 28.70 CS=4PK/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500010 DIAPER ADULTXL 00249 FITPLUSXLG 7.6875 PK=1PK .00 1 00000000 31.00
DIAPER ADULTX 30.75 CS=4PK/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501395 DIAPERS PULL-UP LG. 00249 MSC23505 6.2775 PK=1PK .00 1 00000000 31.00
DIAPERS PULL- 25.11 CS=4PK/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 370
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501394 DIAPERS PULL-UP MED 00249 MSC23005 6.2775 PK=1PK .00 1 00000000 31.00
DIAPERS PULL 25.11 CS=4PK/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501396 DIAPERS PULL-UP XL 00249 MSC23600 6.2775 PK=1PK .00 1 00000000 31.00
DIAPERS PULL- 25.11 CS=4PK/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001405 DIGITAL THERMOMETER 00257 3596916814 4.72 EA=1EA .00 1 00000000 .00
DIGITAL THERM 113.28 CS=24EA/CS 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000461 DINAMAP PAPER 00257 8156 24.00 BX=1BX .00 1 00000000 .00
DINAMAP PAPER 24.00 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
890009 DIRECT ADMIT OBSERVA .00 EA= .00 1 00000000 162.00
DIRECT ADMIT .00 .00 2 00000000 .00
.......... EJ(0762) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0379 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2500250 DISP. VAGINAL SPECULUM 00249 W-A59001Z 1.4058 EA=1EA .00 1 00000000 81.00
DISP. VAGINAL 33.74 BX=24EA/BX 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000688 DISPOSABLE HEADSTRAP FOR B 01304 73312106 4.78 EA=1EA .00 1 00000000 59.00
DISPOSABLE HE 47.80 PK=10EA/PK 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 371
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500251 DONUT CUSHION 00249 2867-351819 1.34 EA=1EA .00 1 00000000 59.00
DONUT CUSHION 1.34 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500098 DRAINAGE BAG 00249 DYND15205 2.3995 EA=1EA .00 1 00000000 30.00
DRAINAGE BAG 47.99 CS=20EA/CS 20 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501030 DRAPE LOWER EXTREMITY 00249 DYNJP8002 4.93 EA=1EA .00 1 00000000 46.00
DRAPE LOWER E 59.16 CS=12EA/CS 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500299 DRAPE SHEET 00249 DYNJP2419 1.96 EA=1EA .00 1 00000000 45.00
DRAPE SHEET 23.52 CS=12EA/CS 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501069 DRAPE UNDER BUTTOCK 00249 1259001229 .99 EA=1EA .00 1 00000000 110.00
DRAPE UNDER B 53.43 CS=54EA/CS 54 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001451 DUAL LUER LOCK M/FEM. 00249 BHL2C6250 .1788 EA=1EA .00 1 00000000 .00
DUAL LUER LOC 90.13 CS=504EA/CS 504 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000186 DURAPORE TAPE 1" 00249 MMM15382 6.394 BX=1BX .00 1 00000000 .00
DURAPORE TAPE 63.94 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501059 DURAPREP 00249 4509008630 5.297 EA=1EA .00 1 00000000 30.00
DURAPREP 105.94 CS=20EA/CS 20 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 372
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501267 DYNA-HEX4 4OZ. 00249 MDS098710 1.7058 EA=1EA .00 1 00031110 25.00
DYNA-HEX4 4 81.88 CS=48EA/CS 48 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500124 E TRACH TUBE UNCUFFED 4.5 00277 4130-86226 1.04 EA=1EA .00 1 00031110 25.00
E TRACH TUBE 10.39 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500129 E,TRACH TUBE 6.0 00249 4130-086109 1.58 EA=1EA .00 1 00031110 25.00
E,TRACH TUBE 15.84 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001316 E-TRAP 00372 711099 11.00 EA=1EA .00 1 00000000 .00
E-TRAP 00414 711099 275.00 CS=25EA/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500134 E. TRACH TUBE 8.0 00249 4130086113 2.16 EA=1EA .00 1 00031110 25.00
E. TRACH TUBE 21.56 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500136 E. TRACH TUBE CUFF 10.0 00249 4130-086117 4.01 EA=1EA .00 1 00031110 35.00
E. TRACH TUBE 40.11 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500132 E. TRACH TUBE CUFF 7.5 00249 4130-086112 1.026 EA=1EA .00 1 00031110 25.00
E. TRACH TUBE 10.26 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500128 E.TRACH TUBE 5.5 00249 4130-086108 3.42 EA=1EA .00 1 00031110 35.00
E.TRACH TUBE 34.22 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 373
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500127 E.TRACH TUBE CUFF 5.0 00249 4130-86107 1.92 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 19.16 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500130 E.TRACH TUBE CUFF 6.5 00249 DYND43065 1.568 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 15.68 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500131 E.TRACH TUBE CUFF 7.0 00249 DYND43070 2.21 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 22.10 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500133 E.TRACH TUBE CUFF 8.5 00249 4130-086114 4.01 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 40.11 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500135 E.TRACH TUBE CUFF 9.0 00249 4130-086115 2.68 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 26.76 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500120 E.TRACH TUBE UNCUFF 2.5 00249 4130-086222 1.33 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 13.27 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500121 E.TRACH TUBE UNCUFFED 3.0 00249 4130-086223 1.04 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 10.39 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500122 E.TRACH TUBE UNCUFFED 3.5 00249 4130-86224 1.04 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 10.39 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 374
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500123 E.TRACH TUBE UNCUFFED 4.0 00249 4130-86225 1.04 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 10.39 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500126 E.TRACH TUBE UNCUFFED 5.5 00249 4130-86228 1.04 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 10.39 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001599 EAR CURETTES BLUE 00257 819004888 36.69 BX=1BX .00 1 00000000 .00
EAR CURETTES 36.69 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001600 EAR CURETTES GREEN 00257 819001222 36.69 BX=1BX .00 1 00000000 .00
EAR CURETTES 36.69 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001601 EAR CURETTES WHITE 00257 819009555 36.69 BX=1BX .00 1 00000000 .00
EAR CURETTES 36.69 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001133 EKG RECORDING PAPER 00929 9402-024 48.34 EA=1EA .00 1 00000000 .00
EKG RECORDING 48.34 CS=1EA/CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001134 EKG RECORDING TABS 00929 120 49.00 EA=1EA .00 1 00000000 .00
EKG RECORDING 49.00 CS=1EA/CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001236 ELASTIC NET 4 00249 NONNET04 12.41 BX=1BX .00 1 00000000 .00
ELASTIC NET 4 12.41 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 375
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001237 ELASTIC NET 6 00249 NONNET06 17.09 BX=1BX .00 1 00000000 .00
ELASTIC NET 6 17.09 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000401 ELASTIC NET 7" 00249 NONNET07 19.78 BX=1BX .00 1 00000000 .00
ELASTIC NET 7 19.78 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000116 ELECTRODE ADULT 00249 MMM2560 5.785 PK=1PK .00 1 00000000 .00
ELECTRODE ADU 115.70 CS=20PK/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000115 ELECTRODE INFANT 00249 MDS611303AH 1.31 PK=1PK .00 1 00000000 .00
ELECTRODE INF 1.31 PK=1EA/PK 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500180 EMESIS BASIN 00249 DYND80321 .061 EA=1EA .00 1 00000000 5.00
EMESIS BASIN 15.24 CS=250EA/CS 250 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2504020 EMPI FLEECE PADS 00249 4509001581 .51 EA=1EA .00 1 00031110 214.00
EMPI FLEEC PA 3.04 CS=6EA/CS 6 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501137 ENDO POUCH 10MM 00249 ETHPOUCH 52.15 EA=1EA .00 1 00000000 .00
ENDO POUCH 10 00202 POUCH 312.90 BX=6EA/BX 6 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500005 ENEMA SET 00249 DYND-70100 .766 EA=1EA .00 1 00000000 68.00
ENEMA SET 36.77 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 376
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001157 ENVELOPES W/O WINDOWS CCH 00393 123 17.99 BX=1BX .00 1 00000000 .00
ENVELOPES W/ 17.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001194 ENVELOPES WINDOW CCH 00393 1234 52.99 BX=1BX .00 1 00000000 .00
ENVELOPES WIN 52.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000679 ENVELOPES-#10 PAYROLL 00107 8003 49.00 BX=1BX .00 1 00000000 .00
ENVELOPES-#10 49.00 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000581 ENVELOPES-BROWN CLASP 10X1 00052 UNV35267 23.99 BX=1BX .00 1 00000000 .00
ENVELOPES-BRO 23.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000580 ENVELOPES-BROWN CLASP 9X12 00052 UNV35264 19.99 BX=1BX .00 1 00000000 .00
ENVELOPES-BRO 00361 187021 19.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500990 ER LACERATION TRAY 00249 DYNJ03000 3.5338 EA=1EA .00 1 00000000 133.00
ER LACERATION 00062 11-4523 56.54 CS=16EA/CS 16 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500866 ESMARK BANDAGE 4X9 00249 5868055514 2.58 EA=1EA .00 1 00000000 35.00
ESMARK BANDAG 51.55 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000119 ESOPH. STETH 18FR 00249 DTXM1024215 4.4488 EA=1EA .00 1 00000000 .00
ESOPH. STETH 111.22 BX=25EA/BX 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 377
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500125 ETRACH TUBE UNCUFFED 5.0 00249 4130-86227 1.04 EA=1EA .00 1 00031110 25.00
ETRACH TUBE U 10.39 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000205 EXAM GLOVE NITRILE LG. 00249 T-X925030 3.254 BX=1BX .00 1 00000000 .00
EXAM GLOVE NI 00062 11-2523 32.54 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000204 EXAM GLOVE NITRILE MED. 00249 T-X925020 3.254 BX=1BX .00 1 00000000 .00
EXAM GLOVE NI 00062 11-2522 32.54 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000203 EXAM GLOVE NITRILE SM. 00249 T-X925010 3.254 BX=1BX .00 1 00000000 .00
EXAM GLOVE NI 00062 11-2521 32.54 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000332 EXAM GLOVES LG S 00249 MDS194136Z .2234 EA=1EA .00 1 00000000 .00
EXAM GLOVES L 22.34 BX=100EA/BX 100 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001615 EXAM PAPER 00249 NON23322 1.8092 RL=1RL .00 1 00000000 .00
EXAM PAPER 21.71 CS=12RL/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2504004 EXUDERM 2X2 00249 MSC5522 .765 EA=1EA .00 1 00000000 18.00
EXUDERM 2X2 7.65 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501139 EXUDERM 4X4 00249 MSC5544 1.504 EA=1EA .00 1 00000000 26.00
EXUDERM 4X4 15.04 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 378
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500173 EYE PAD SMALL 00249 NON21600Z .0632 EA=1EA .00 1 00000000 11.00
EYE PAD SMALL 3.16 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000737 EZPAP THERAPY SYS PRESS PO 01304 26230747 15.00 EA=1EA .00 1 00031110 100.00
EZPAP THERAPY 150.00 CS=10EA/CS 10 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500216 FACIAL TISSUE 00249 NON243275 .1347 BX=1BX .00 1 00031110 5.00
FACIAL TISSUE 00062 13-200 26.94 CS=200BX/CS 200 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501510 FALL RISK KIT LARGE 00249 6238Y 3.69 EA=1EA .00 1 00000000 146.00
FALL RISK KIT 00304 6237Y 3.69 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501509 FALL RISK KIT REGULAR 00249 6236Y 19.37 EA=1EA .00 1 00000000 146.00
FALL RISK KIT 19.37 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501511 FALL RISK SLIPPERS LARGE 00249 516306250L 5.08 EA=1EA .00 1 00000000 38.00
FALL RISK SLI 5.08 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501512 FALL RISK SLIPPERS MEDIUM 00249 516306250M 4.93 EA=1EA .00 1 00000000 86.00
FALL RISK SLI 4.93 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501514 FALL RISK SLIPPERS SMALL 00249 516306250S 5.17 EA=1EA .00 1 00000000 86.00
FALL RISK SLI 124.08 CS=24EA/CS 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 379
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501508 FALL RISK SOCKS STANDARD 00249 MDTPS4B03FPY .96 EA=1EA .00 1 00000000 .00
FALL RISK SOC 00304 6239Y 46.08 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501507 FALL RISK SOCKS LARGE 00249 MDTPS4B04FPY .9906 EA=1EA .00 1 00031110 10.00
FALL RISK SOC 00304 6239LY 47.55 CS=48EA/CS 48 .00 2 00031111 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000656 FASTENERS-2" 00499 UNV81002 2.69 EA=1EA .00 1 00000000 .00
FASTENERS-2" 2.69 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000666 FASTENERS-SELF ADHESIVE 00361 SMD68220 17.99 BX=1BX .00 1 00000000 .00
FASTENERS-SEL 00118 SMD68220 17.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001258 FAX CART.TN430 00052 IVRTN430 49.99 EA=1EA .00 1 00000000 .00
FAX CART.TN43 00361 IVRTN430 49.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000623 FAX CARTRIDGE TN420 00361 IVRTN420 47.99 EA=1EA .00 1 00000000 .00
BRTTN420 47.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
890014 FB REMOVAL COMPLEX .00 EA= .00 1 00000000 168.00
FB REMOVAL CO .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
890013 FB REMOVAL INTERMEDI .00 EA= .00 1 00000000 116.00
FB REMOVAL IN .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 380
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
890012 FB REMOVAL SIMPLE .00 EA= .00 1 00000000 74.00
FB REMOVAL SI .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501231 FEMALE CATH KIT 00249 DYND10805 1.5424 EA=1EA .00 1 00000000 23.00
FEMALE CATH K 38.56 CS=25EA/CS 25 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500333 FENESTRATED TOWEL 00249 DYA4409Z .2098 EA=1EA .00 1 00000000 5.00
FENESTRATED T 10.49 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000585 FILE FOLDER STANDARD 00052 UNV12113 8.29 BX=1BX .00 1 00000000 .00
FILE FOLDER S 00361 744100 8.29 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001635 FILTER NEEDLE 18GA.X11/2 00257 3.58381E+11 22.50 BX=1BX .00 1 00000000 .00
FILTER NEEDLE 22.50 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001204 FINGER SPLINT 00249 ZIM254801700 1.9183 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 23.02 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001205 FINGER SPLINT 00420 66-0025-002-00 2.41 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 28.93 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001206 FINGER SPLINT 00420 66-0017-001-00 1.17 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 13.98 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 381
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001207 FINGER SPLINT 00249 ZIM254801500 3.1617 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 18.97 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001208 FINGER SPLINT 00420 00-2548-016-00 .88 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 5.28 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001209 FINGER SPLINT 00420 00-2548-017-00 .94 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 5.63 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001210 FINGER SPLINT PLASTALUME 00420 00-2548-015-00 .97 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 5.82 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001211 FINGER SPLINT PLASTALUME 00420 00-2548-018-00 1.02 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 6.09 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001230 FLEXISENSOR ADULT 00719 0998-00-0076-05 51.46 PK=1PK .00 1 00000000 .00
FLEXISENSOR A 154.38 PK=3PK/PK 3 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000067 FLEXISENSOR ADULT BANDAGE 00719 0683-00-0409-02 103.08 BX=1BX .00 1 00000000 .00
FLEXISENSOR A 103.08 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001112 FLOW SELECTOR,STANDARD 01304 715-PM1000 28.38 EA=1EA .00 1 00000000 .00
FLOW SELECTOR 28.38 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 382
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000303 FOG FREE MASK GREEN 00249 NON27378A 7.8617 BX=1BX .00 1 00000000 .00
FOG FREE MASK 47.17 CS=6BX/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000302 FOG FREE MASK W/ SHIELD OR 00249 NON27710 8.95 BX=1BX .00 1 00000000 .00
FOG FREE MASK 53.70 CS=6BX/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2330516 FOLEY CATH INSERTION .00 EA= .00 1 00000000 185.00
FOLEY CATH IN .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 51702 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2500091 FOLEY TRAY 14FR 00249 DYND160414 21.036 EA=1EA .00 1 00000000 128.00
FOLEY TRAY 14 210.36 CS=10EA/CS 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500092 FOLEY TRAY 16FR 00249 BRD800361 6.725 CS=1EA .00 1 00000000 288.00
FOLEY TRAY 16 00062 27-802016 67.25 CS=10EA/CS 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500093 FOLEY TRAY 18FR 00249 BRD800362 6.725 EA=1EA .00 1 00000000 288.00
FOLEY TRAY 18 67.25 CS=10EA/CS 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501636 FOLEY TRAY URINE METER 16F 00249 0620303316A 18.94 EA=1EA .00 1 00000000 131.00
FOLEY TRAY UR 189.41 CS=10EA/CS 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 383
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501637 FOLEY TRAY URINE METER 18F 00249 0620303318A 18.94 EA=1EA .00 1 00000000 .00
FOLEY TRAY UR 189.41 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001591 FOLEY TRICOT STAT LOK 00257 0620FOL0102 3.01 EA=1EA .00 1 00000000 .00
FOLEY TRICOT 75.31 CS=25EA/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001317 FOREARM SPLINT LEFT 00585 79-71973 4.26 EA=1EA .00 1 00000000 .00
FOREARM SPLIN 4.26 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001398 FOREARM SPLINT LEFT 00585 79-71972 4.36 EA=1EA .00 1 00000000 .00
FOREARM SPLIN 4.36 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001490 FROG FINGER SPLINT 13/4" 00522 VC5407 22.00 EA=1EA .00 1 00000000 18.00
FROG FINGER S 22.00 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001488 FROG FINGER SPLINT 21/4 00522 VC5406 22.00 EA=1EA .00 1 00000000 18.00
FROG FINGER S 22.00 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001489 FROG FINGER SPLINT 3" 00522 VC5408 22.00 EA=1EA .00 1 00000000 18.00
FROG FINGER S 22.00 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
890018 G TUBE INSERTION .00 EA= .00 1 00000000 160.00
G TUBE INSERT .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 43760 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 384
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501390 GASTROSTOMY TUBE 00058 51364 23.37 EA=1EA .00 1 00000000 163.00
GASTROSTOMY T 00249 DYND70320 23.37 EA=1EA/EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500172 GAUZE 2X2 8PLY S 00249 PRM21224H 1.94 EA=1EA .00 1 00031110 2.00
GAUZE 2X2 8PL 1.94 BX=1BX 1 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 1.94 1 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500157 GAUZE 4X4 X12PLY S 00249 NON21424 .0548 EA=1EA .00 1 00031110 14.00
GAUZE 4X4 X12 32.88 CS=600EA/CS 600 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500171 GAUZE4X4 16PLY S 00249 NON21428 .4205 EA=1EA .00 1 00031110 63.00
GAUZE4X4 16PL 53.82 CS=128EA/CS 128 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:Y MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2146224 GRANEE NEEDLE 00249 BAR9001C0212 22.57 EA=1EA .00 1 00000000 98.00
GRANEE NEEDLE 00043 9001C0212 225.70 BX=10EA/BX 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500031 GRIPPER 20GA X 1" 00249 PTX21286624 5.0675 EA=1EA .00 1 00000000 79.00
GRIPPER 20GA 00062 11-212866 60.81 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 31300025 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501304 GRIPPER NEEDLE 20 11/4 00249 PDI21286724 5.0675 EA=1EA .00 1 00000000 35.00
GRIPPER NEEDL 60.81 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000584 HANGING FILES 00052 ESS415215 3.40 BX=1BX .00 1 00000000 .00
HANGING FILES 3.40 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 385
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001266 HIBICLENS 16OZ. 00257 158057516 9.51 EA=1EA .00 1 00000000 .00
HIBICLENS 16O 114.12 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000642 HIGHLIGHTERS-GREEN 00499 UNV08862 .6658 EA=1EA .00 1 00000000 .00
HIGHLIGHTERS- 7.99 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000643 HIGHLIGHTERS-PINK 00052 UNV08865 .6658 EA=1EA .00 1 00000000 .00
HIGHLIGHTERS- 7.99 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000644 HIGHLIGHTERS-YELLOW 00118 UNV08861 .6658 EA=1EA .00 1 00000000 .00
HIGHLIGHTERS- 00361 UNV08861 7.99 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001111 HUMIDIFIER 500ML.W/ADAPTER 00107 04-2D0803 3.17 EA=1EA .00 1 00000000 .00
HUMIDIFIER 50 37.98 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
890032 HYDRATION ADD HOURS .00 EA= .00 1 00000000 107.00
HYDRATION ADD .00 .00 2 00000000 .00
.......... 3I(0260) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96361 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330533 HYDRATION EA ADDITIONAL HR .00 EA= .00 1 00000000 134.00
HYDRATION EA .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96361 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 386
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
890031 HYDRATION INITIAL HR .00 EA= .00 1 00000000 212.00
HYDRATION INI .00 .00 2 00000000 .00
.......... 3I(0260) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96360 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890016 I&D HEMATOMA .00 EA= .00 1 00000000 213.00
I&D HEMATOMA .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 10140 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2501426 I.V.CONN.EXTENSION SET 00044 7N8300 1.7517 EA=1EA .00 1 00000000 38.00
I.V.CONN.EXTE 00249 BHL7N8301 350.34 CS=200EA/CS 200 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001536 ICE BAGS 00661 S-7494 52.00 CS=1CS .00 1 00000000 .00
ICE BAGS 52.00 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500006 ICE PACK 00249 NON4420 .663 EA=1EA .00 1 00000000 32.00
ICE PACK 66.30 CS=100EA/CS 100 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001123 ID BANDS BLUE 00249 MDS133037B 46.07 BX=1BX .00 1 00000000 .00
ID BANDS BLUE 46.07 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001516 ID BANDS PURPLE DNR 00431 WBCDNA-8 42.95 BX=1BX .00 1 00000000 .00
ID BANDS PURP 42.95 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 387
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001274 ID BANDS RED 00249 MDS133037R 43.11 BX=1BX .00 1 00000000 .00
ID BANDS RED 00107 8592 43.11 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001118 ID BANDS RED ALLERGY 00257 518984516PDJ 24.10 BX=1BX .00 1 00000000 .00
ID BANDS RED 24.10 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001517 ID BANDS YELLOW FALL RISK 00431 WBCFRA-3 63.27 EA=1EA .00 1 00000000 .00
ID BANDS YELL 63.27 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2330524 IM INJECTION .00 EA= .00 1 00000000 113.00
IM INJECTION .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96372 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890023 IM INJECTION ANTIBIO .00 EA= .00 1 00000000 149.00
IM INJECTION .00 .00 2 00000000 .00
.......... 3I(0260) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96372 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330523 IM/SQ INJECTION .00 EA= .00 1 00000000 113.00
IM/SQ INJECTI .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96372 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2500415 IMPER STOCKINETTE-LG 00249 1259000274 3.27 EA=1EA .00 1 00000000 40.00
IMPER STOCKIN 49.08 CS=15EA/CS 15 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 388
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500414 IMPER STOCKINETTE-M 00249 1259000273 2.08 EA=1EA .00 1 00000000 40.00
IMPER STOCKIN 31.25 CS=15EA/CS 15 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
890017 IN & OUT CATH .00 EA= .00 1 00000000 43.00
IN & OUT CATH .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: P9612 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330503 IN AND OUT CATH .00 EA= .00 1 00000000 54.00
IN AND OUT CA .00 .00 2 00000000 .00
.......... 56(0301) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: P9612 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
90000738 IN-LINE AEROSOL H2O TRAPS 01304 45276 1.86 EA=1EA .00 1 00000000 12.00
IN-LINE AEROS 92.75 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
890040 INFLUENZA ADMINISTRTATION .00 EA= .00 1 00000000 61.00
INFLUENZA ADM .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0008 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
80000640 INK PENS BLACK 00118 BICGSF11BK 2.29 BX=1BX .00 1 00000000 .00
INK PENS BLAC 00361 382241 2.29 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000639 INK PENS BLUE 00499 UNV27411 1.55 BX=1BX .00 1 00000000 .00
INK PENS BLUE 1.55 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 389
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000638 INK PENS RED 00499 UNV27412 1.19 BX=1BX .00 1 00000000 .00
INK PENS RED 1.19 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001136 INSP.FILTERS/760 00394 4-074601-00 51.30 EA=1EA .00 1 00000000 .00
INSP.FILTERS/ 51.30 CS=1EA/CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001106 INSULIN SYRINGE 00249 SWD511110Z 28.06 BX=1BX .00 1 00000000 .00
INSULIN SYRIN 28.06 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001476 INSULIN SYRINGE LL 00249 SWD8100777Z .478 EA=1EA .00 1 00000000 .00
INSULIN SYRIN 28.68 BX=60EA/BX 60 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500011 INSYTE AUTOGUARD 24GA. 00249 BMG4251601Z 1.5854 EA=1EA .00 1 00000000 88.00
INSYTE AUTOGU 79.27 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001642 INTERMEC DURATHEM11 LABELS 00754 E15532 12.61 EA=1EA .00 1 00000000 .00
INTERMEC DURA 100.90 CS=8EA/CS 8 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2330512 INTERMEDIATE PROCEDURE .00 EA= .00 1 00000000 709.00
INTERMEDIATE .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500012 INTROCAN 22X1 00249 BMG4251628Z 1.5854 EA=1EA .00 1 00000000 88.00
INSYTE AUTOGU 00039 4251628-02 79.27 BX=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 390
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500013 INTROCAN 20X1 00249 BMG4251652Z 1.5854 EA=1EA .00 1 00000000 88.00
INSYTE AUTOGU 00039 4251652-02 79.27 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500016 INTROCAN 14G 00249 BMG4251717H 1.60 EA=1EA .00 1 00000000 39.00
INTROCAN 14G 1.60 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500015 INTROCAN 16G 00249 4052 .94 EA=1EA .00 1 00000000 39.00
INTROCAN 16G 46.95 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500014 INTROCAN 18G 00249 BMG4251687Z 1.5854 EA=1EA .00 1 00000000 88.00
INTROCAN 18G 79.27 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000628 INVISIBLE TAPE 00118 UNV83436 1.89 RL=1RL .00 1 00000000 .00
INVISIBLE TAP 00361 STP487908 1.89 RL=1RL/RL 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000290 IRRIGATION SYRINGE 00257 3583067000 .74 EA=1EA .00 1 00000000 .00
IRRIGATION SY 37.00 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500280 IRRIGATION TRAY 00249 DYND20102 .844 EA=1EA .00 1 00000000 45.00
IRRIGATION TR 16.88 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500281 IRRIGATION TRAY PISTON 00249 DYNC2303 1.7665 EA=1EA .00 1 00000000 54.00
IRRIGATION TR 35.33 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 391
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000144 ISOLATION GOWN 00249 NON27236XL 3.404 PK=1PK .00 1 00000000 .00
ISOLATION GOW 17.02 CS=5PK/CS 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000994 ISOLATION MASK-YELLOW 00249 NON27120 3.105 BX=1BX .00 1 00000000 .00
ISOLATION MAS 00218 4515A 18.63 CS=6BX/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501365 IV BASIC SOL. SET 2C8425 00044 2C8425 2.4533 EA=1EA .00 1 00000000 29.00
IV BASIC SOL. 00249 BHL2C8425 117.76 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501367 IV BURETROL ADD-ON SET 00044 2C7565 2.25 EA=1EA .00 1 00000000 30.00
IV BURETROL A 108.18 CS=48EA/CS 48 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501368 IV CATH EXT.SET 2N3374 00044 2N3374 1.95 EA=1EA .00 1 00000000 45.00
IV CATH EXT.S 00249 389.40 CS=200EA/CS 200 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501427 IV CONN CAP 00249 BHL7N8399 1.0858 EA=1EA .00 1 00000000 23.00
IV CONN CAP 217.15 CS=200EA/CS 200 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501371 IV CONT-FLO SET NON-VENTED 2C 00793 M46445690 4.371 EA=1EA .00 1 00031110 68.00
CONT-FLO SET 00249 BHL2C8537 131.13 CS=30EA/CS 30 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501372 IV CONT-FLO VENTED 2C8541 00044 2C8541 3.2833 EA=1EA .00 1 00000000 117.00
IV CONT-FLO V 157.60 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 392
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501373 IV DIAL-A-FLO EXT. 00103 S2-12 .83 EA=1EA .00 1 00000000 23.00
IV DIAL-A-FLO 50.00 CS=60EA/CS 60 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501369 IV FAT SET 00044 2C1106 1.99 EA=1EA .00 1 00000000 .00
IV FAT SET 95.45 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501370 IV FILTER SET 2H8671 00249 BHL2H8671 3.0496 EA=1EA .00 1 00000000 24.00
IV FILTER SET 146.38 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2330504 IV HEPLOCK ONLY .00 EA= .00 1 00000000 57.00
IV HEPLOCK ON .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330532 IV HYDRATION INT HOU .00 EA= .00 1 00000000 265.00
IV HYDRATION .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96360 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890029 IV INFUSION CONCUREN .00 EA= .00 1 00000000 220.00
IV INFUSION C .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96368 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330529 IV INFUSION EA ADDITIONAL HOUR .00 EA= .00 1 00000000 221.00
IV INFUSION E .00 .00 2 00000000 .00
.......... 3I(0260) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96366 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 393
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2330528 IV INFUSION INT .00 EA= .00 1 00000000 473.00
IV INFUSION I .00 .00 2 00000000 .00
.......... 3I(0260) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96365 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890030 IV INFUSION STOPSTAR .00 EA= .00 1 00000000 90.00
IV INFUSION S .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96367 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330526 IV PUSH EA ADD NEWRX .00 EA= .00 1 00000000 133.00
IV PUSH EA AD .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96375 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1350008 IV PUSH EA ADDTL NEW DRUG .00 EA= .00 1 00000000 106.00
IV PUSH EA AD .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300013 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96375 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1350009 IV PUSH EA ADDTL SAME DRUG .00 EA= .00 1 00000000 198.00
IV PUSH EA AD .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300013 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96376 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330525 IV PUSH INIT DRUG .00 EA= .00 1 00000000 193.00
IV PUSH INIT .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96374 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890024 IV PUSH INITIAL .00 EA= .00 1 00000000 154.00
IV PUSH INITI .00 .00 2 00000000 .00
.......... 3I(0260) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96374 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 394
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1350007 IV PUSH INITIAL DRUG .00 EA= .00 1 00000000 231.00
IV PUSH INITI .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300013 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96374 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890025 IV PUSH SAME DRUG .00 EA= .00 1 00000000 198.00
IV PUSH SAME .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96376 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890026 IV PUSH SUBSEQUENT .00 EA= .00 1 00000000 106.00
IV PUSH SUBSE .00 .00 2 00000000 .00
.......... 3I(0260) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96375 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2501375 IV SECONDARY MED SET 2C746 00793 M77460030 1.1085 EA=1EA .00 1 00031110 12.00
IV SECONDARY 00249 BHL2C7461 44.34 CS=40EA/CS 40 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501534 IV SET MINI DRIP OR 2C854 00044 2C8546 3.2467 EA=1EA .00 1 00000000 117.00
IV SET MINI D 00249 BHL2C8546 155.84 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500984 IV START KIT 00249 DYND74271 .6652 EA=1EA .00 1 00000000 34.00
IV START KIT 00084 IV330 66.52 CS=100EA/CS 100 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500179 K-PADS 00249 070766N410CC 11.94 EA=1EA .00 1 00000000 203.00
K-PADS 119.43 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 395
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500176 KERLIX S 00249 PRM25865 .4374 EA=1EA .00 1 00000000 14.00
KERLIX S 43.74 CS=100EA/CS 100 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:Y MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500178 KERLIX SUPER 00249 3583004308 .77 EA=1EA .00 1 00000000 8.00
KERLIX SUPER 7.71 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000163 KLING 2" 00249 NON25492 1.3563 BG=1BG .00 1 00000000 .00
KLING 2" 10.85 CS=8BG/CS 8 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500159 KLING 2" S 00249 NON25496 .1221 EA=1EA .00 1 00000000 32.00
KLING 2" S 11.72 BX=96EA/BX 96 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000164 KLING 3" 00249 NON25493 1.9425 BG=1BG .00 1 00000000 .00
KLING 3" 15.54 CS=8BG/CS 8 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500160 KLING 3" S 00249 NON25497 .1435 EA=1EA .00 1 00000000 41.00
KLING 3" S 13.78 CS=96EA/CS 96 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000165 KLING 4" 00257 6904 1.56 BG=1BG .00 1 00000000 .00
KLING 4" 12.46 CS=8BG/CS 8 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500161 KLING 4" S 00249 NON25498 .1809 EA=1EA .00 1 00000000 52.00
KLING 4" S 17.37 CS=96EA/CS 96 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 396
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000166 KLING 6" 00257 6906 5.72 BG=1BG .00 1 00000000 .00
KLING 6" 5.72 BG=1BG/BG 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500162 KLING 6" S 00249 NON25499 .32 EA=1EA .00 1 00000000 59.00
KLING 6" S 15.36 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500377 KNEE HIGH LG 00249 MDS160664 4.8925 EA=1EA .00 1 00000000 153.00
KNEE HIGH LG 00432 2040009 58.71 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500376 KNEE HIGH MED 00249 MDS160644 4.8925 EA=1EA .00 1 00000000 153.00
KNEE HIGH MED 00432 204008 58.71 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500375 KNEE HIGH SM 00249 MDS160624 3.6942 EA=1EA .00 1 00000000 153.00
KNEE HIGH SM 44.33 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500378 KNEE HIGH XL 00432 204010 5.871 EA=1EA .00 1 00000000 153.00
KNEE HIGH XL 00249 MDS160684 58.71 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500860 KNEE SLEEVES SCD LARGE 00657 3583005489 33.38 EA=1EA .00 1 00000000 113.00
KNEE SLEEVES 166.91 CS=5EA/CS 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501045 KUMPE 5FR 40CM 00254 54038KA2 11.50 EA=1EA .00 1 00000000 124.00
KUMPE 5FR 40 00058 31-407 57.50 BX=5EA/BX 5 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 397
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501046 KUMPE 5FR 65CM 00254 56538KA2 11.50 EA=1EA .00 1 00000000 124.00
KUMPE 5FR 65C 00058 31-409 57.50 BX=5EA/BX 5 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000245 KY JELLY 2.7 00249 MDS032273Z 5.1317 BX=1BX .00 1 00000000 .00
KY JELLY 2.7 00062 24-3627D 30.79 CS=6BX/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000246 KY JELLY 4OZ. 00249 MDS032290Z .7825 EA=1EA .00 1 00000000 .00
KY JELLY 4OZ. 9.39 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
890035 LACERATION RPR COMPL .00 EA= .00 1 00000000 664.00
LACERATION RP .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
890034 LACERATION RPR INTER .00 EA= .00 1 00000000 473.00
LACERATION RP .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
890033 LACERATION RPR SIMPL .00 EA= .00 1 00000000 205.00
LACERATION RP .00 .00 2 00000000 .00
.......... 3I(0260) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001442 LAP CHOLE PACK 00249 DYNJS0310 34.1525 EA=1EA .00 1 00000000 210.00
LAP CHOLE PAC 136.61 CS=4EA/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001321 LASER LABELS AND ARM BANDS 00306 WBW61 66.75 PK=1PK .00 1 00000000 .00
LASER LABELS 00107 7263 267.00 CS=4PK/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 398
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000096 LEG BAG 00249 DYND12574H 1.98 EA=1EA .00 1 00000000 .00
LEG BAG 1.98 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000097 LEG STRAP 00249 1821-000316 3.07 EA=1EA .00 1 00000000 .00
LEG STRAP 30.74 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000619 LEGAL PADS -LETTER YELLOW 00052 UNV10630 1.2492 EA=1EA .00 1 00000000 .00
LEGAL PADS -L 00361 815080 14.99 PK=12EA/EA 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000618 LEGAL PADS-SMALL YELLOW 00052 UNV46200 .7908 EA=1EA .00 1 00000000 .00
LEGAL PADS-SM 00361 163832 9.49 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001299 LEMON GLYCERIN SWABSTICK 00249 MDS090600 2.313 BX=1BX .00 1 00000000 .00
LEMON GLYCERI 23.13 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001087 LETTER HEAD CCH 00783 CCH 94.10 BX=1BX .00 1 00000000 .00
LETTER HEAD C 941.00 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000721 LG DISP VINYL NASAL MASK 01304 83312104EA 14.49 EA=1EA .00 1 00000000 44.00
LG DISP VINYL 14.49 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000724 LG/NARR DISP VINYL NASAL M 01304 73312123EA 14.49 EA=1EA .00 1 00000000 44.00
LG/NARR DISP 14.49 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 399
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501325 LIGAMAX EL5ML 00202 EL5ML 130.03 EA=1EA .00 1 00000000 1042.00
LIGAMAX EL5ML 00249 ETHEL5ML 390.09 BX=3EA/BX 3 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500154 LIMB HOLDER 00304 2532 6.69 EA=1EA .00 1 00000000 90.00
LIMB HOLDER 00249 NON243074 6.69 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000194 LOTION 00249 MSC095001 .1761 EA=1EA .00 1 00000000 .00
LOTION 16.91 CS=96EA/CS 96 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500048 LUMBAR PUNT TRAY 00249 BXT4301CH 8.16 EA=1EA .00 1 00000000 115.00
LUMBAR PUNT. 8.16 EA=1EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001270 MAGNETIC INSTRUMENT PAD 00257 603425D001 3.63 CS=1CS .00 1 00000000 .00
MAGNETIC INST 108.92 CS=30CS/CS 30 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001443 MAJOR EXTREMITY PACK 00249 DYNJS0804 32.155 EA=1EA .00 1 00000000 328.00
MAJOR EXTREMI 128.62 CS=4EA/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501346 MAJOR LAP PACK (NEW) 00249 DYNJS0301 46.01 EA=1EA .00 1 00000000 352.00
MAJOR LAP PAC 92.02 CS=2EA/CS 2 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501124 MALE CATH TEXAS SMALL 00249 DYND12303H 1.51 EA=1EA .00 1 00000000 39.00
MALE CATH TEX 1.51 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 400
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000648 MARKER-BLACK 00052 AVE08888 .7908 EA=1EA .00 1 00000000 .00
MARKER-BLACK 9.49 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501263 MASTISOL 00249 FRN052348Z 1.6242 EA=1EA .00 1 00000000 20.00
MASTISOL 77.96 BX=48EA/BX 48 .00 2 00000000 .00
.......... 78(0250) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500536 MAX 30 INFLATION 00104 G31027 30.00 BX=1BX .00 1 00000000 277.00
MAX 30 INFLAT 00058 M0067101131 30.00 BX=1BX/BX 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000761 MED CONCENTR AD O2 MASK-SI 01304 301180 .55 EA=1EA .00 1 00000000 54.00
MED CONCENTR 27.50 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000722 MED/SMA DISP VINYL NASAL M 01304 73312105EA 14.49 EA=1EA .00 1 00000000 44.00
MED/SMA DISP 14.49 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2504022 MEDIHONEY 2X2 SHEET 00249 DER31815 37.445 EA=1EA .00 1 00031110 100.00
MEDIHONEY SHE 449.34 CS=12EA/CS 12 .00 2 00031220 .00
.......... 43(0270) INV.GL=41115091 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2504021 MEDIHONEY GEL 00249 DER31815 11.5733 EA=1EA .00 1 00031110 63.00
MEDIHONEY 138.88 CS=12EA/CS 12 .00 2 00031220 .00
.......... 43(0270) INV.GL=41115091 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001232 MEDIPORE DRESSING 00257 4509003562 9.04 BX=1BX .00 1 00000000 .00
MEDIPORE DRES 36.15 CS=4BX/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 401
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501560 MEDIPORE DRESSING 3566 00249 4509003566 .52 EA=1EA .00 1 00000000 7.00
MEDIPORE DRES 52.42 CS=100EA/CS 100 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501164 MEFIX 4" 00249 ALA311099H 7.02 BX=1BX .00 1 00000000 119.00
MEFIX 4" 7.02 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501189 MEFIX 6" 00249 ALA311599H 10.5125 BX=1BX .00 1 00000000 53.00
MEFIX 6" 10.5125 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001446 MERITZ PLUS 00249 MDS8840128 15.51 EA=1EA .00 1 00000000 .00
MERITZ PLUS 62.04 CS=4EA/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000755 METHACHOLINE CHALLE ASTHMA 01304 26773100 28.26 EA=1EA .00 1 00000000 90.00
METHACHOLINE 28.26 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500980 MIDSTREAM 00249 DYND30240 .6207 EA=1EA .00 1 00031110 56.00
MIDSTREAM 62.07 CS=100EA 100 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000466 MINDRAY RECORDING PAPER 00263 0683-00-0505-02 3.49 RL=1RL .00 1 00000000 .00
MINDRAY 34.90 BX=10RL/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501337 MINI ACCESS KIT 5FR. 00916 MAK501N/A 35.00 BX=1BX .00 1 00000000 78.00
MINI ACCESS K 35.00 BX=1BX/BX 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 402
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001590 MITTS 00573 2826 1.07 EA=1EA .00 1 00000000 .00
MITTS 12.80 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001116 MONOCRYL 4-0 Y845G 00249 ETHY845G 50.37 BX=1BX .00 1 00000000 .00
MONOCRYL 4-0 50.37 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500196 MOUTHWASH 00249 CTR000413 .2013 EA=1EA .00 1 00000000 .00
MOUTHWASH 12.08 CS=60EA/CS 60 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001486 MULTI ABSORBER 00547 8003138 15.40 EA=1EA .00 1 00000000 .00
MULTI ABSORBE 92.37 CS=6EA/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000765 NASAL AIRWAY 00249 HUD1088 6.00 EA=1EA .00 1 00031110 69.00
300.00 CS=50EA/CS 50 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000740 NASAL CANNULA EZ WRAP (EAR 01304 771016 .85 EA=1EA .00 1 00000000 .00
NASAL CANNULA 42.35 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001563 NASAL CANNULA W/25FT.TUBIN 01304 301-104 1.81 EA=1EA .00 1 00000000 35.00
NASAL CANNULA 45.32 CS=25EA/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000766 NEBULIZER 00396 301200 1.1308 EA=1EA .00 1 00031110 42.00
NEBULIZER 00249 HCS4483 56.54 CS=50EA/CS 50 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 403
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000029 NEEDLE 25X2 00249 358381-200441 8.98 BX=1BX .00 1 00000000 .00
NEEDLE 25X2 8.98 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000564 NEEDLE COUNTER 00257 31142337 8.73 BX=1BX .00 1 00000000 .00
NEEDLE COUNTE 69.80 BX=8BX/BX 8 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500052 NEEDLE LOCK DEVICE 00044 2C7833 .50 EA=1EA .00 1 00000000 5.00
NEEDLE LOCK D 49.91 BX=100EA/BX 100 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000053 NG STRIP 00249 CURNASTUB50 .5182 EA=1EA .00 1 00000000 .00
NG STRIP 25.91 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501419 NITREX WIRES 00916 MAK001N 2.30 EA=1EA .00 1 00000000 71.00
NITREX WIRES 23.00 BX=10EA/BX 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500334 NONFENESTRATED TOWEL 00249 BXT3520Z .3412 EA=1EA .00 1 00000000 5.00
NONFENESTRATE 17.06 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001091 NOTEBOOK 1" 00052 UNV20962 3.1658 EA=1EA .00 1 00000000 .00
NOTEBOOK 1" 00361 374815 3.1658 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000677 NOTEBOOK 2" 00052 UNV20982 5.99 EA=1EA .00 1 00000000 .00
NOTEBOOK 2" 00361 648814 5.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 404
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001095 NOTEBOOK 3" 00052 UNV20992 7.99 EA=1EA .00 1 00000000 .00
NOTEBOOK 3" 00361 374819 7.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000678 NOTEBOOK-1.5" 00499 UNV20972 3.79 EA=1EA .00 1 00000000 .00
NOTEBOOK-1.5" 3.79 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001305 NOVO INSULIN NEEDLES 00249 NOV185275 57.63 BX=1BX .00 1 00000000 .00
NOVO INSULIN 57.63 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500265 NUGAUZE 1" 00249 NON255015 1.7183 EA=1EA .00 1 00000000 53.00
NUGAUZE 1" 20.62 CS=12EA 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000175 NUGAUZE 4X4 00257 3460007634 2.03 PK=1PK .00 1 00000000 .00
NUGAUZE 4X4 20.30 CS=10PK/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500267 NUGAUZE IDOFORM.50 00249 NON256125 1.5767 EA=1EA .00 1 00000000 53.00
NUGAUZE IDOFO 18.92 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500268 NUGAUZE IODOFORM 1" 00249 NON256015 1.9667 EA=1EA .00 1 00000000 135.00
NUGAUZE IODOF 23.60 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501200 NUGAUZE PACK IODOFORM 1/4 00249 NON256145 1.5092 BT=1BT .00 1 00000000 53.00
NUGAUZE PACK 18.11 CS=12BT/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 405
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500264 NUGAUZE PACKING 1/2 00249 NON255125 1.5708 EA=1EA .00 1 00000000 46.00
NUGAUZE PACKI 18.85 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501199 NUGAUZE PACKING 1/4 00249 NON255145 1.4358 BT=1BT .00 1 00000000 53.00
NUGAUZE PACKI 17.23 CS=12BT/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000305 NURSES CAP 00249 BRLB77-4502 2.794 BX=1BX .00 1 00000000 .00
NURSES CAP 13.97 CS=5BX/CS 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000756 O2 TUBING 7’ EXTENSION 00396 301145EA .3458 EA=1EA .00 1 00031110 20.00
O2 TUBING 7’ 00249 HCS4507 17.29 CS=50EA/CS 50 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501246 OB PADS PK 00249 NON241281 1.0146 PK=1PK .00 1 00000000 .00
OB PADS PK 24.35 CS=24PK/CS 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
890010 OBSERVATION HOUR .00 EA= .00 1 31110013 36.00
OBSERVATION H .00 .00 2 31220013 .00
.......... EJ(0762) INV.GL= EXP.GL= .00 .00 3 31300013 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0378 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
80001406 ODOR ELIMINATOR 00249 CRR101003 2.0608 EA=1EA .00 1 00000000 .00
ODOR ELIMINAT 98.92 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 406
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000234 ONE-STEP SAFETY LANCET 00249 SRG1SLN20010C 6.198 BX=1BX .00 1 00000000 .00
ONE-STEP SAFE 00062 75-200100N 92.97 CS=15BX/CS 15 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500274 OPSITE 10X5.50 00249 MMM1627Z 1.102 EA=1EA .00 1 00000000 155.00
OPSITE 10X5.5 22.04 BX=20EA/BX 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500275 OPSITE 4X5.50 00249 MSC2304 .5994 EA=1EA .00 1 00000000 54.00
OPSITE 4X5.50 29.97 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000620 PAPER CLIPS-JUMBO 00361 UNV72220 11.49 BX=1BX .00 1 00000000 .00
PAPER CLIPS-J 00118 UNV72220 11.49 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000621 PAPER CLIPS-SM. 00499 UNV72210 4.99 BX=1BX .00 1 00000000 .00
PAPER CLIPS-S 00118 UNV72210 4.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000417 PAT.BELONGING BAG 00249 NON026310 2.531 PK=1PK .00 1 00000000 .00
PAT.BELONGING 00062 99-BELB 25.31 CS=10PK/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
25014343 PATIENT BED PAD 00249 MDT8445B1 29.97 EA=1EA .00 1 00031110 100.00
PATIENT BED P 29.97 EA=1EA/EA 1 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501342 PATIENT CHAIR PAD 00249 MDT82145C6 15.53 EA=1EA .00 1 00000000 90.00
PATIENT CHAIR 93.18 CS=6EA/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 407
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001150 PDS 11 SUTURE Z497G 00257 23000Z497G 42.90 BX=1BX .00 1 00000000 .00
PDS 11 SUTURE 42.90 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501103 PED.MULTI-LUMEN CENTRAL CA 00249 ARWAK14553 46.732 EA=1EA .00 1 00000000 232.00
PED.MULTI-LUM 233.66 CS=5EA/CS 5 .00 2 00000000 .00
.......... 50(0278) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: C1751 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2501067 PEDIATRIC WRIST SPLINT L 00249 IMP121816 30.25 EA=1EA .00 1 00000000 41.00
PEDIATRIC WRI 00123 79-87291 30.25 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501066 PEDIATRIC WRIST SPLINT R 00249 ORT19900RXXS 11.88 EA=1EA .00 1 00000000 41.00
PEDIATRIC WRI 00123 79-87281 11.88 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501127 PELVIC TRACTION BELT UNIVE 00420 1678-001 14.16 BX=1BX .00 1 00000000 45.00
PELVIC TRACTI 14.16 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000637 PENCILS 00118 UNV55400 .39 BX=1BX .00 1 00000000 .00
PENCILS .39 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001502 PHILLIP EKG PAPER 00249 GCO32016653 87.17 CS=1CS .00 1 00000000 .00
PHILLIP EKG P 87.17 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 408
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90000346 PHYSICIAN ORDERS 00783 HFS14 49.50 BX=1BX .00 1 00000000 .00
PHYSICIAN ORD 495.00 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501421 PICC TRAY 00487 21-2904-24 50.40 EA=1EA .00 1 00000000 377.00
PICC TRAY 252.00 CS=5EA/CS 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000008 PILLOW 00249 PM1824-15 1.3483 EA=1EA .00 1 00000000 .00
PILLOW 16.18 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001528 PILLOWS REUSABLE 00249 MDT219683 3.69 EA=1EA .00 1 00000000 .00
PILLOWS REUSA 3.69 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2330508 PNEUMOCOCCAL VACCINE ADMINISTRATION .00 EA= .00 1 00000000 788.00
ADMIN PNEUMOC .00 .00 2 00000000 .00
.......... EL(0771) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0009 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
90000769 POCKET CHAMBER 01304 317-621-210 7.52 EA=1EA .00 1 00000000 26.00
POCKET CHAMBE 75.15 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2330495 PORT-A-CATH BLOOD DRAW .00 EA= .00 1 00000000 51.00
PORT-A-CATH B .00 .00 2 00000000 .00
.......... 56(0301) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36591 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 409
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000626 POST-ITS 1 1/2X2 YELLOW 00499 UNV35662 .5242 EA=1PK .00 1 00000000 .00
POST-ITS 1 1/ 6.29 PK=12PK/PK 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000625 POST-ITS-3X3 YELLOW 00052 UNV35688 1.2492 EA=1PK .00 1 00000000 .00
POST-ITS-3X3 00361 562896 14.99 PK=12PK/PK 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501473 POST-OP SHOE PEDIATRIC 00420 8601-697-01 11.73 EA=1EA .00 1 00000000 99.00
POST-OP SHOE 11.73 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001386 POSTERIOR TIB/FIB LARGE 30 00123 79-72297 19.52 EA=1EA .00 1 00000000 39.00
POSTERIOR TIB 19.52 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000195 POWDER 00249 MSC095390 .4422 EA=1EA .00 1 00000000 .00
POWDER 15.92 CS=36EA/CS 36 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2146225 PPH STAPLE GUN 00249 BAR9001C0212 22.57 EA=1EA .00 1 00000000 924.00
PPH STAPLE GU 00043 9001C0212 225.70 BX=10EA/BX 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001376 PREFILLED NS SYRINGE 10ML 00257 723306546 7.94 BX=1BX .00 1 00000000 10.00
PREFILLED NS 238.14 CS=30BX/CS 30 .00 2 00000000 .00
.......... 78(0250) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000170 PROBE COVER CRITIKON 00257 1720008815 19.90 BX=1BX .00 1 00000000 .00
PROBE COVER C 19.90 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 410
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000242 PROBE COVER WELCH ALLYN 00062 75-05031 66.85 BX=1BX .00 1 00000000 .00
PROBE COVER W 00249 W-A05031750 66.85 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
890037 PROCEDURE INTERMEDIA .00 EA= .00 1 00000000 567.00
PROCEDURE INT .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501146 PROCEDURE TRAY (PICC) 00487 21-2501-01 26.20 EA=1EA .00 1 00000000 377.00
PROCEDURE TRA 262.00 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2146227 PROLENE MESH PMII 3X6 00249 ETHPMII 78.815 EA=1EA .00 1 00000000 478.00
PRLENEMESHP3X 00043 9001C0212 472.89 BX=6EA/BX 6 .00 2 00000000 .00
.......... 50(0278) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: C1781 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
80001431 PRONOVA 6-0 00257 230003805H 288.34 BX=1BX .00 1 00000000 .00
PRONOVA 6-0 288.34 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001500 PROTEST BI TEST PACK 00452 PT-3-BITP 155.43 CS=1CS .00 1 00000000 .00
PROTEST BI TE 155.43 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001119 PROXIMATE LINEAR CUTTER TC 00249 TCR75 69.20 EA=1EA .00 1 00000000 173.00
PROXIMATE LIN 830.35 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 411
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
890019 PULSE OX .00 EA= .00 1 00000000 57.00
PULSE OX .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 94760 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2500681 PULSE OXISENSOR ADULT 00263 0600-00-0121 10.9917 EA=1EA .00 1 00031110 234.00
PULSE OXISENS 00249 MM01859 263.80 CS=24EA/CS 24 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501620 PULSE OXISENSOR ADULT (OR) 00249 4110001001 8.98 EA=1EA .00 1 00000000 104.00
PULSE OXISENS 179.69 CS=20EA/CS 20 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500682 PULSE OXISENSOR PED. 00263 00600-00-0122 12.9765 EA=1EA .00 1 00031110 203.00
PULSE OXISENS 00249 MMO1860 259.53 CS=20EA/CS 20 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001447 PURPLE ID BAND 00257 518905033PDM 88.25 BX=1BX .00 1 00000000 .00
PURPLE ID BAN 88.25 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000464 PYXIS PAPER 00302 107071-01 1.95 RL=1RL .00 1 00000000 .00
PYXIS PAPER 97.65 PK=50RL/PK 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501098 QUIK -COMBO ELECTRODE ADUL 00295 11996000091 24.05 EA=1EA .00 1 00000000 179.00
QUIK -COMBO E 00249 PHY1199600091 24.05 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 412
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
890042 RABIES VACCINE .00 EA= .00 1 00000000 61.00
RABIES VACCIN .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001644 RAPICIDE GLUT HIGH LEVEL 00249 SDCML020127 24.83 EA=1EA .00 1 00000000 .00
OPA 28 00248 ML02-0059 99.32 CS=4EA/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500202 RAZOR 00249 BRN1333Z .394 EA=1EA .00 1 00031110 10.00
RAZOR 00062 80-02 3.94 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001135 RE/X EXP FILTER/760 00394 G-060526-00 102.60 EA=1EA .00 1 00000000 .00
RE/X EXP FILT 102.60 CS=1EA/CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001535 READY BATH COMPLETE 00249 MSC095304 .7073 EA=1EA .00 1 00000000 .00
READY BATH CO 21.22 CS=30EA/CS 30 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500085 RED RUBBER 10FR 00249 DYND13510 .8275 EA=1EA .00 1 00000000 20.00
RED RUBBER 10 9.93 CS=12EA/CS 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500086 RED RUBBER 12 FR 00249 0620-94120 .87 EA=1EA .00 1 00000000 20.00
RED RUBBER 12 87.00 CS=100EA/CS 100 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500087 RED RUBBER 14FR 00249 0620-94140 .83 EA=1EA .00 1 00000000 20.00
RED RUBBER 14 82.75 CS=100EA/CS 100 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 413
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500088 RED RUBBER 16FR 00257 0620-94160 .80 EA=1EA .00 1 00000000 20.00
RED RUBBER 16 80.00 CS=100EA/CS 100 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500089 RED RUBBER 18FR 00249 0620-94180 .83 EA=1EA .00 1 00000000 20.00
RED RUBBER 18 82.75 CS=100EA/CS 100 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90002195 RESPIRONIC MED NASAL CONT 01304 73-302180 51.35 EA=1EA .00 1 00000000 44.00
RESPIRONIC ME 51.35 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90002199 RESPIRONICS LG GOLDS NAS M 01304 73-302356 57.00 EA=1EA .00 1 00000000 44.00
RESPIRONICS L 57.00 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90002197 RESPIRONICS LG NASAL CONT 01304 73-302188 41.44 EA=1EA .00 1 00000000 44.00
RESPIRONICS L 41.44 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90002198 RESPIRONICS MED GOLDS NAS 01304 73-302354 57.00 EA=1EA .00 1 00000000 44.00
RESPIRONICS M 57.00 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90002196 RESPIRONICS SM NASAL CONT 01304 73-302187 51.35 EA=1EA .00 1 00000000 44.00
RESPIRONICS S 51.35 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501253 RHINO ROCKET 00249 SGY11S05008AS 23.445 EA=1EA .00 1 00000000 63.00
RHINO ROCKET 93.78 BX=4EA/BX 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 414
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001044 RHYTHM STRIPS 00062 D3247P 53.25 BX=1BX .00 1 00000000 .00
RHYTHM STRIPS 00265 1234 532.50 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501255 RIB BELT FEMALE 00420 2722-008 .29 EA=1EA .00 1 00000000 98.00
RIB BELT FEMA 3.49 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501254 RIB BELT MALE 00420 2721-008 .29 EA=1EA .00 1 00000000 98.00
RIB BELT MALE 3.49 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000664 RUBBERBANDS 00499 UNV00432 9.99 BX=1BX .00 1 00000000 .00
RUBBERBANDS 9.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001262 SAFE SORB 00249 DYNDS1500B 1.2286 EA=1EA .00 1 00000000 .00
SAFE SORB 117.95 CS=96EA/CS 96 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000493 SAFETY GLASSES 00249 NON24770H 1.78 EA=1EA .00 1 00000000 .00
SAFETY GLASSE 1.78 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001215 SAFETY NEEDLE 18X11/2 00257 3.58382E+11 21.40 BX=1BX .00 1 00000000 .00
SAFETY NEEDLE 21.40 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001238 SAFETY NEEDLE 21X1 00249 B-D305764Z 15.175 BX=1BX .00 1 00000000 .00
SAFETY NEEDLE 15.175 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 415
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001239 SAFETY NEEDLE 22X1 00249 SWD850210Z 9.35 BX=1BX .00 1 00000000 .00
SAFETY NEEDLE 9.35 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001216 SAFETY NEEDLE 22X11/2 00249 B-D305763Z 15.175 BX=1BX .00 1 00000000 .00
SAFETY NEEDLE 15.175 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001217 SAFETY NEEDLE 23X1 00249 B-D305762Z 15.175 BX=1BX .00 1 00000000 .00
SAFETY NEEDLE 15.175 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001219 SAFETY NEEDLE 25X1 00249 B-D305916Z 11.075 BX=1BX .00 1 00000000 .00
SAFETY NEEDLE 11.075 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001218 SAFETY NEEDLE 25X11/2 00249 SYRS100257Z 21.84 BX=1BX .00 1 00000000 .00
SAFETY NEEDLE 21.84 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001221 SAFETY NEEDLE 25X5/8 00249 B-D305901Z 11.0775 BX=1BX .00 1 00000000 .00
SAFETY NEEDLE 11.0775 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001391 SAFETY NEEDLES 18X1 00249 SWD850810Z 12.82 BX=1BX .00 1 00000000 .00
SAFETY NEEDLE 12.82 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000235 SAFETY PINS 00257 286730392C .89 BG=1BG .00 1 00000000 .00
SAFETY PINS 10.62 BX=12BG/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 416
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500222 SAFETY SCALPEL 10 00249 MDS15310 1.707 EA=1EA .00 1 00000000 32.00
SAFETY SCALPE 17.07 BX=1BX/10 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500223 SAFETY SCALPEL 11 00249 MDS153111 1.301 EA=1EA .00 1 00000000 32.00
SAFETY SCALPE 13.01 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500224 SAFETY SCALPEL 15 00249 MDS15315 .8708 EA=1EA .00 1 00000000 14.00
SAFETY SCALPE 10.45 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001349 SALUTE INSTRUMENT 00467 113077 230.00 EA=1EA .00 1 00000000 .00
SALUTE INSTRU 1150.00 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000199 SCISSOR SHARP/BLUNT 00249 DYND04000 1.7904 EA=1EA .00 1 00000000 .00
SCISSOR SHARP 44.76 BX=25EA/BX 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501378 SENSI-TOUCH GLOVES 61/2 00249 MSG4065Z .2456 EA=1EA .00 1 00031110 12.00
SENSI-TOUCH G 12.28 BX=50EA/BX 50 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501379 SENSI-TOUCH GLOVES 7.0 00249 MSG4070Z .2456 EA=1EA .00 1 00031110 12.00
SENSI-TOUCH G 12.28 BX=50EA/BX 50 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501380 SENSI-TOUCH GLOVES 71/2 00249 MSG4075Z .2456 EA=1EA .00 1 00031110 12.00
SENSI-TOUCH G 12.28 BX=50EA/BX 50 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 417
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501381 SENSI-TOUCH GLOVES 8.0 00249 MSG4080Z .2456 EA=1EA .00 1 00031110 12.00
SENSI-TOUCH G 12.28 BX=50EA/BX 50 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001336 SHAMPOO CAP 00249 MSC095230 .9678 EA=1EA .00 1 00000000 .00
SHAMPOO CAP 38.71 CS=30EA/CS 40 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001060 SHARP CONT. LAB 00249 KDL31143665 5.0033 EA=1EA .00 1 00000000 .00
SHARP CONT. L 30.02 CS=6EA/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000040 SHARP CONT.17 GAL 00249 KDL8991 13.582 EA=1EA .00 1 00000000 .00
SHARP CONT.17 00062 68-8980C 67.91 CS=5EA/CS 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=41115109 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000041 SHARP CONT.NEEDLE 00249 3.58331E+11 .94 EA=1EA .00 1 00000000 .00
SHARP CONT.NE 75.20 CS=80EA/CS 80 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001034 SHARP CONTAINER HK 00249 BEH175020 113.12 CS=1CS .00 1 00000000 .00
SHARP CONTAIN 113.12 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000645 SHARPIE-BLACK FINE POINT 00499 SAN30001 11.99 EA=1EA .00 1 00000000 .00
SHARPIE-BLACK 11.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000646 SHARPIE-XTRA FINE POINT BL 00499 125443 .8158 EA=1EA .00 1 00000000 .00
SHARPIE-XTRA 9.79 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 418
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501203 SHAVING CREAM 00249 MSC095014 .5314 EA=1EA .00 1 00000000 .00
SHAVING CREAM 76.52 CS=144EA/CS 144 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000582 SHEET PROTECTOR TOP 00499 UNV-21125 13.99 BX=1BX .00 1 00000000 .00
SHEET PROTECT 13.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000306 SHOECOVER 00249 CRI2002 4.82 BX=1BX .00 1 00000000 .00
SHOECOVER 14.46 CS=3BX/CS 3 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500434 SHOULDER BRACE MENS SM 00420 78301 7.32 BX=1BX .00 1 00000000 128.00
SHOULDER BRAC 7.32 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500437 SHOULDER BRACE MENS XL 00249 ORT16100XL 13.71 BX=1BX .00 1 00000000 128.00
SHOULDER BRAC 13.71 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500433 SHOULDER BRACE WOMEN XL 00420 78404 7.24 BX=1BX .00 1 00000000 128.00
SHOULDER BRAC 7.24 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500436 SHOULDER MENS LG 00249 ORT16100L 12.77 BX=1BX .00 1 00000000 128.00
SHOULDER MENS 12.77 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500435 SHOULDER MENS MD 00249 ORT16100M 17.49 BX=1BX .00 1 00000000 128.00
SHOULDER MENS 17.49 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 419
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500432 SHOULDER WOMEN LG 00249 ORT16100L 12.28 BX=1BX .00 1 00000000 128.00
SHOULDER WOME 12.28 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500431 SHOULDER WOMEN MD 00420 78402 9.28 BX=1BX .00 1 00000000 128.00
SHOULDER WOME 9.28 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500430 SHOULDER WOMEN SM 00249 ORT16100S 19.49 BX=1BX .00 1 00000000 128.00
SHOULDER WOME 19.49 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501466 SILVERSORB 1" 00249 MSC9310EP 2.5333 BX=1BX .00 1 00031110 51.00
SILVERSORB 1" 76.00 BX=30EA/BX 30 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2330511 SIMPLE PROCEDURE ER .00 EA= .00 1 00000000 230.00
SIMPLE PROCED .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501458 SINGLE BASIN SET 00249 DYNJ06610A 3.8517 EA=1EA .00 1 00000000 24.00
SINGLE BASIN 23.11 CS=6EA/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500197 SITZ BATH 00249 DYND801020 1.619 EA=1EA .00 1 00000000 90.00
SITZ BATH 16.19 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500862 SKIN MARKERS 00249 DYNJSM01 .369 EA=1EA .00 1 00000000 20.00
SKIN MARKERS 18.45 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 420
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90000723 SMALL DISPOS VINYL NASAL M 01304 73312102EA 14.49 EA=1EA .00 1 00000000 44.00
SMALL DISPOS 14.49 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001392 SODIUM CHLORIDE INJECTION 00257 4131118881 312.75 CS=1CS .00 1 00000000 .00
SODIUM CHLORI 312.75 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001501 SODIUM CHLORIDE INJECTION 00257 723306544 .48 EA=1EA .00 1 00000000 .00
SODIUM CHLORI 231.31 CS=480EA/CS 480 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001387 SONY COLOR FILM ACCESS LAB 00085 UPT210BL 260.00 BX=1BX .00 1 00000000 .00
SONY COLOR FI 260.00 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001240 SONY COLOR PRINT 2010 00435 UPC-2010 85.00 BX=1BX .00 1 00000000 .00
SONY COLOR PR 85.00 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001241 SONY COLOR PRINT 5010 00435 UPC-501 140.00 BX=1BX .00 1 00000000 .00
SONY COLOR PR 140.00 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000465 SPACELAB PAPER 00249 SHE307438001 1.816 RL=1RL .00 1 00000000 .00
SPACELAB PAPE 18.16 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500182 SPECIMEN CUP STERILE 00249 DYND30330 .113 EA=1EA .00 1 00031110 23.00
SPECIMEN CUP 00084 ST6 11.30 CS=100EA/CS 100 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 421
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
890020 SPINAL/LUMBAR PUNCTU .00 EA= .00 1 00000000 525.00
SPINAL/LUMBAR .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 62270 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
80000174 SPONGE DRAINAGE 4X4 6PLY 00249 NON256000H 2.51 BX=1BX .00 1 00000000 .00
SPONGE DRAINA 2.51 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000177 SPONGES 4X4 NS 00249 PRM21412C 2.823 PK=1PK .00 1 00000000 .00
SPONGES 4X4 N 28.23 CS=10PK/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500055 SPRING WIRE GUIDE 00035 AW14735 9.87 EA=1EA .00 1 00000000 40.00
SPRING WIRE G 246.75 CS=25EA/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000632 STAPLE REMOVER 00499 UNV00700 .23 EA=1EA .00 1 00000000 .00
STAPLE REMOVE .23 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500201 STAPLER REM.TRAY 00249 DYNJ04058Z .7683 EA=1EA .00 1 00000000 16.00
STAPLER REM.T 9.22 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000631 STAPLES 00118 UNV79000 1.29 BX=1BX .00 1 00000000 .00
STAPLES 1.29 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 422
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001428 STATLOCK PICC PLUS 00257 PIC0220 4.33 EA=1EA .00 1 00000000 .00
STATLOCK PICC 216.73 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500272 STERI-STRIP .25 00249 NON250114Z .4006 EA=1EA .00 1 00000000 41.00
STERI-STRIP . 20.03 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500273 STERI-STRIP .50 00249 MMMR1547Z .8362 EA=1EA .00 1 00000000 35.00
STERI-STRIP . 41.81 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501260 STERI-STRIPS W8514 (OR) 00249 NON250114Z 1.0708 EA=1EA .00 1 00000000 18.00
STERI-STRIPS 53.54 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500534 STERILE GUIDE 18GA NEEDLES 00249 BAR9001C0212 22.652 EA=1EA .00 1 00000000 144.00
STERILE GUIDE 00043 9001C0212 226.52 BX=10EA/BX 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001400 STERIS HAND SANITIZER 00249 DBU118187 5.3854 EA=1EA .00 1 00000000 .00
STERIS 64.625 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=41115109 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001220 STETHOSCOPE ISOLATION 00249 MDS9543 2.34 EA=1EA .00 1 00000000 .00
STETHOSCOPE I 2.34 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001433 STIFF GUIDE WIRE 00035 GS3508 69.30 EA=1EA .00 1 00000000 .00
STIFF GUIDE W 346.50 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 423
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000413 STOCKINETTE 3" 00249 MDT221203 5.49 BX=1BX .00 1 00000000 .00
STOCKINETTE 3 5.49 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000412 STOCKINETTE 4" 00249 MDT221204 7.18 BX=1BX .00 1 00000000 .00
STOCKINETTE 4 7.18 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001181 STOMADHESIVE POWDER 00257 1638025510 3.20 EA=1EA .00 1 00000000 .00
STOMADHESIVE 3.20 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001180 STOMEHESIVE PASTE 00249 SQU183910 2.07 EA=1EA .00 1 00000000 .00
STOMEHESIVE P 2.07 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000183 STOOL CUPS 00249 DYND30510 .894 PK=1PK .00 1 00000000 .00
STOOL CUPS 22.35 CS=25PK/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500309 STOPCOCK 3-WAY 00249 MDXMX412SL 1.4022 EA=1EA .00 1 00000000 25.00
STOPCOCK 3-WA 70.11 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000586 STRAIGHT CUT END TAB FOLDE 00361 24110 27.99 BX=1BX .00 1 00000000 .00
STRAIGHT CUT 00118 SMD24110 27.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501366 STRAIGHT TYPE BLOOD SET 2C 00793 M46443160 3.5437 EA=1EA .00 1 00000000 110.00
STRAIGHT TYPE 00249 BHL2C8750H 106.31 CS=30EA/CS 30 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 424
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000342 STRAWS 00249 NON02325 3.7724 BX=1BX .00 1 00000000 .00
STRAWS 00380 1234 94.31 CS=25BX/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001340 STYROFOAM CUP 8OZ. 00692 318 17.45 CS=1CS .00 1 00000000 .00
STYROFOAM CUP 17.45 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500084 SUCTION CANNISTER 1200 00249 BXT65651395 1.668 EA=1EA .00 1 00031110 54.00
SUCTION CANNI 50.04 CS=30EA/CS 30 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500077 SUCTION CATH 10FR 00249 DYND41900 .28 EA=1EA .00 1 00031110 18.00
SUCTION CATH 28.47 CS=100EA/CS 100 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500078 SUCTION CATH 12FR 00249 DYND41901H 1.40 EA=1EA .00 1 00031110 18.00
SUCTION CATH 1.40 EA=1EA/EA 1 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500079 SUCTION CATH 14FR 00249 DYND41902H 1.40 EA=1EA .00 1 00031110 18.00
SUCTION CATH 1.40 EA=1EA/EA 1 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500080 SUCTION CATH 16FR 00249 DYND41903 .2242 EA=1EA .00 1 00031110 41.00
SUCTION CATH 22.42 CS=100EA/CS 100 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500081 SUCTION CATH 18FR 00249 DYND40904 .32 EA=1EA .00 1 00031110 18.00
SUCTION CATH 31.90 CS=100EA/CS 100 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 425
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500075 SUCTION CATH 6FR 00249 413085370 .58 EA=1EA .00 1 00031110 18.00
SUCTION CATH 58.00 CS=100EA/CS 100 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500076 SUCTION CATH 8FR 00249 DYND41908H 1.40 EA=1EA .00 1 00031110 18.00
SUCTION CATH 1.40 EA=1EA 1 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500082 SUCTION CATH TRAY 14FR 00249 DYND41442 1.2486 EA=1EA .00 1 00031110 68.00
SUCTION CATH 44.95 CS=36EA/CS 36 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000311 SUR.GLOVES ALOETOUCH 6.0 00249 MDS206060Z .93 EA=1EA .00 1 00000000 .00
SUR.GLOVES AL 46.50 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501397 SURE SEAL 00249 2610085200 11.73 BX=1BX .00 1 00000000 7.00
SURE SEAL 11.73 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000217 SURG.BLADES 10 00257 0723-371110 12.32 BX=1BX .00 1 00000000 .00
SURG.BLADES 1 12.32 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000218 SURG.BLADES 11 00257 0723-371111 13.685 BX=1BX .00 1 00000000 .00
SURG.BLADES 1 13.685 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000220 SURG.BLADES 15 00249 B-D371153Z 15.74 BX=1BX .00 1 00000000 .00
SURG.BLADES 1 15.74 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 426
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500316 SURG.GLOVES 81/2 00249 407008327 .89 EA=1EA .00 1 00031110 12.00
SURG.GLOVES 8 44.33 BX=50EA/BX 50 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500312 SURG.GLOVES ALOE-TOUCH 61/ 00249 MSG1065Z 1.3736 EA=1EA .00 1 00031110 12.00
SURG.GLOVES A 34.34 BX=25EA/BX 25 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500313 SURG.GLOVES ALOETOUCH 7 00249 MSG1070Z 1.4016 EA=1EA .00 1 00031110 12.00
SURG.GLOVES A 35.04 BX=25EA/BX 25 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500314 SURG.GLOVES ALOETOUCH 7.5 00249 MSG1075Z 1.3736 EA=1EA .00 1 00031110 12.00
SURG.GLOVES A 34.34 BX=25EA/BX 25 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500315 SURG.GLOVES ALOETOUCH 8.0 00249 MSG1080Z 1.4016 EA=1EA .00 1 00031110 12.00
SURG.GLOVES A 35.04 BX=25EA/BX 25 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000301 SURG.MASK (BLUE) 00249 NON27376 7.9217 BX=1BX .00 1 00000000 .00
SURG.MASK (BL 47.53 CS=6BX/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000304 SURGEON CAPS 00249 NON28626 7.80 BX=1BX .00 1 00000000 .00
SURGEON CAPS 39.00 CS=5BX/CS 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001520 SURGEON GLOVES LF,PF 7.0 00257 407008514 76.63 BX=1BX .00 1 00000000 .00
SURGEON GLOVE 76.63 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 427
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001519 SURGEON GLOVES LF,PF 71/2 00257 407008515 76.63 BX=1BX .00 1 00000000 .00
SURGEON GLOVE 76.63 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000300 SURGICAL GOWN XL 00249 DYNJP2307P 3.3658 EA=1EA .00 1 00000000 .00
SURGICAL GOWN 80.78 CS=24EA/CS 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500474 SURGICEL 2X3 00249 ETH1953Z 51.2333 EA=1EA .00 1 00000000 79.00
SURGICEL 2X3 614.80 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500473 SURGICEL 4X8 00249 1952 52.14 EA=1EA .00 1 00000000 143.00
SURGICEL 4X8 625.71 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500237 SUSPENSORY LG 00249 IMP091103 4.86 EA=1EA .00 1 00000000 21.00
SUSPENSORY L 4.86 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500236 SUSPENSORY MD 00249 IMP091102 4.86 EA=1EA .00 1 00000000 21.00
SUSPENSORY MD 4.86 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500238 SUSPENSORY XL 00249 723202612 4.36 EA=1EA .00 1 00000000 21.00
SUSPENSORY XL 4.36 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500200 SUTURE REM.TRAY 00249 DYND70900 .8146 EA=1EA .00 1 00000000 36.00
SUTURE REM.TR 40.73 CS=50EA/CS 50 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 428
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000036 SYRINGE 10CC 00249 B-D309604 12.975 BX=1BX .00 1 00000000 .00
SYRINGE 10CC 25.95 CS=2BX/CS 2 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000057 SYRINGE 20CC 00249 SYR120010 35.07 BX=1BX .00 1 00000000 .00
SYRINGE 20CC 00062 68-9661 35.07 CS=4BX/CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000060 SYRINGE 3CC 00249 SYR103010 6.7325 BX=1BX .00 1 00000000 .00
SYRINGE 3CC 00062 68-1610 53.86 CS=8BX/CS 8 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000035 SYRINGE 5CC 00249 SYR105010 8.5575 BX=1BX .00 1 00000000 .00
SYRINGE 5CC 34.23 CS=4BX/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000065 SYRINGE 60CC CT 00249 B-D309620Z 11.89 BX=1BX .00 1 00000000 .00
SYRINGE 60CC 11.89 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000064 SYRINGE 60CC LL 00249 B-D309653Z 11.89 BX=1BX .00 1 00000000 .00
SYRINGE 60CC 11.89 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501068 SYRINGE EAR 2OZ 00249 DYND70280 .4136 EA=1EA .00 1 00000000 11.00
SYRINGE EAR 2 20.68 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001377 SYRINGE PREFILLED NS 3ML 00257 723306544 7.62 BX=1BX .00 1 00000000 .00
SYRINGE PREFI 228.61 CS=30BX/CS 30 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 429
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000629 TAPE DISPENSER 00052 MMMC38 4.99 EA=1EA .00 1 00000000 .00
TAPE DISPENSE 00361 649245 4.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000876 TAPE MICROPORE 00249 NON260001D .4669 EA=1EA .00 1 00000000 .00
TAPE MICROPOR 67.24 CS=144EA/CS 144 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000995 TB MASK 00249 MMM1860 10.485 BX=1BX .00 1 00000000 .00
TB MASK 62.91 CS=6BX/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001300 TB MASK SMALL 00249 MMM1860S 10.485 BX=1BX .00 1 00000000 .00
TB MASK SMALL 62.91 CS=6BX/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001105 TB SYRINGE 00249 B-D305945Z 29.85 BX=1BX .00 1 00000000 .00
TB SYRINGE 29.85 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500992 TEGERDERM IV 00249 MSC2302 .2391 EA=1EA .00 1 00000000 23.00
TEGERDERM IV 23.91 BX=100EA/BX 100 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500289 TELFA 4X8 ADH 00257 3583005111 .55 EA=1EA .00 1 00000000 14.00
TELFA 4X8 AD 27.29 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500288 TELFA 3X4 NON-ADH. 00249 NON25710 1.0762 EA=1EA .00 1 00000000 14.00
TELFA 3X4 NON 53.81 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 430
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500287 TELFA 3X8 NON-ADH 00249 NON25720Z .0912 EA=1EA .00 1 00000000 6.00
TELFA 3X8 NON 4.56 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500533 TEMP SHARP HOLDER 00249 DYNJNDLNEST .643 EA=1EA .00 1 00000000 .00
TEMP SHARP HO 32.15 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000341 TERRI-WIPES 00249 NON260506 2.15 BX=1BX .00 1 00000000 .00
TERRI-WIPES 00062 10-DW501 21.50 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2599999 TEST ITEM 00249 TEST123 8.8878 EA=1 EA .00 1 00000000 .00
TEST ITEM 159.98 CS=18EA/CS 18 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 8.8878 1 .00 3 00000000 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1496372 THERAPEUTIC PROPHYLACTIC INJECTION .00 EA= .00 1 00031110 50.00
THERAPEUTIC P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96372 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2500381 THIGH HIGH LG 00432 204029 8.04 EA=1EA .00 1 00000000 115.00
THIGH HIGH LG 00249 MDS160860 40.20 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500380 THIGH HIGH MED 00249 MDS160844 8.1417 EA=1EA .00 1 00000000 115.00
THIGH HIGH ME 48.85 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 431
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500379 THIGH HIGH SM 00249 MDS160824 9.2567 EA=1EA .00 1 00000000 115.00
THIGH HIGH SM 55.54 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500382 THIGH HIGH XL 00249 MDS160884 9.785 EA=1EA .00 1 00000000 259.00
THIGH HIGH XL 58.71 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501425 TIP STOPS 00249 GMO114555H 2.48 EA=1EA .00 1 00000000 15.00
TIP STOPS 2.48 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000192 TONGUE BLADE NON 00257 5937W0D3002 3.25 BX=1BX .00 1 00000000 .00
TONGUE BLADE 3.25 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000193 TONGUE BLADE S 00249 MDS202075 1.673 BX=1BX .00 1 00000000 .00
TONGUE BLADE 16.73 CS=1BX/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501195 TOOTHPASTE 00249 NONTP6IZ .1101 EA=1EA .00 1 00000000 .00
TOOTHPASTE 15.86 CS=144EA/CS 144 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001334 TOURNIQUET 00249 DYND75020 170.30 BX=1BX .00 1 00000000 .00
TOURNIQUET 00462 ML14325 170.30 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
890039 TOXOID VACCINE .00 EA= .00 1 00000000 61.00
TOXOID VACCIN .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90471 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 432
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500083 TRACH CLEANING TRAY 00249 DYND40589 1.8935 EA=1EA .00 1 00031110 50.00
TRACH CLEANIN 37.87 CS=20EA/CS 20 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000090 TRACH TUBE HOLDER 00249 1821000240 2.77 EA=1EA .00 1 00000000 .00
TRACH TUBE HO 27.65 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000188 TRANSPORE TAPE 1" 00249 MMM15271 6.394 BX=1BX .00 1 00000000 .00
TRANSPORE TAP 63.94 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000189 TRANSPORE TAPE 2" 00249 MMM15272 6.591 BX=1BX .00 1 00000000 .00
TRANSPORE TAP 65.91 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000336 TRASH BAGS 24X33 00249 HTBD4832RC 23.107 CS=1CS .00 1 00000000 .00
TRASH BAGS 24 00380 5595806 23.107 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=41115109 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000337 TRASHBAGS 43X48 00249 HTBX7658AK 26.8075 CS=1CS .00 1 00000000 .00
TRASHBAGS 43X 00380 1298845 26.8075 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=41115109 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
890021 TRIGGER POINT INJECT .00 EA= .00 1 00000000 296.00
TRIGGER POINT .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20552 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 433
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000295 TUBING NON-CONDUCTIVE 00249 BXTN7100RL 8.305 BX=1BX .00 1 00000000 .00
TUBING NON-CO 8.305 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501249 TWIN-CATH MULTIPLE -LUMEN 00249 ARWIV01100H 4.17 EA=1EA .00 1 00000000 44.00
TWIN-CATH MUL 4.17 EA=1EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001383 ULTRA SONIC GEL 00249 MDS092010 12.79 EA=1EA .00 1 00000000 .00
ULTRA SONIC G 51.16 CS=4EA/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500986 UNDERPADS 00249 MSC281226 .0967 EA=1EA .00 1 00000000 11.00
UNDERPADS 00074 KC7176 14.50 CS=150EA/CS 150 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501039 UNIVERSAL ARM SLING 00249 ORT11010D 9.4125 EA=1EA .00 1 00000000 65.00
ARM SLING UNI 00432 1796-12-10 37.65 CS=4EA/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501117 UNNA BOOT (WHITE BOX) 00249 GHFUNNA4H 11.12 BX=1BX .00 1 00000000 98.00
UNNA BOOT (WH 11.12 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500402 UNNA BOOT MEDICO PASTE 00249 4927001053 6.85 BX=1BX .00 1 00000000 98.00
UNNA BOOT MED 68.51 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500999 URETHRAL CATH TRAY 00249 BRD772415 1.2295 EA=1EA .00 1 00031110 110.00
URETHRAL CATH 00062 21-802214 24.59 CS=20EA/CS 20 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 434
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500185 URINALS 00249 DYND80235S .3194 EA=1EA .00 1 00000000 14.00
URINALS 00084 910 15.33 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500262 URINE FILTER 00249 2748010713 .08 EA=1EA .00 1 00000000 8.00
URINE FILTER 20.70 BX=250EA/BX 250 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000063 URINE JAR 24HR 00249 DYND80024 .985 EA=1EA .00 1 00000000 .00
URINE JAR 24H 19.70 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500244 URINE TOLET MEASURE 00249 DYND36600 .2354 EA=1EA .00 1 00000000 45.00
URINE TOLET M 23.54 CS=100EA/CS 100 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000023 VAC NEEDLE 21GA 00249 358381-216041 5.55 BX=1BX .00 1 00000000 .00
VAC NEEDLE 21 5.55 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1490471 VACCINE ADMINISTRATION FIRST SHOT .00 EA= .00 1 00000000 49.00
VACCINE ADMIN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90471 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330509 VACCINE/RABIES .00 EA= .00 1 00000000 76.00
VACCINE/RABIE .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90372 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 435
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2330506 VACCINE/TOXOID TETANUS .00 EA= .00 1 00000000 76.00
VACCINE/TOXOI .00 .00 2 00000000 .00
.......... EL(0771) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90471 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2501287 VAGINAL PACKING 00249 4684010026 5.05 EA=1EA .00 1 00000000 30.00
VAGINAL PACKI 121.24 CS=24EA/CS 24 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500276 VASELINE GAUZE 3X9 00249 CUR251390Z .3744 EA=1EA .00 1 00000000 12.00
VASELINE GAUZ 18.72 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001338 VASELINE LIP THERAPY 00257 123302831HP .92 EA=1EA .00 1 00000000 .00
VASELINE LIP 22.11 BX=24EA/BX 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000248 VASELINE TUBE 00249 MSC095034 1.8383 EA=1EA .00 1 00000000 .00
VASELINE TUBE 22.06 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000744 VENTISURE DIS INFANT RESUS 01304 76750 81.75 EA=1EA .00 1 00000000 221.00
VENTISURE DIS 81.75 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000743 VENTISURE DISP PED RESUS B 01304 3015580EA 32.20 EA=1EA .00 1 00000000 221.00
VENTISURE DIS 32.20 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 436
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500153 VEST REST LG 00249 MDT828024 6.4783 EA=1EA .00 1 00031110 99.00
VEST REST LG 38.87 CS=6EA/CS 6 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500152 VEST REST MD 00249 MDT828022 6.4783 EA=1EA .00 1 00000000 99.00
VEST REST MD 38.87 CS=6EA/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500151 VEST REST SM 00249 MDT828020 6.115 EA=1EA .00 1 00031110 99.00
VEST REST SM 36.69 CS=6EA/CS 6 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501290 VEST RESTRAINT XL 00249 52557991628 8.49 EA=1EA .00 1 00000000 99.00
VEST RESTRAIN 84.88 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500889 WALKING BOOT PNEUMATIC MED 00249 ORT28610M 85.12 BX=1BX .00 1 00000000 344.00
WALKING BOOT 00123 O1F-M 85.12 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500864 WARMING BLANKETS-ER/ICU 00093 243 7.049 EA=1EA .00 1 00000000 119.00
WARMING BLANK 00249 CSZ82243 70.49 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90002040 WASTE BAGS 00048 81904 30.69 EA=1EA .00 1 00000000 .00
WASTE BAGS 30.69 EA=1EA 1 .00 2 00000000 .00
.......... 55(0300) INV.GL=41115041 EXP.GL= .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000338 WATER SOLUBLE BG 00249 NON02800 7.405 PK=1PK .00 1 00000000 .00
WATER SOLUBLE 29.62 CS=4PK/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 437
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001027 WHITE-OUT 00052 PAP-56401 24.99 EA=1EA .00 1 00000000 .00
WHITE-OUT 00361 131383 24.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500557 WIRE GUIDE 145CM 00264 G09607 44.38 EA=1EA .00 1 00000000 128.00
WIRE GUIDE 14 44.38 EA=1EA/EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000318 WRAP 24 00249 GEM3124 45.00 PK=1PK .00 1 00000000 .00
WRAP 24 45.00 CS=1PK/CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000317 WRAP 36 00249 GEM3136 19.9933 PK=1PK .00 1 00000000 .00
WRAP 36 59.98 CS=3PK/CS 3 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000307 WRAP 54 00249 GEM4154 40.68 PK=1PK .00 1 00000000 .00
WRAP 54 40.68 CS=1PK/PK 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501037 WRIST SPLINT R 00432 1769-02 8.33 EA=1EA .00 1 00000000 92.00
WRIST SPLINT 00249 ORT18000R 8.33 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501036 WRIST SPLINT COCKUP L 00432 1769-03 8.33 EA=1EA .00 1 00000000 92.00
WRIST SPLINT 00249 ORT18000L 8.33 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500278 XEROFORM 4X4 00249 CUR253440Z .9864 EA=1EA .00 1 00000000 9.00
XEROFORM 4X4 24.66 BX=25EA/BX 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 438
TIME: 08:24 ITEM MASTER LIST DEPT# 008 INFUSION CENTER H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500277 XEROFORM 5X9 00249 CUR253590WZ .729 EA=1EA .00 1 00000000 16.00
XEROFORM 5X9 36.45 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500297 YANK.SUCTION W/TUBING 00249 16080034910 1.41 EA=1EA .00 1 00031110 171.00
YANK.SUCTION 28.11 CS=20EA/CS 20 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500296 YANKAUER SUCTION 00249 DYND50130 .258 EA=1EA .00 1 00031110 171.00
YANKAUER SUCT 12.90 CS=50EA/CS 50 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000359 YELLOW/WHITE CHARGE LABELS 00107 7228 127.60 BX=1BX .00 1 00000000 .00
YELLOW LABLES 127.60 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500391 ZIM-FLEX CAST TAPE 4" 00420 889704 7.78 EA=1EA .00 1 00000000 70.00
ZIM-FLEX CAST 77.77 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 439
TIME: 08:24 ITEM MASTER LIST DEPT# 009 GERIATRIC PSYCH H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
920026 EVAL/ASSESSMENT FACILITY FEE (W/MEDI .00 EA= .00 1 00000000 400.00
EVALUATION/AS .00 .00 2 00000000 .00
.......... NG(0900) INV.GL= EXP.GL= .00 .00 3 31300009 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90792 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
920025 EVALUATION/ASSESSMENT FACILITY FEE .00 EA= .00 1 00000000 347.00
EVALUATION/AS .00 .00 2 00000000 .00
.......... NG(0900) INV.GL= EXP.GL= .00 .00 3 31300009 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90791 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
920027 FACILITY FEE MD .00 EA= .00 1 00000000 300.00
FAC FEE MD .00 .00 2 00000000 .00
.......... PQ(0914) INV.GL= EXP.GL= .00 .00 3 31300009 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0463 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
920024 FAMILY THERAPY W PT 1HR .00 EA= .00 1 00000000 176.00
FAMILY THERAP .00 .00 2 00000000 .00
.......... PS(0916) INV.GL= EXP.GL= .00 .00 3 31300009 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90847 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
920023 FAMILY THERAPY W/O PT 1 HR .00 EA= .00 1 00000000 176.00
FAMILY THERAP .00 .00 2 00000000 .00
.......... PS(0916) INV.GL= EXP.GL= .00 .00 3 31300009 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90846 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
920030 FOLLOW UP 5 MINUTES .00 EA= .00 1 00000000 150.00
FOLLOW UP 5 M .00 .00 2 00000000 .00
.......... PQ(0914) INV.GL= EXP.GL= .00 .00 3 31300009 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99211 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
920019 GROUP THERAPY 1 HOUR .00 EA= .00 1 00000000 243.00
GROUP THERAPY .00 .00 2 00000000 .00
.......... PR(0915) INV.GL= EXP.GL= .00 .00 3 31300009 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90853 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 440
TIME: 08:24 ITEM MASTER LIST DEPT# 009 GERIATRIC PSYCH H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2330524 IM INJECTION .00 EA= .00 1 00000000 113.00
IM INJECTION .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96372 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
920020 INDIVIDUAL THERAPY 20-30 MIN .00 EA= .00 1 00000000 93.00
INDIVIDUAL TH .00 .00 2 00000000 .00
.......... PQ(0914) INV.GL= EXP.GL= .00 .00 3 31300009 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90832 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
920021 INDIVIDUAL THERAPY 45-50 MIN .00 EA= .00 1 00000000 176.00
INDIVIDUAL TH .00 .00 2 00000000 .00
.......... PQ(0914) INV.GL= EXP.GL= .00 .00 3 31300009 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90834 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
920022 INDIVIDUAL THERAPY 75-80 MIN .00 EA= .00 1 00000000 353.00
INDIVIDUAL TH .00 .00 2 00000000 .00
.......... PQ(0914) INV.GL= EXP.GL= .00 .00 3 31300009 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90837 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410008 INFLUENZA ADMINISTRATION (MEDICARE O .00 EA= .00 1 00000000 25.00
INFLUENZA ADM .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0008 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 441
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501040 ARM SLING L 00432 1796-13-10 3.72 EA=1EA .00 1 00000000 65.00
ARM SLING L 37.16 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000833 ETHIBOND CX27D 00257 23000X27D 96.01 BX=1BX .00 1 00000000 .00
O ETHIBOND CX 96.01 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000777 0 VICRYL J260H 00249 ETHJ260H 45.06 BX=1BX .00 1 00000000 .00
0 VICRYL J260 45.06 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000778 0 VICRYL JJ81G 00249 ETHJJ81G 154.38 BX=1BX .00 1 00000000 .00
0 VICRYL JJ81 154.38 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000820 0-SILK 622H 00257 23000622H 43.82 BX=1BX .00 1 00000000 .00
0-SILK 622H 43.82 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000816 0-SILK SA66G 00249 ETHSA66G 27.49 BX=1BX .00 1 00000000 .00
0-SILK SA66G 27.49 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000785 1 VICRYL J347H 00257 23000J347H 57.78 BX=1BX .00 1 00000000 .00
1 VICRYL J347 57.78 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000615 1 X 2 5/8 WHITE LABLES 816 00499 UNV80201 9.99 PK=1PK .00 1 00000000 .00
1 X 2 5/8 WHI 9.99 PK=1PK/PK 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 442
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000614 1"X 2 5/8 CLEAR LABELS 866 00499 AVE8660 23.99 PK=1PK .00 1 00000000 .00
1"X 2 5/8 CLE 23.99 PK=1PK/PK 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000802 1-PROLENE 8425H 00249 ETH8425H 66.71 BX=1BX .00 1 00000000 .00
1-PROLENE 842 66.71 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000739 1.2 GAL CAP ROOM HUMIDIFIE 01304 4714100HF 31.91 EA=1EA .00 1 00000000 93.00
1.2 GAL CAP R 31.91 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000754 100FT ROLL-SEG 6"-COR TUB 01304 301150 11.70 EA=1EA .00 1 00000000 69.00
100FT ROLL-SE 11.70 RL=1EA/RL 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000793 2-0 VICRYL J905T 00257 23000J905T 156.44 BX=1BX .00 1 00000000 .00
2-0 VICRYL J9 156.44 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000838 2-O CHROMIC G123H 00249 ETHG123H 80.95 BX=1BX .00 1 00000000 .00
2-O CHROMIC G 80.95 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000853 2-O ETHILON 664G 00249 ETH664G 14.63 BX=1BX .00 1 00000000 .00
2-O ETHILON 6 14.63 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000799 2-O PROLENE 8523H 00257 230008523H 137.08 BX=1BX .00 1 00000000 .00
2-O PROLENE 8 137.08 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 443
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000805 2-O PROLENE 8523H 00249 ETH8523H 150.46 BX=1BX .00 1 00000000 .00
2-O PROLENE 8 150.46 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000827 2-O SILK 685G 00257 23000685G 22.92 BX=1BX .00 1 00000000 .00
2-O SILK 685G 22.92 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000819 2-O SILK A185H 00249 ETHA185H 45.47 BX=1BX .00 1 00000000 .00
2-O SILK A185 45.47 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000826 2-O SILK K833H 00249 ETHK833H 33.345 BX=1BX .00 1 00000000 .00
2-O SILK K833 33.345 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000815 2-O SILK SA65H 00257 23000SA65H 54.54 BX=1BX .00 1 00000000 .00
2-O SILK SA65 54.54 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000781 2-O VICRYL J317H 00249 ETHJ317H 44.87 BX=1BX .00 1 00000000 .00
2-O VICRYL J3 44.87 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000784 2-O VICRYL J345H 00249 23000J345H 47.88 BX=1BX .00 1 00000000 .00
2-O VICRYL J3 47.88 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500512 2WAY CATH 12FR. FOLEY 5CC 00249 S512 4.3092 EA=1EA .00 1 00000000 44.00
2WAY CATH 12F 51.71 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 444
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500513 2WAY CATH 14FR 5CC BALLON 00249 DYND11501 4.3092 EA=1EA .00 1 00000000 44.00
2WAY CATH 14F 51.71 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500514 2WAY CATH 16FR 5CC BALLON 00249 DYND11502 4.3092 EA=1EA .00 1 00000000 44.00
2WAY CATH 16F 51.71 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500499 2WAY CATH 16FR FOLEY 30CC 00249 S186 4.91 EA=1EA .00 1 00000000 35.00
2WAY CATH 16F 58.89 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500515 2WAY CATH 18FR 5CC BALLON 00249 DYND11503 4.3092 EA=1EA .00 1 00000000 44.00
2WAY CATH 18F 51.71 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500500 2WAY CATH 18FR FOLEY 30CC 00249 S618 4.91 EA=1EA .00 1 00000000 35.00
2WAY CATH 18F 58.89 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500516 2WAY CATH 20FR 5CC BALLON 00249 S520 1.31 EA=1EA .00 1 00000000 44.00
2WAY CATH 20F 15.66 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500501 2WAY CATH 20FR FOLEY 30CC 00249 S620 4.91 EA=1EA .00 1 00000000 35.00
2WAY CATH 20F 58.89 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500517 2WAY CATH 22FR 5CC BALLON 00249 DYND11504 4.3092 EA=1EA .00 1 00000000 44.00
2WAY CATH 22F 51.71 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 445
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500502 2WAY CATH 22FR FOLEY 30CC 00249 S622 1.18 EA=1EA .00 1 00000000 35.00
2WAY CATH 22F 14.13 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500518 2WAY CATH 24FR 5CC BALLON 00249 S524 1.31 EA=1EA .00 1 00000000 44.00
2WAY CATH 24F 15.66 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500503 2WAY CATH 24FR FOLEY 30CC 00249 S624 1.18 EA=1EA .00 1 00000000 35.00
2WAY CATH 24F 14.13 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500519 2WAY CATH 26FR 5CC BALLON 00249 S526 1.31 EA=1EA .00 1 00000000 44.00
2WAY CATH 26F 15.66 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500520 2WAY CATH 28FR 5CC BALLON 00249 S528 .28 EA=1EA .00 1 00000000 44.00
2WAY CATH 28F 3.40 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500504 2WAY CATH 28FR FOLEY 30CC 00249 S628 .28 EA=1EA .00 1 00000000 35.00
2WAY CATH 28F 3.40 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500521 2WAY CATH 30FR 5CC BALLON 00249 265730 .28 EA=1EA .00 1 00000000 44.00
2WAY CATH 30F 3.40 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500505 2WAY CATH 30FR FOLEY 30CC 00249 S630 1.21 EA=1EA .00 1 00000000 35.00
2WAY CATH 30F 14.49 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 446
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001016 3-0 VICRYL J416H 00257 23000J416H 44.995 BX=1BX .00 1 00000000 .00
3-0 VICRYL J4 44.995 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000792 3-0 VICRYL J904T 00249 ETHJ904T 143.36 BX=1BX .00 1 00000000 .00
3 VICRYL J904 143.36 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000837 3-O CHROMIC G122H 00249 ETHG122H 82.19 BX=1BX .00 1 00000000 .00
3-O CHROMIC G 82.19 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000857 3-O ETHILON 1671G 00257 230001671G 47.25 BX=1BX .00 1 00000000 .00
3-O ETHILON 1 47.25 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000849 3-O ETHILON 642G 00249 ETH642G 15.39 BX=1BX .00 1 00000000 .00
3-O ETHILON 6 15.39 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000852 3-O ETHILON 663G 00249 ETH663G 15.39 BX=1BX .00 1 00000000 .00
3-O ETHILON 6 15.39 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000854 3-O ETHILON 669H 00257 230000669H 48.55 BX=1BX .00 1 00000000 .00
3-O ETHILON 6 48.55 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000846 3-O PLAIN H822H 00257 23000H822H 119.40 BX=1BX .00 1 00000000 .00
3-O PLAIN H82 119.40 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 447
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000809 3-O PROLENE 8684H 00249 ETH8684G 25.26 BX=1BX .00 1 00000000 .00
3-O PROLENE 8 25.26 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000821 3-O SILK 622H 00257 230000622H 41.49 BX=1BX .00 1 00000000 .00
3-O SILK 622H 41.49 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000825 3-O SILK 684G 00249 230000684G 16.84 BX=1BX .00 1 00000000 .00
3-O SILK 684G 16.84 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000818 3-O SILK A184H 00257 23000A184H 64.90 BX=1BX .00 1 00000000 .00
3-O SILK A184 64.90 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000829 3-O SILK K832H 00257 23000K832H 53.70 BX=1BX .00 1 00000000 .00
3-O SILK K832 53.70 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000783 3-O VICRYL J344H 00249 ETHJ344H 48.47 BX=1BX .00 1 00000000 .00
3-O VICRYL J3 48.47 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000759 340 ML HUMIDIFIER W/ ADAPT 01304 36-003-40 1.01 EA=1EA .00 1 00000000 12.00
340 ML HUMIDI 20.12 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500506 3WAY CATH 16FR 30CC 00249 DYND11572 7.3233 EA=1EA .00 1 00000000 63.00
3WAY CATH 16F 87.88 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 448
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500507 3WAY CATH 18FR 30CC 00249 DYND11573 7.3233 EA=1EA .00 1 00000000 63.00
3WAY CATH 18F 87.88 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500508 3WAY CATH 20FR 00249 PS720 3.70 EA=1EA .00 1 00000000 63.00
3WAY CATH 20F 44.37 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500509 3WAY CATH 22FR 30CC 00249 DYND11575 7.3233 EA=1EA .00 1 00000000 63.00
3WAY CATH 22F 87.88 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500510 3WAY CATH 24FR 00249 06200167L24 8.82 EA=1EA .00 1 00000000 63.00
3WAY CATH 24F 105.78 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500511 3WAY CATH 26FR 00249 2D2655 2.85 EA=1EA .00 1 00000000 63.00
3WAY CATH 26F 34.20 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000836 4-O CHROMIC G121H 00249 ETHG121H 115.32 BX=1BX .00 1 00000000 .00
4-O CHROMIC G 115.32 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000851 4-O ETHILON 662G 00249 ETH662G 14.12 BX=1BX .00 1 00000000 .00
4-O ETHILON 6 14.12 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000856 4-O ETHILON 699G 00257 230000699G 30.99 BX=1BX .00 1 00000000 .00
4-O ETHILON 6 30.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 449
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000844 4-O PLAIN 1627G 00257 230001627G 78.88 BX=1BX .00 1 00000000 .00
4-O PLAIN 162 78.88 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000845 4-O PLAIN H821H 00257 23000H821H 119.40 BX=1BX .00 1 00000000 .00
4-O PLAIN H82 119.40 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000813 4-O PROLENE 8699G 00257 230008699G 42.94 BX=1BX .00 1 00000000 .00
4-O PROLENE 8 42.94 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000812 4-O PROLENE 8699H 00257 230008699H 42.43 BX=1BX .00 1 00000000 .00
4-O PROLENE 8 42.43 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000824 4-O SILK 683H 00257 230000683G 15.21 BX=1BX .00 1 00000000 .00
4-O SILK 683H 15.21 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000814 4-O SILK M14T 00257 23000M14T 327.34 BX=1BX .00 1 00000000 .00
4-O SILK M14T 327.34 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000779 4-O VICRYL J304H 00257 23000J304H 46.79 BX=1BX .00 1 00000000 .00
4-O VICRYL J3 46.79 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000780 4-O VICRYL J315H 00257 23000J315H 54.93 BX=1BX .00 1 00000000 .00
4-O VICRYL J3 54.93 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 450
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000791 4-O VICRYL J845G 00257 23000J845G 40.98 BX=1BX .00 1 00000000 .00
4-O VICRYL J8 40.98 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000850 5-O ETHILON 661H 00257 230000661H 46.36 BX=1BX .00 1 00000000 .00
5-O ETHILON 6 46.36 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000855 5-O ETHILON 698G 00249 ETH698G 27.655 BX=1BX .00 1 00000000 .00
5-O ETHILON 6 27.655 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000830 5-O SILK 1676G 00257 230001676G 34.66 BX=1BX .00 1 00000000 .00
5-O SILK 1676 34.66 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000817 5-O SILK A182H 00257 23000A182H 41.11 BX=1BX .00 1 00000000 .00
5-O SILK A182 41.11 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000790 5-O VICRYL J844G 00257 23000J844G 41.38 BX=1BX .00 1 00000000 .00
5-O VICRYL J8 41.38 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000859 6-O ETHILON 1698G 00249 ETH1698G 27.71 BX=1BX .00 1 00000000 .00
6-O ETHILON 1 27.71 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000789 6-O VICRYL J843G 00249 ETHJ843G 41.89 BX=1BX .00 1 00000000 .00
6-O VICRYL J8 41.89 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 451
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90000764 760ML NEB W/ADAPTER (HUMI 01304 04-3D0808 3.29 EA=1EA .00 1 00000000 78.00
760ML NEB W/ 39.51 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500471 ABDOMIBAL BINDER 60-75 IN 00249 1821000818 22.06 EA=1EA .00 1 00000000 166.00
ABDOMIBAL BIN 22.06 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500468 ABDOMINAL BINDER 12" 00249 MDS169028 17.66 EA=1EA .00 1 00000000 166.00
ABDOMINAL BIN 17.66 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500470 ABDOMINAL BINDER 58-442 00249 58442 11.90 EA=1EA .00 1 00000000 166.00
ABDOMINAL BIN 11.90 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500467 ABDOMINAL BINDER 9" 00249 MDS169022 12.69 EA=1EA .00 1 00000000 166.00
ABDOMINAL BIN 12.69 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500469 ABDOMNIAL BINDER 9"58432 00249 58432 9.52 EA=1EA .00 1 00000000 166.00
ABDOMNIAL BIN 9.52 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501141 ABDUCTION PILLOW 00249 17.09 EA=1EA .00 1 00000000 185.00
ABDUCTION PIL 102.52 CS=6EA/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500985 ACUDYNE SWABSTICKS 00249 MDS093901ZZ .2044 EA=1EA .00 1 00000000 .00
ACUDYNE SWABS 10.22 BX=50/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 452
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501001 ADAPTIC 3X3 00249 CUR250330Z .2074 EA=1EA .00 1 00000000 8.00
ADAPTIC 3X3 10.37 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501002 ADAPTIC 3X8 00249 CUR250381Z .5342 EA=1EA .00 1 00000000 32.00
ADAPTIC 3X8 12.82 BX=24EA/BX 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:Y MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000326 ADHERENT DRAPE 92-0500 2.22 EA=1EA .00 1 00000000 .00
ADHERENT DRAP 55.51 BX=25EA/BX 25 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001228 ADHESIVE MEDICAL SPRAY 00257 3158007730 11.41 EA=1EA .00 1 00000000 .00
ADHESIVE MEDI 45.62 BX=4EA/BX 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001003 ADMISSION KIT 00249 DYKD2002A 2.4525 EA=1EA .00 1 00000000 .00
ADMISSION KIT 29.43 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000762 ADULT AEROSOL MASK 00396 301-170EA .4968 EA=1EA .00 1 00031110 49.00
ADULT AEROSOL 00249 HCS4630B 24.84 CS=50EA/CS 50 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2504032 ADULT BP CUFF 00249 MDS9913HP 2.954 EA=1EA .00 1 00000000 .00
ADULT BP CUFF 14.77 PK=5EA/PK 5 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 2.954 1 .00 3 00000000 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000763 ADULT NASAL CANNULA 7’ 00396 301-100EA .4694 EA=1EA .00 1 00031110 35.00
ADULT NASAL C 00249 HCS4514 23.47 CS=50EA/CS 50 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 453
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90000760 ADULT NON-REBREATHER 01304 301181 .7226 EA=1EA .00 1 00031110 69.00
ADULT NON-REB 36.13 CS=50EA/CS 50 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501339 ADULT SLIPPERS XXL 00249 MDT211218XXLI 1.0215 EA=1EA .00 1 00031110 7.50
ADULT SLIPPER 00304 6239LG 49.03 CS=48EA/CS 48 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500039 ADULT WIPES 00249 MSC263810 1.5171 EA=1EA .00 1 00031110 16.00
ADULT WIPES 00062 10-710 36.41 CS=24EA/CS 24 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001537 AERO CHAMBERS 01304 317-621-210 101.46 CS=1CS .00 1 00031110 150.00
AERO CHAMBERS 101.46 CS=1CS 1 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501021 AIRCAST LEFT 00123 02BLK 25.41 EA=1EA .00 1 00000000 425.00
AIRCAST LEFT 00249 ARC02BLK 25.41 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501022 AIRCAST RIGHT 00123 02BRK 31.46 EA=1EA .00 1 00000000 425.00
AIRCAST RIGHT 00249 ARC02BRK 31.46 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500142 AIRWAY 100MM 00249 DYND60425 .2267 EA=1EA .00 1 00031110 32.00
AIRWAY 100MM 2.72 BX=12EA/BX 12 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500143 AIRWAY 110MM 0249 5568122006 .3233 EA=1EA .00 1 00031110 14.00
AIRWAY 110MM 3.88 BX=12EA/BX 12 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 454
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500137 AIRWAY 40MM 00249 6697-002041 .18 EA=1EA .00 1 00031110 14.00
AIRWAY 40MM 2.21 BX=12EA/BX 12 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500138 AIRWAY 60MM 00249 DYND60410 .2267 EA=1EA .00 1 00031110 14.00
AIRWAY 60MM 2.72 BX=12EA/BX 12 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500139 AIRWAY 70MM 00249 6697412071 .21 EA=1EA .00 1 00031110 14.00
AIRWAY 70MM 2.52 BX=12EA/BX 12 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500140 AIRWAY 80MM 00249 DYND60415 .2267 EA=1EA .00 1 00031110 14.00
AIRWAY 80MM 2.72 BX=12EA/BX 12 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500141 AIRWAY 90MM 00249 6697412091 .21 EA=1EA .00 1 00031110 14.00
AIRWAY 90MM 2.52 BX=12EA/BX 12 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000209 ALCOHOL 00249 MDS098003Z .9875 EA=1EA .00 1 00000000 .00
ALCOHOL 11.85 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000001 ALCOHOL PREP 00249 KDL5750 1.0175 BX=1BX .00 1 00000000 .00
ALCOHOL PREP 00074 KC5033 20.35 CS=20BX/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001276 ALLEN WRIST SPLINT LG. 00123 79-71047 18.20 EA=1EA .00 1 00000000 41.00
ALLEN WRIST S 00249 ORT33600L 18.20 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 455
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001275 ALLEN WRIST SPLINT SM. 00249 SDJ7971043 9.74 EA=1EA .00 1 00000000 41.00
ALLEN WRIST S 9.74 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000367 ALLERGIC TO LABEL 00783 59704578 48.06 BX=1BX .00 1 00000000 .00
ALLERGIC TO L 48.06 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501526 ALOE VESTA BODY WASH &SHAM 00249 MSC095348 .3583 EA=1EA .00 1 00000000 .00
ALOE VESTA BO 00062 82-0994 17.20 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001499 AMBU BAG ADULT 00396 520-612-000 13.28 EA=1EA .00 1 00031110 65.00
AMBU BAG ADUL 00249 CPRM1116 79.68 CS=6EA/CS 6 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001432 AMPLATZ WIRE 00058 46-525 40.654 EA=1EA .00 1 00000000 102.00
AMPLATZ WIRE 203.27 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500374 ANKLE BRACE LG 00420 176705 15.18 EA=1EA .00 1 00000000 161.00
ANKLE BRACE L 15.18 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500373 ANKLE BRACE MED 00420 176704 15.66 EA=1EA .00 1 00000000 161.00
ANKLE BRACE M 15.66 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500372 ANKLE BRACE SM 00420 176703 13.50 EA=1EA .00 1 00000000 161.00
ANKLE BRACE S 13.50 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 456
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001185 AQUACEL AG 4X4 00257 1638177902 10.39 EA=1EA .00 1 00000000 14.00
AQUACEL AG 4X 103.86 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500069 ARM BOARD INFANT 00249 NON24288H .60 EA=1EA .00 1 00000000 20.00
ARM BOARD INF .60 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501038 ARM SLING CHILD 00249 ORT11400SD 5.86 BX=1BX .00 1 00000000 65.00
ARM SLING S 23.44 BX=4EA/BX 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500071 ARMBOARD 18" 00249 NON24291H 1.42 EA=1EA .00 1 00000000 20.00
ARMBOARD 18" 1.42 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500070 ARMBOARD 9" 00249 5189450010 .39 EA=1EA .00 1 00000000 20.00
ARMBOARD 9" 39.00 CS=100EA/CS 100 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500038 ART LINE ARM BD 00249 18686010 6.00 EA=1EA .00 1 00000000 45.00
ART LINE ARM 120.06 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000736 ASMAPLANT STAND PEAK FLOW 01304 26111300 10.00 EA=1EA .00 1 00000000 48.00
ASMAPLANT STA 100.00 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001028 ATRAC-TAIN CREAM 5OZ TUBE 00249 COL1814 5.1238 EA=1EA .00 1 00000000 25.00
ATRAC-TAIN CR 61.485 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 457
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90000734 AULT VOLUME VENT CIRCUIT 01304 301-TA3001 3.94 EA=1EA .00 1 00000000 20.00
AULT VOLUME V 78.80 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500404 BANDAGE ACE 2" 00249 MDS046002 .2944 EA=1EA .00 1 00000000 5.00
BANDAGE ACE 2 14.72 BX=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500405 BANDAGE ACE 3" 00249 MDS046003 .3758 EA=1EA .00 1 00000000 7.00
BANDAGE ACE 3 18.79 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500406 BANDAGE ACE 4" 00249 MDS087004LF .4236 EA=1EA .00 1 00000000 9.00
BANDAGE ACE 4 21.18 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500407 BANDAGE ACE 6" 00249 MDS046006 .7446 EA=1EA .00 1 00000000 14.00
BANDAGE ACE 6 37.23 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001277 BANDAID 1" 00249 NON25600 1.10 BX=1BX .00 1 00000000 .00
BANDAID 1" 13.20 CS=12BX/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001678 BANDAID 2" 00249 NON25504 2.3242 BX=1BX .00 1 00000000 .00
BANDAID 2" 27.89 CS=12BX/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001176 BARALYME 00299 32-55-001-0006 94.75 CS=1CS .00 1 00000000 .00
BARALYME 94.75 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 458
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001179 BARRIER WIPES 00257 1638037439 5.79 BX=1BX .00 1 00000000 .00
BARRIER WIPES 5.79 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500150 BASIN 7QT 00249 DYND80347 .2964 EA=1EA .00 1 00000000 14.00
BASIN 7QT 00062 93-H36210 14.82 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001093 BATTERY 9V 00249 DRCPC1604Z .6988 EA=1EA .00 1 00000000 .00
BATTERY 9V 00361 810694 8.386 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001092 BATTERY AAA 00249 DRCPC2400Z .1982 EA=1EA .00 1 00000000 .00
BATTERY AAA 4.756 BX=24EA/BX 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001309 BATTERY C 00249 DRCPC1400Z .4588 EA=1EA .00 1 00000000 .00
BATTERY C 5.505 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001310 BATTERY D 00249 DRCPC1300Z .605 EA=1EA .00 1 00000000 .00
BATTERY D 7.26 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001020 BATTERY-AA 00249 DRCPC1500 .1963 EA=1EA .00 1 00000000 .00
BATTERY-AA 00052 EVEE91SBP36H 28.26 CS=144EA/CS 144 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500003 BEDPAN 00249 DYND80245 .4694 EA=1EA .00 1 00000000 36.00
BEDPAN 00062 541-5072-0000 23.47 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 459
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500004 BEDPAN FRACTURE 00249 DYNC8521 .5696 EA=1EA .00 1 00000000 39.00
BEDPAN FRACTU 13.67 CS=24EA/CS 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500556 BENSON WIRE 180CM 00104 G01431 11.50 EA=1EA .00 1 00000000 128.00
BENSON WIRE 1 00058 49-147 11.50 EA=1EA/EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000072 BIO-HAZ BAG 6X9 00249 DYND30261 4.715 PK=1PK .00 1 00000000 .00
BIO-HAZ BAG 6 00084 SB69BZ 47.15 CS=10PK/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500472 BIO-PATCH DRESSING 00249 J-J4150Z 7.50 EA=1EA .00 1 00000000 115.00
BIO-PATCH DRE 75.00 BX=10EA/BX 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000339 BIOHAZARD BAG 17X17 00249 NON151717 56.12 CS=1CS .00 1 00000000 .00
BIOHAZARD BAG 56.12 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000340 BIOHAZARD BAG 40X46 00249 HTBA8046ZR 55.20 CS=1CS .00 1 00000000 .00
BIOHAZARD BAG 00146 14-828-89 55.20 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001332 BIOHAZARD BAGS 24X33 00249 NON122433 5.748 RL=1RL .00 1 00000000 .00
BIOHAZARD BAG 57.48 CS=10RL/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001345 BIOPSY SKIN PUNCH 2MM 00285 DD-2MM 25.00 BX=1BX .00 1 00000000 20.00
BIOPSY SKIN P 25.00 BX=1BX 1 .00 2 00000000 .00
.......... 44(0272) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 460
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001344 BIOPSY SKIN PUNCH 4MM 00285 DD-4MM 25.00 BX=1BX .00 1 00000000 20.00
BIOPSY SKIN P 25.00 BX=1BX 1 .00 2 00000000 .00
.......... 44(0272) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001404 BLOOD GAS CARTRIDGE 00316 945-713 807.84 EA=1EA .00 1 00000000 .00
BLOOD GAS CAR 807.84 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2504027 BLOOD PRESSURE CUFF LARGE ADULT 00249 .00 = .00 1 00000000 .00
BLOOD PRESSUR .00 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 1 .00 3 00000000 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001459 BLUNT FILL NEEDLE 00249 B-D305180 6.601 BX=1BX .00 1 00000000 .00
BLUNT FILL NE 66.01 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001638 BLUNT FILTER NEEDLE 00249 B-D305211Z 19.90 BX=1BX .00 1 00000000 .00
BLUNT FILTER 19.90 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500073 BONE MARROW NEEDLE 00249 0707DIN1515X 11.03 EA=1EA .00 1 00000000 135.00
BONE MARROW N 110.30 CS=10EA/CS 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001503 BP CUFF ISOLATION 00328 39203 3.82 EA=1EA .00 1 00000000 .00
BP CUFF ISOLA 76.32 BX=20EA/BX 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500033 BUTTERFLY 19GA X7/8 00249 45900101 .54 EA=1EA .00 1 00000000 16.00
BUTTERFLY 19G 26.95 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 461
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500034 BUTTERFLY 25GA X1/2 00249 B-D367298Z .5814 EA=1EA .00 1 00000000 36.00
BUTTERFLY 25G 29.07 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501518 BUTTERFLY SETS 21GA. 00249 723367296 .59 EA=1EA .00 1 00000000 16.00
BUTTERFLY SET 29.67 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2146226 C-QUR/TACSHIELD MESH 4X6 00249 BAR9001C0212 .00 EA=1EA .00 1 00000000 2325.00
CQURTASMESH4X 00043 9001C0212 .00 BX=10EA/BX 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: C1781 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
80000653 CALCULATOR TAPE-2 1/4 00499 UNV35715 .9992 EA=1EA .00 1 00000000 .00
CALCULATOR TA 11.99 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500056 CARRA-KLENZ 00249 CRR102060 2.7892 EA=1EA .00 1 00000000 144.00
CARRA-KLENZ 33.47 CS=12EA/CS 12 .00 2 00000000 .00
.......... 78(0250) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500408 CAST PADDING 2" 00420 889002 .60 EA=1EA .00 1 00000000 9.00
CAST PADDING 12.00 BG=20EA/BG 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500409 CAST PADDING 3" 00249 MDS067003Z 1.5917 BG=1BG .00 1 00000000 12.00
CAST PADDING 19.10 BG=12/BG 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 462
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500410 CAST PADDING 4" 00249 MDS067004Z 1.8808 EA=1EA .00 1 00000000 20.00
CAST PADDING 22.57 BG=12EA/BG 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500411 CAST PADDING 5" 00420 889005 3.29 EA=1EA .00 1 00000000 24.00
CAST PADDING 65.79 BG=20EA/BG 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000974 CASTILE SOAP 00249 MDS001005H .76 EA=1EA. .00 1 00000000 .00
CASTILE SOAP .76 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501223 CATH 10FR PED 00249 DYND11710 3.65 EA=1EA .00 1 00031110 44.00
CATH 10FR PED 43.77 BX=12EA/BX 12 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500531 CATH 16FR 5CC COUDE 00249 DYND11216 4.2158 EA=1EA .00 1 00000000 49.00
CATH 16FR 5CC 50.59 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: C1758 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2500529 CATH 22FR 30CC TELFON 3WA 00249 0167V22S 12.77 EA=1EA .00 1 00000000 44.00
CATH 22FR 30 153.20 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500532 CATH 22FR 5CC COUDE 00249 0168L22 1.22 EA=1EA .00 1 00000000 49.00
CATH 22FR 5CC 14.69 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: C1758 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 463
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500530 CATH 24FR 30CC TEFLON 3WAY 00249 0167V24 12.77 EA=1EA .00 1 00000000 63.00
CATH 24FR 30C 153.20 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501222 CATH 8FR PED 00249 DYND11708 3.18 EA=1EA .00 1 00031110 44.00
CATH 8FR PED 38.14 BX=12EA/BX 12 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501014 CATH FOLEY 2WAY 26 FR 00249 5626 1.21 EA=1EA .00 1 00000000 35.00
CATH FOLEY 2W 14.49 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500526 CATH FOLEY 2WAY 30FR 30CC 00249 0166SI30 10.65 EA=1EA .00 1 00000000 35.00
CATH FOLEY 2W 127.80 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500522 CATH FOLEY 30CC 16FR SILVE 00249 06200166S116 11.22 EA=1EA .00 1 00000000 35.00
CATH FOLEY 30 134.61 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500523 CATH FOLEY 30CC 18FR SILVE 00249 06200166S118 11.22 EA=1EA .00 1 00000000 35.00
CATH FOLEY 30 134.61 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500524 CATH FOLEY 30CC 20FR SILVE 00249 06200166S120 11.22 EA=1EA .00 1 00000000 35.00
CATH FOLEY 30 134.61 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500525 CATH FOLEY 30CC 22FR SILVE 00249 06200166S122 11.51 EA=1EA .00 1 00000000 35.00
CATH FOLEY 30 138.07 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 464
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500528 CATH FOLEY 30CC 30FR SILVE 00249 016SS128 10.65 EA=1EA .00 1 00000000 44.00
CATH FOLEY 30 127.80 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500527 CATH FOLEY 5CC 28FR SILVER 00249 01655I30 10.65 EA=1EA .00 1 00000000 44.00
CATH FOLEY 5C 127.80 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500095 CATH MALE LG TEXAS 00249 RCH33304 .816 EA=1EA .00 1 00000000 39.00
CATH MALE LG 24.48 BX=30EA/BX 30 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500094 CATH MALE MED TEXAS 00249 DYND12302 .6288 EA=1EA .00 1 00000000 39.00
CATH MALE MED 15.72 CS=25EA/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500976 CATH PLUG 00249 76 .32 EA=1EA .00 1 00000000 6.00
CATH PLUG 80.24 CS=250EA/CS 250 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000977 CATH STRIP 00249 DERCS50Z 1.4352 EA=1EA .00 1 00000000 .00
CATH STRIP 71.76 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500996 CATH TRAY ADD-A FOLEY 00249 DYND11020 8.696 EA=1EA .00 1 00000000 288.00
CATH TRAY ADD 86.96 CS=10EA/CS 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501114 CATH. PED. 6FR. 00249 DYND11706 3.18 EA=1EA .00 1 00000000 44.00
CATH. PED. 6F 38.14 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 465
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001523 CAVICIDE 00249 MAP131150 5.5956 EA=1EA .00 1 00000000 .00
CAVICIDE 67.1466 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500050 CENTRAL VENOUS SET 00310 CS04300 21.50 EA=1EA .00 1 00000000 232.00
CENTRAL VENOU 107.48 CS=5EA/CS 5 .00 2 00000000 .00
.......... 50(0278) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: C1751 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2501227 CERVICAL RIGID COLLAR PED. 00420 167601 11.88 EA=1EA .00 1 00000000 183.00
CERVICAL RIGI 11.88 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501225 CERVICAL RIGID COLLAR TALL 00432 167605 14.10 EA=1EA .00 1 00000000 183.00
CERVICAL RIGI 14.10 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501226 CERVICAL RIGID REGULAR 00432 1676-04-00 14.10 EA=1EA .00 1 00000000 412.00
CERVICAL RIGI 14.10 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2504034 CHILD BP CUFF 00249 MDS9911HP 3.558 EA=1EA .00 1 00000000 .00
CHILD BP CUFF 17.79 PK=5EA/PK 5 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 3.558 1 .00 3 00000000 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000689 CHINSTRAP FOR BIPSP/CPSP 01304 73302175 18.90 EA=1EA .00 1 00000000 59.00
CHINSTRAP FOR 18.90 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 466
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501423 CHLORAPREP 26ML. 00249 MDF260815 5.6012 EA=1EA .00 1 00000000 122.00
CHLORAPREP 26 140.03 CS=25EA/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001493 CHLORASCRUB SWABS 00249 NPKB10800z 10.43 BX=1BX .00 1 00000000 .00
CHLORASCRUB S 10.43 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500426 CLAVICAL SPL. S 00420 73512 6.03 BX=1BX .00 1 00000000 49.00
CLAVICAL SPL. 6.03 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500428 CLAVICLE SPL.LG 00249 SDJ7985007 6.18 BX=1BX .00 1 00000000 49.00
CLAVICLE SPL. 6.18 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500427 CLAVICLE SPL.MD 00420 73513 6.60 BX=1BX .00 1 00000000 49.00
CLAVICLE SPL. 6.60 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500429 CLAVICLE SPL.XL 00420 73515 8.27 BX=1BX .00 1 00000000 49.00
CLAVICLE SPL. 8.27 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001603 CLIPPER CHARGER 00257 4509009662 32.70 EA=1EA .00 1 00000000 .00
CLIPPER CHARG 32.70 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001602 CLIPPER SURGICAL 00241 MMM9661 31.96 EA=1EA .00 1 00000000 .00
CLIPPER SURGI 31.96 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 467
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90000767 COACH INCENTIVE SPIROMETER 00249 DHD221200 4.8017 EA=1EA .00 1 00000000 30.00
COACH INCENTI 57.62 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL=41115017 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500393 COBAN 1" 00249 4509001581 .51 EA=1EA .00 1 00031110 12.00
COBAN 1" 3.04 CS=6EA/CS 6 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501420 COBAN 2 COMPRESSION SYSTEM 00249 4509002094 13.00 BX=1BX .00 1 00000000 40.00
COBAN 2 COMPR 104.02 CS=8BX/CS 8 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501585 COBAN 2" 00249 MDS089002 1.3964 EA=1EA .00 1 00000000 35.00
COBAN 2" 50.27 CS=36EA/CS 36 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:Y MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500395 COBAN 3" 00249 MDS089003 1.8392 EA=1EA .00 1 00031110 59.00
COBAN 3" 44.14 CS=24EA/CS 24 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:Y MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500396 COBAN 4" 00249 MDS089004 2.3061 EA=1EA .00 1 00031110 79.00
COBAN 4" 41.51 CS=18EA/CS 18 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:Y MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500886 COBAN STERILE 4" 00249 MMM1584S 1.6194 EA=1EA .00 1 00000000 35.00
COBAN STERILE 29.15 CS=18EA/CS 18 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500423 COLLAR LG 00249 ORT13100L 3.45 BX=1BX .00 1 00000000 99.00
COLLAR LG 3.45 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 468
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500422 COLLAR MD 00249 ORT13100M 2.58 BX=1BX .00 1 00000000 223.00
COLLAR MD 2.58 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500421 COLLAR SM 00249 ORT13100S 3.22 BX=1BX .00 1 00000000 99.00
COLLAR SM 3.22 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500424 COLLAR UNIVERSAL 00420 73705 3.50 BX=1BX .00 1 00000000 99.00
COLLAR UNIVER 3.50 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500425 COLLAR X-LONG 00420 73706 3.50 BX=1BX .00 1 00000000 99.00
COLLAR X-LONG 3.50 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001280 COLLES FOREARM L LG. 00249 ORT33300LL 7.05 EA=1EA .00 1 00000000 18.00
COLLES FOREAR 7.05 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001278 COLLES FOREARM L MD. 00249 ORT33300LM 6.81 EA=1EA .00 1 00000000 18.00
COLLES FOREAR 6.81 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001279 COLLES FOREARM R LG. 00249 ORT33300RL 7.20 EA=1EA .00 1 00000000 18.00
COLLES FOREAR 7.20 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001277 COLLES FOREARM RIGHT MD. 00249 ORT33300RM 6.81 EA=1EA .00 1 00000000 18.00
COLLES FOREAR 6.81 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 469
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001362 COLLES FOREARM SMALL LEFT 00249 ORT33300LS 6.06 EA=1EA .00 1 00000000 18.00
COLLES FOREAR 6.06 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500158 COMBINE DRESSING SURGIPAD 00249 NON21453 .083 EA=1EA .00 1 00000000 2.00
COMBINE DRESS 19.92 CS=240EA/CS 240 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2330513 COMPLEX PROCEDURE .00 EA= .00 1 00000000 985.00
COMPLEX PROCE .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001521 COMPLY 3983MM 00249 3983MM 106.71 BX=1BX .00 1 00000000 .00
COMPLY 3983M 106.71 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000352 COPY PAPER 00118 4COPY 3.45 RM=1RM .00 1 00000000 .00
COPY PAPER 00361 135848 34.50 CS=10RM/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000569 COPY PAPER-14" 00499 HAM10329-01 12.99 RM=1RM .00 1 00000000 .00
COPY PAPER-14 12.99 RM=1RM/RM 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000573 COPY PAPER-BLUE 00052 UNV11202 12.99 RM=1RM .00 1 00000000 .00
COPY PAPER-BL 12.99 RM=1RM/RM 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000570 COPY PAPER-GOLDENROD 00499 UNV11205 5.44 RM=1RM .00 1 00000000 .00
COPY PAPER-GO 5.44 RM=1RM/RM 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 470
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000575 COPY PAPER-GREEN 00499 UNV11203 10.49 RM=1RM .00 1 00000000 .00
COPY PAPER-GR 10.49 RM=1RM/RM 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000576 COPY PAPER-PINK 00499 UNV11204 4.03 RM=1RM .00 1 00000000 .00
COPY PAPER-PI 4.03 RM=1RM/RM 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000572 COPY PAPER-YELLOW 00499 UNV11201 12.99 RM=1RM .00 1 00000000 .00
COPY PAPER-YE 12.99 RM=1RM/RM 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000571 COPY PAPRER-BUFF 00499 UNV11206 5.27 RM=1RM .00 1 00000000 .00
COPY PAPRER-B 5.27 RM=1RM/RM 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001076 CORRECTION TAPE 00118 BICWOETP21 3.145 EA=1EA .00 1 00000000 .00
CORRECTION TA 6.29 EA=2EA/EA 2 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000975 COTTON TIP 6" STERILE 00249 MDS202000 1.666 BX=1BX .00 1 00000000 .00
COTTON TIP 6" 16.66 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000007 COTTONBALLS 00249 MDS21461 1.0015 BG=1BG .00 1 00000000 .00
COTTONBALLS 00062 13-3170 20.03 CS=20BG/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001705 COVIDIEN PROBE COVER 00249 KDL500500 .6408 BX=1B .00 1 00000000 .00
COVIDIEN PROB 16.02 BX=25/BX 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .6408 1 .00 3 00000000 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 471
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500459 CRADLE BOOT 00249 5.95551E+11 17.89 EA=1EA .00 1 00000000 49.00
CRADLE BOOT 17.89 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001023 CRITIKON PAPER ER 00760 E9050JC 25.00 BX=1BX .00 1 00000000 .00
CRITIKON PAPE 25.00 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001140 CRITIKON PAPER OR 00760 E9050K 25.00 BX=1BX .00 1 00000000 .00
CRITIKON PAPE 25.00 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000705 CROUP TENT CANOPIES(CAM3MI 01304 81THS5522 8.60 EA=1EA .00 1 00000000 33.00
CROUP TENT CA 51.60 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500480 CRUTCHES ADULT 5’10"-6’6" 00249 MDSV80534 12.5617 EA=1EA .00 1 00000000 75.00
CRUTCHES ADUL 75.37 CS=6EA/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500481 CRUTCHES ADULT 5’2"TO 5’10 00249 MDSV80535 9.4213 EA=1EA .00 1 00000000 169.00
CRUTCHES ADUL 75.37 CS=8EA/CS 8 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500479 CRUTCHES XLONG 6’6"-7 2" 00249 9.84 EA=1EA .00 1 00000000 75.00
CRUTCHES XLON 59.03 CS=6EA/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500482 CRUTCHES YOUTH 4’6"TO 5’2" 00249 MDSV80536 9.9063 EA=1EA .00 1 00000000 75.00
CRUTCHES YOUT 79.25 CS=8EA/CS 8 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 472
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001550 CUFF 1 TUBE L ADULT LG.972 00328 99872 5.21 EA=1EA .00 1 00000000 .00
CUFF 1 TUBE L 104.20 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001627 CUFF ADULT SINGLE MDS9723D 00249 MDS9723DM 5.01 EA=1EA .00 1 00000000 .00
CUFF ADULT SI 25.07 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001626 CUFF CHILD SINGLE MDS9721D 00249 MDS9911HP 3.554 EA=1EA .00 1 00000000 .00
CUFF CHILD SI 17.77 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001552 CUFF DUAL ADULT LONG 3929 00328 39294 3.75 EA=1EA .00 1 00000000 .00
CUFF DUAL ADU 75.00 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001621 CUFF DUAL ADULT MDS9713DM 00249 MDS9713DM 3.82 EA=1EA .00 1 00000000 .00
CUFF DUAL ADU 19.08 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001581 CUFF DUAL ADULT MDS9713HP 00328 99593 5.52 EA=1EA .00 1 00000000 .00
CUFF DUAL ADU 110.48 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001554 CUFF DUAL CHILD 39296 00328 39296 4.14 EA=1EA .00 1 00000000 .00
CUFF DUAL CHI 82.80 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001624 CUFF DUAL CHILD MDS9711CM 00249 MDS9711DM 3.75 EA=1EA .00 1 00000000 .00
CUFF DUAL CHI 18.76 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 473
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001623 CUFF DUAL INFANT MDS9710DM 00249 MDS9710DM 3.23 EA=1EA .00 1 00000000 .00
CUFF DUAL INF 16.15 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001553 CUFF DUAL L.ADULT MDS9714H 00328 39291 5.05 EA=1EA .00 1 00000000 .00
CUFF DUAL L.A 101.04 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001622 CUFF DUAL LG ADULT MDS9714 00249 MDS9714DM 4.11 EA=1EA .00 1 00000000 .00
CUFF DUAL LG 20.53 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001625 CUFF INFANT SINGLE MDS9720 00249 MDS9720DM 4.83 EA=1EA .00 1 00000000 .00
CUFF INFANT S 24.17 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001628 CUFF LG.ADULT SING.MDS9724 00249 MDS9724DM 5.53 EA=1EA .00 1 00000000 .00
CUFF LG.ADULT 27.65 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001551 CUFF S.ADULT LONG MDS9723H 00249 MDS9723HPL 5.108 EA=1EA .00 1 00000000 .00
CUFF S.ADULT 25.54 PK=5EA/PK 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001546 CUFF SINGLE ADULT MDS9913HP 00249 MDS9913HP 2.954 EA=1EA .00 1 00000000 .00
CUFF SINGLE A 14.77 PK=5EA/PK 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001548 CUFF SINGLE CHILD MDS9911HP 00249 MDS9911HP 3.558 EA=1EA .00 1 00000000 .00
CUFF SINGLE C 17.79 PK=5EA/PK 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 474
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001549 CUFF SINGLE INFANT MDS9720 00249 MDS9720HP 3.23 EA=1EA .00 1 00000000 .00
CUFF SINGLE I 16.15 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001545 CUFF SINGLE L.ADULT MDS9914HP 00249 MDS9914HP 4.272 EA=1EA .00 1 00000000 .00
CUFF SINGLE L 21.36 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001547 CUFF SINGLE SM.ADULT MDS9912HP 00249 MDS9912HP 3.904 EA=1EA .00 1 00000000 .00
CUFF SINGLE S 19.52 CS=5EA/CS 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500002 CULTURE SWAB 00249 B-D220109 1.1872 EA=1EA .00 1 00031110 18.00
CULTURE SWAB 00146 220109 59.36 BG=50EA/BG 50 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001341 CUP 16OZ. 00692 2373 40.77 CS=1CS .00 1 00000000 .00
CUP 16OZ. 40.77 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000343 CUP SOUFFLE 00249 NON024220 1.53 PK=1PK .00 1 00000000 .00
CUP SOUFFLE 30.60 CS=20PK/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000345 CUPS 5OZ 00249 NON03005 1.9224 PK=1PK .00 1 00000000 .00
CUPS 5OZ 00062 63-0351 48.06 CS=25PK/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000344 CUPS MED PLASTIC 00249 DYND80000 .523 PK=1PK .00 1 00000000 .00
CUPS MED PLAS 26.15 CS=50PK/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 475
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000187 CURAD CLOTH TAPE 2" 00249 1538-2 5.40 BX=1BX .00 1 00000000 .00
DURAPORE TAPE 64.79 CS=12BX/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001707 CUROS CAP 00249 MMMCFJ1270Z 79.30 BX=1BX .00 1 00000000 .00
CUROS CAP 79.30 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 79.30 1 .00 3 00000000 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001424 CUSTOM CD 00089 XX 1.05 BX=1BX .00 1 00000000 .00
CUSTOM CD 1.05 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001487 CUSTOM HOLTER KITS 00111 S0A2R5ABKW 4.35 EA=1EA .00 1 00000000 .00
CUSTOM HOLTER 4.35 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501403 CVP DRESSING TRAY 00249 DYND75223 2.7213 EA=1EA .00 1 00000000 169.00
CVP DRESSING 108.85 CS=40EA/CS 40 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 31300025 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000100 CYSTO BLADDER 00249 07062C4040 3.31 EA=1EA .00 1 00000000 .00
CYSTO BLADDER 159.05 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501575 CYTOLOGY BRUSH 00756 158R 11.50 EA=1EA .00 1 00000000 79.00
CYTOLOGY BRUS 230.00 BX=20BX/BX 20 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000101 DEFIB PAD 00249 4509-02346N 4.00 EA=1EA .00 1 00000000 .00
DEFIB PAD 39.95 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 476
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001261 DEFOAMER 00522 3238 13.99 BT=1BT .00 1 00000000 .00
DEFOAMER 13.99 BT=1BT 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000979 DENTIPS 00249 MDS096502 32.75 BX=1BX .00 1 00000000 .00
DENTIPS 65.50 CS=2BX/CS 2 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000181 DENTURE CUPS 00249 DYND70293 .9024 PK=1PK .00 1 00000000 .00
DENTURE CUPS 22.56 CS=25PK/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501202 DEODRANT 00249 MSC095010 .2293 EA=1EA .00 1 00000000 .00
DEODRANT 00062 D82-752 22.01 CS=96EA/CS 96 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500494 DERMABOND 00249 ETHDHVM12 15.6108 EA=1EA .00 1 00000000 103.00
DERMABOND 00202 DHVM12 187.33 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001096 DESK CALENDAR PD/WALL BK 00499 7.99 EA=1EA .00 1 00000000 .00
DESK CALENDAR 7.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000630 DESK STAPLER 00118 UNV43119 5.99 EA=1EA .00 1 00000000 .00
DESK STAPLER 5.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500009 DIAPER ADULT 00249 FITULTRALG 7.175 BG=1BG .00 1 00000000 70.00
DIAPER ADULT 00062 10-VB013 28.70 CS=4PK/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 477
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500010 DIAPER ADULTXL 00249 FITPLUSXLG 7.6875 PK=1PK .00 1 00000000 31.00
DIAPER ADULTX 30.75 CS=4PK/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501395 DIAPERS PULL-UP LG. 00249 MSC23505 6.2775 PK=1PK .00 1 00000000 31.00
DIAPERS PULL- 25.11 CS=4PK/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501394 DIAPERS PULL-UP MED 00249 MSC23005 6.2775 PK=1PK .00 1 00000000 31.00
DIAPERS PULL 25.11 CS=4PK/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501396 DIAPERS PULL-UP XL 00249 MSC23600 6.2775 PK=1PK .00 1 00000000 31.00
DIAPERS PULL- 25.11 CS=4PK/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001405 DIGITAL THERMOMETER 00257 3596916814 4.72 EA=1EA .00 1 00000000 .00
DIGITAL THERM 113.28 CS=24EA/CS 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000461 DINAMAP PAPER 00257 8156 24.00 BX=1BX .00 1 00000000 .00
DINAMAP PAPER 24.00 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000695 DISP CUFFLESS FENE TRACH 8 00394 8DCFN 38.00 EA=1EA .00 1 00000000 175.00
DISP CUFFLESS 38.00 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000699 DISP INNER CANN FENE 4 00394 4DICFEN 3.60 EA=1EA .00 1 00000000 12.00
DISP INNER CA 36.00 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 478
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90000700 DISP INNER CANN FENE 6 00394 6DICFEN 3.60 EA=1EA .00 1 00000000 12.00
DISP INNER CA 36.00 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000701 DISP INNER CANN FENE 8 00394 8DICFEN 3.60 EA=1EA .00 1 00000000 12.00
DISP INNER CA 36.00 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500250 DISP. VAGINAL SPECULUM 00249 W-A59001Z 1.4058 EA=1EA .00 1 00000000 81.00
DISP. VAGINAL 33.74 BX=24EA/BX 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000718 DISPOSABLE CUFFED TRACH 10 00394 10DCT 38.00 EA=1EA .00 1 00000000 175.00
DISPOSABLE CU 38.00 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000715 DISPOSABLE CUFFED TRACH 4 00394 4DCT 67.12 EA=1EA .00 1 00000000 175.00
DISPOSABLE CU 67.12 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000716 DISPOSABLE CUFFED TRACH 6 00394 6DCT 67.12 EA=1EA .00 1 00000000 175.00
DISPOSABLE CU 67.12 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000717 DISPOSABLE CUFFED TRACH 8 00394 8DCT 67.12 EA=1EA .00 1 00000000 175.00
DISPOSABLE CU 67.12 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000719 DISPOSABLE FENE TRACH 6 00394 6DFEN 38.00 EA=1EA .00 1 00000000 175.00
DISPOSABLE FE 38.00 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 479
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90000694 DISPOSABLE FENE TRACH 8 00394 8DFEN 38.00 EA=1EA .00 1 00000000 175.00
DISPOSABLE FE 38.00 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000688 DISPOSABLE HEADSTRAP FOR B 01304 73312106 4.78 EA=1EA .00 1 00000000 59.00
DISPOSABLE HE 47.80 PK=10EA/PK 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000697 DISPOSABLE INNER CANNULA 4 00394 4DIC 3.60 EA=1EA .00 1 00000000 12.00
DISPOSABLE IN 36.00 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000698 DISPOSABLE INNER CANNULA 8 00394 8DIC 3.60 EA=1EA .00 1 00000000 12.00
DISPOSABLE IN 36.00 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000696 DISPOSABLE INNNER CANNULA 00394 6DIC 3.60 EA=1EA .00 1 00000000 12.00
DISPOSABLE IN 36.00 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500251 DONUT CUSHION 00249 2867-351819 1.34 EA=1EA .00 1 00000000 59.00
DONUT CUSHION 1.34 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500258 DRAIN BAG 1.50 00249 401933 1.16 EA=1EA .00 1 00000000 18.00
DRAIN BAG 1.5 11.62 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500260 DRAIN BAG 2.25 00249 SQU401935 .651 EA=1EA .00 1 00000000 18.00
DRAIN BAG 2.2 00072 401513 6.51 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 480
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500261 DRAIN BAG 2.75 00249 SQU401936 .651 EA=1EA .00 1 00000000 18.00
DRAIN BAG 2.7 00072 401936 6.51 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500098 DRAINAGE BAG 00249 DYND15205 2.3995 EA=1EA .00 1 00000000 30.00
DRAINAGE BAG 47.99 CS=20EA/CS 20 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500259 DRAINBAG 1.75 00249 SQU401512 .523 EA=1EA .00 1 00000000 18.00
DRAINBAG 1.7 5.23 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500257 DRAINBAG 1.25 00249 401510 1.65 EA=1EA .00 1 00000000 18.00
DRAINBAG 1.25 16.49 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501030 DRAPE LOWER EXTREMITY 00249 DYNJP8002 4.93 EA=1EA .00 1 00000000 46.00
DRAPE LOWER E 59.16 CS=12EA/CS 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500299 DRAPE SHEET 00249 DYNJP2419 1.96 EA=1EA .00 1 00000000 45.00
DRAPE SHEET 23.52 CS=12EA/CS 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501069 DRAPE UNDER BUTTOCK 00249 1259001229 .99 EA=1EA .00 1 00000000 110.00
DRAPE UNDER B 53.43 CS=54EA/CS 54 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001451 DUAL LUER LOCK M/FEM. 00249 BHL2C6250 .1788 EA=1EA .00 1 00000000 .00
DUAL LUER LOC 90.13 CS=504EA/CS 504 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 481
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500283 DUODERM 4X4 00249 SQU187660 1.912 EA=1EA .00 1 00000000 14.00
DUODERM 4X4 9.56 BX=5EA/BX 5 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500284 DUODERM 8X8 00249 1638187662 10.19 EA=1EA .00 1 00000000 49.00
DUODERM 8X8 50.93 BX=5EA/BX 5 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000186 DURAPORE TAPE 1" 00249 MMM15382 6.394 BX=1BX .00 1 00000000 .00
DURAPORE TAPE 63.94 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501059 DURAPREP 00249 4509008630 5.297 EA=1EA .00 1 00000000 30.00
DURAPREP 105.94 CS=20EA/CS 20 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501267 DYNA-HEX4 4OZ. 00249 MDS098710 1.7058 EA=1EA .00 1 00031110 25.00
DYNA-HEX4 4 81.88 CS=48EA/CS 48 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500124 E TRACH TUBE UNCUFFED 4.5 00277 4130-86226 1.04 EA=1EA .00 1 00031110 25.00
E TRACH TUBE 10.39 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500129 E,TRACH TUBE 6.0 00249 4130-086109 1.58 EA=1EA .00 1 00031110 25.00
E,TRACH TUBE 15.84 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001316 E-TRAP 00372 711099 11.00 EA=1EA .00 1 00000000 .00
E-TRAP 00414 711099 275.00 CS=25EA/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 482
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500134 E. TRACH TUBE 8.0 00249 4130086113 2.16 EA=1EA .00 1 00031110 25.00
E. TRACH TUBE 21.56 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500136 E. TRACH TUBE CUFF 10.0 00249 4130-086117 4.01 EA=1EA .00 1 00031110 35.00
E. TRACH TUBE 40.11 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500132 E. TRACH TUBE CUFF 7.5 00249 4130-086112 1.026 EA=1EA .00 1 00031110 25.00
E. TRACH TUBE 10.26 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500128 E.TRACH TUBE 5.5 00249 4130-086108 3.42 EA=1EA .00 1 00031110 35.00
E.TRACH TUBE 34.22 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500127 E.TRACH TUBE CUFF 5.0 00249 4130-86107 1.92 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 19.16 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500130 E.TRACH TUBE CUFF 6.5 00249 DYND43065 1.568 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 15.68 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500131 E.TRACH TUBE CUFF 7.0 00249 DYND43070 2.21 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 22.10 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500133 E.TRACH TUBE CUFF 8.5 00249 4130-086114 4.01 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 40.11 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 483
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500135 E.TRACH TUBE CUFF 9.0 00249 4130-086115 2.68 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 26.76 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500120 E.TRACH TUBE UNCUFF 2.5 00249 4130-086222 1.33 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 13.27 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500121 E.TRACH TUBE UNCUFFED 3.0 00249 4130-086223 1.04 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 10.39 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500122 E.TRACH TUBE UNCUFFED 3.5 00249 4130-86224 1.04 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 10.39 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500123 E.TRACH TUBE UNCUFFED 4.0 00249 4130-86225 1.04 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 10.39 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500126 E.TRACH TUBE UNCUFFED 5.5 00249 4130-86228 1.04 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 10.39 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001229 EAKIN SEAL COHESIVE 00257 1638839001 3.82 EA=1EA .00 1 00000000 .00
EAKIN SEAL CO 38.24 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001599 EAR CURETTES BLUE 00257 819004888 36.69 BX=1BX .00 1 00000000 .00
EAR CURETTES 36.69 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 484
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001600 EAR CURETTES GREEN 00257 819001222 36.69 BX=1BX .00 1 00000000 .00
EAR CURETTES 36.69 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001601 EAR CURETTES WHITE 00257 819009555 36.69 BX=1BX .00 1 00000000 .00
EAR CURETTES 36.69 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500988 EGG CRATE 00249 NON081962H 29.66 EA=1EA .00 1 00000000 200.00
EGG CRATE 29.66 EA=IEA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001133 EKG RECORDING PAPER 00929 9402-024 48.34 EA=1EA .00 1 00000000 .00
EKG RECORDING 48.34 CS=1EA/CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001134 EKG RECORDING TABS 00929 120 49.00 EA=1EA .00 1 00000000 .00
EKG RECORDING 49.00 CS=1EA/CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001120 ELASTIC NET 2" 00249 NONNET02 10.13 BX=1BX .00 1 00000000 .00
ELASTIC NET 2 10.13 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001121 ELASTIC NET 3" 00257 4304058440 6.15 BX=1BX .00 1 00000000 .00
ELASTIC NET 3 6.15 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001236 ELASTIC NET 4 00249 NONNET04 12.41 BX=1BX .00 1 00000000 .00
ELASTIC NET 4 12.41 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 485
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001237 ELASTIC NET 6 00249 NONNET06 17.09 BX=1BX .00 1 00000000 .00
ELASTIC NET 6 17.09 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000401 ELASTIC NET 7" 00249 NONNET07 19.78 BX=1BX .00 1 00000000 .00
ELASTIC NET 7 19.78 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000116 ELECTRODE ADULT 00249 MMM2560 5.785 PK=1PK .00 1 00000000 .00
ELECTRODE ADU 115.70 CS=20PK/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001102 ELECTRODE EMPI 2" 00551 198928-001 .53 EA=1EA .00 1 00000000 39.00
ELECTRODE EMP .52 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000115 ELECTRODE INFANT 00249 MDS611303AH 1.31 PK=1PK .00 1 00000000 .00
ELECTRODE INF 1.31 PK=1EA/PK 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500180 EMESIS BASIN 00249 DYND80321 .061 EA=1EA .00 1 00000000 5.00
EMESIS BASIN 15.24 CS=250EA/CS 250 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001126 EMPI ELECTRODES 6000 SERIE 00551 199485-001 16.15 EA=1EA .00 1 00000000 59.00
EMPI ELECTROD 16.15 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2504020 EMPI FLEECE PADS 00249 4509001581 .51 EA=1EA .00 1 00031110 214.00
EMPI FLEEC PA 3.04 CS=6EA/CS 6 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 486
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501137 ENDO POUCH 10MM 00249 ETHPOUCH 52.15 EA=1EA .00 1 00000000 .00
ENDO POUCH 10 00202 POUCH 312.90 BX=6EA/BX 6 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500005 ENEMA SET 00249 DYND-70100 .766 EA=1EA .00 1 00000000 68.00
ENEMA SET 36.77 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001157 ENVELOPES W/O WINDOWS CCH 00393 123 17.99 BX=1BX .00 1 00000000 .00
ENVELOPES W/ 17.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001194 ENVELOPES WINDOW CCH 00393 1234 52.99 BX=1BX .00 1 00000000 .00
ENVELOPES WIN 52.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000679 ENVELOPES-#10 PAYROLL 00107 8003 49.00 BX=1BX .00 1 00000000 .00
ENVELOPES-#10 49.00 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000581 ENVELOPES-BROWN CLASP 10X1 00052 UNV35267 23.99 BX=1BX .00 1 00000000 .00
ENVELOPES-BRO 23.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000580 ENVELOPES-BROWN CLASP 9X12 00052 UNV35264 19.99 BX=1BX .00 1 00000000 .00
ENVELOPES-BRO 00361 187021 19.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001385 EPIDURAL TRAY 00530 332256 16.05 EA=1EA .00 1 00000000 .00
EPIDURAL TRAY 160.47 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 487
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501333 EPISTAT NASAL CATH KIT 00251 15-27030 71.92 EA=1EA .00 1 00000000 503.00
EPISTAT NASAL 71.92 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500990 ER LACERATION TRAY 00249 DYNJ03000 3.5338 EA=1EA .00 1 00000000 133.00
ER LACERATION 00062 11-4523 56.54 CS=16EA/CS 16 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500866 ESMARK BANDAGE 4X9 00249 5868055514 2.58 EA=1EA .00 1 00000000 35.00
ESMARK BANDAG 51.55 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000119 ESOPH. STETH 18FR 00249 DTXM1024215 4.4488 EA=1EA .00 1 00000000 .00
ESOPH. STETH 111.22 BX=25EA/BX 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001411 ETHILON 1663G 00257 230001663G 35.61 BX=1BX .00 1 00000000 .00
ETHILON 1663G 35.61 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001587 ETHILON 3-0 1683H 00257 230001683H 119.26 BX=1BX .00 1 00000000 .00
ETHILON 3-0 1 119.26 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500125 ETRACH TUBE UNCUFFED 5.0 00249 4130-86227 1.04 EA=1EA .00 1 00031110 25.00
ETRACH TUBE U 10.39 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000205 EXAM GLOVE NITRILE LG. 00249 T-X925030 3.254 BX=1BX .00 1 00000000 .00
EXAM GLOVE NI 00062 11-2523 32.54 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 488
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000204 EXAM GLOVE NITRILE MED. 00249 T-X925020 3.254 BX=1BX .00 1 00000000 .00
EXAM GLOVE NI 00062 11-2522 32.54 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000203 EXAM GLOVE NITRILE SM. 00249 T-X925010 3.254 BX=1BX .00 1 00000000 .00
EXAM GLOVE NI 00062 11-2521 32.54 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000332 EXAM GLOVES LG S 00249 MDS194136Z .2234 EA=1EA .00 1 00000000 .00
EXAM GLOVES L 22.34 BX=100EA/BX 100 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001615 EXAM PAPER 00249 NON23322 1.8092 RL=1RL .00 1 00000000 .00
EXAM PAPER 21.71 CS=12RL/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2504004 EXUDERM 2X2 00249 MSC5522 .765 EA=1EA .00 1 00000000 18.00
EXUDERM 2X2 7.65 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501139 EXUDERM 4X4 00249 MSC5544 1.504 EA=1EA .00 1 00000000 26.00
EXUDERM 4X4 15.04 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500173 EYE PAD SMALL 00249 NON21600Z .0632 EA=1EA .00 1 00000000 11.00
EYE PAD SMALL 3.16 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001595 EZ STABILIZER 00053 9066 4.00 EA=1EA .00 1 00000000 36.00
EZ STABILIZER 4.00 EA=1EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 489
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90000737 EZPAP THERAPY SYS PRESS PO 01304 26230747 15.00 EA=1EA .00 1 00031110 100.00
EZPAP THERAPY 150.00 CS=10EA/CS 10 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500216 FACIAL TISSUE 00249 NON243275 .1347 BX=1BX .00 1 00031110 5.00
FACIAL TISSUE 00062 13-200 26.94 CS=200BX/CS 200 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501510 FALL RISK KIT LARGE 00249 6238Y 3.69 EA=1EA .00 1 00000000 146.00
FALL RISK KIT 00304 6237Y 3.69 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501509 FALL RISK KIT REGULAR 00249 6236Y 19.37 EA=1EA .00 1 00000000 146.00
FALL RISK KIT 19.37 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501511 FALL RISK SLIPPERS LARGE 00249 516306250L 5.08 EA=1EA .00 1 00000000 38.00
FALL RISK SLI 5.08 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501512 FALL RISK SLIPPERS MEDIUM 00249 516306250M 4.93 EA=1EA .00 1 00000000 86.00
FALL RISK SLI 4.93 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501514 FALL RISK SLIPPERS SMALL 00249 516306250S 5.17 EA=1EA .00 1 00000000 86.00
FALL RISK SLI 124.08 CS=24EA/CS 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501508 FALL RISK SOCKS STANDARD 00249 MDTPS4B03FPY .96 EA=1EA .00 1 00000000 .00
FALL RISK SOC 00304 6239Y 46.08 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 490
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501507 FALL RISK SOCKS LARGE 00249 MDTPS4B04FPY .9906 EA=1EA .00 1 00031110 10.00
FALL RISK SOC 00304 6239LY 47.55 CS=48EA/CS 48 .00 2 00031111 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000656 FASTENERS-2" 00499 UNV81002 2.69 EA=1EA .00 1 00000000 .00
FASTENERS-2" 2.69 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000666 FASTENERS-SELF ADHESIVE 00361 SMD68220 17.99 BX=1BX .00 1 00000000 .00
FASTENERS-SEL 00118 SMD68220 17.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001258 FAX CART.TN430 00052 IVRTN430 49.99 EA=1EA .00 1 00000000 .00
FAX CART.TN43 00361 IVRTN430 49.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000623 FAX CARTRIDGE TN420 00361 IVRTN420 47.99 EA=1EA .00 1 00000000 .00
BRTTN420 47.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500293 FECAL INCONT.COLLECTION 00249 9822 5.06 EA=1EA .00 1 00000000 30.00
FECAL INCONT. 50.62 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500105 FEEDING TUBE 8FR 00249 BRD0036410H .56 EA=1EA .00 1 00000000 16.00
FEEDING TUBE .56 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500146 FEEDING TUBE INFANT 5FR‘ 00249 BRD0036400H .57 EA=1EA .00 1 00000000 16.00
FEEDING TUBE .57 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 491
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501231 FEMALE CATH KIT 00249 DYND10805 1.5424 EA=1EA .00 1 00000000 23.00
FEMALE CATH K 38.56 CS=25EA/CS 25 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001382 FEMORAL LEG SPLINT 25" 00585 79-72295 36.39 EA=1EA .00 1 00000000 311.00
FEMORAL LEG S 36.39 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500333 FENESTRATED TOWEL 00249 DYA4409Z .2098 EA=1EA .00 1 00000000 5.00
FENESTRATED T 10.49 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000585 FILE FOLDER STANDARD 00052 UNV12113 8.29 BX=1BX .00 1 00000000 .00
FILE FOLDER S 00361 744100 8.29 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001635 FILTER NEEDLE 18GA.X11/2 00257 3.58381E+11 22.50 BX=1BX .00 1 00000000 .00
FILTER NEEDLE 22.50 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001204 FINGER SPLINT 00249 ZIM254801700 1.9183 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 23.02 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001205 FINGER SPLINT 00420 66-0025-002-00 2.41 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 28.93 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001206 FINGER SPLINT 00420 66-0017-001-00 1.17 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 13.98 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 492
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001207 FINGER SPLINT 00249 ZIM254801500 3.1617 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 18.97 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001208 FINGER SPLINT 00420 00-2548-016-00 .88 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 5.28 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001209 FINGER SPLINT 00420 00-2548-017-00 .94 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 5.63 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001210 FINGER SPLINT PLASTALUME 00420 00-2548-015-00 .97 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 5.82 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001211 FINGER SPLINT PLASTALUME 00420 00-2548-018-00 1.02 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 6.09 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500292 FLATUS BAG 00249 3583145524 1.20 EA=1EA .00 1 00000000 23.00
FLATUS BAG 59.81 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500106 FLEXIFLO 8FR 00249 5520-000473 14.69 EA=1EA .00 1 00000000 158.00
FLEXIFLO 8FR 146.90 CS=10EA/CS 10 .00 2 00000000 .00
.......... 44(0272) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001230 FLEXISENSOR ADULT 00719 0998-00-0076-05 51.46 PK=1PK .00 1 00000000 .00
FLEXISENSOR A 154.38 PK=3PK/PK 3 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 493
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000067 FLEXISENSOR ADULT BANDAGE 00719 0683-00-0409-02 103.08 BX=1BX .00 1 00000000 .00
FLEXISENSOR A 103.08 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001112 FLOW SELECTOR,STANDARD 01304 715-PM1000 28.38 EA=1EA .00 1 00000000 .00
FLOW SELECTOR 28.38 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501303 FLOW TRON 00033 DVT10 17.29 EA=1EA .00 1 00031110 254.00
FLOW TRON 00249 MDS601MD 17.29 EA=1EA/EA 1 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000303 FOG FREE MASK GREEN 00249 NON27378A 7.8617 BX=1BX .00 1 00000000 .00
FOG FREE MASK 47.17 CS=6BX/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000302 FOG FREE MASK W/ SHIELD OR 00249 NON27710 8.95 BX=1BX .00 1 00000000 .00
FOG FREE MASK 53.70 CS=6BX/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500091 FOLEY TRAY 14FR 00249 DYND160414 21.036 EA=1EA .00 1 00000000 128.00
FOLEY TRAY 14 210.36 CS=10EA/CS 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500092 FOLEY TRAY 16FR 00249 BRD800361 6.725 CS=1EA .00 1 00000000 288.00
FOLEY TRAY 16 00062 27-802016 67.25 CS=10EA/CS 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500093 FOLEY TRAY 18FR 00249 BRD800362 6.725 EA=1EA .00 1 00000000 288.00
FOLEY TRAY 18 67.25 CS=10EA/CS 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 494
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501636 FOLEY TRAY URINE METER 16F 00249 0620303316A 18.94 EA=1EA .00 1 00000000 131.00
FOLEY TRAY UR 189.41 CS=10EA/CS 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501637 FOLEY TRAY URINE METER 18F 00249 0620303318A 18.94 EA=1EA .00 1 00000000 .00
FOLEY TRAY UR 189.41 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001591 FOLEY TRICOT STAT LOK 00257 0620FOL0102 3.01 EA=1EA .00 1 00000000 .00
FOLEY TRICOT 75.31 CS=25EA/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001292 FOREARM PADDED LT,LG. 00585 79-71977 4.26 EA=1EA .00 1 00000000 18.00
FOREARM PADDE 4.26 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001291 FOREARM PADDED RT,LG. 00585 79-71987 4.26 EA=1EA .00 1 00000000 18.00
FOREARM PADDE 4.26 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001317 FOREARM SPLINT LEFT 00585 79-71973 4.26 EA=1EA .00 1 00000000 .00
FOREARM SPLIN 4.26 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001398 FOREARM SPLINT LEFT 00585 79-71972 4.36 EA=1EA .00 1 00000000 .00
FOREARM SPLIN 4.36 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001302 FOREARM SPLINT LEFT MED. 00585 79-71975 4.32 EA=1EA .00 1 00000000 18.00
FOREARM SPLIN 4.32 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 495
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001281 FOREARM SPLINT R 00585 79-71985 4.32 EA=1EA .00 1 00000000 18.00
FOREARM SPLIN 4.32 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001490 FROG FINGER SPLINT 13/4" 00522 VC5407 22.00 EA=1EA .00 1 00000000 18.00
FROG FINGER S 22.00 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001488 FROG FINGER SPLINT 21/4 00522 VC5406 22.00 EA=1EA .00 1 00000000 18.00
FROG FINGER S 22.00 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001489 FROG FINGER SPLINT 3" 00522 VC5408 22.00 EA=1EA .00 1 00000000 18.00
FROG FINGER S 22.00 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500403 GAIT TRANSFER BELT 00249 MDT828203 3.5983 EA=1EA .00 1 00000000 35.00
GAIT TRANSFER 21.59 CS=6EA/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501390 GASTROSTOMY TUBE 00058 51364 23.37 EA=1EA .00 1 00000000 163.00
GASTROSTOMY T 00249 DYND70320 23.37 EA=1EA/EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500172 GAUZE 2X2 8PLY S 00249 PRM21224H 1.94 EA=1EA .00 1 00031110 2.00
GAUZE 2X2 8PL 1.94 BX=1BX 1 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 1.94 1 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001697 GAUZE 2X2 NS 00249 PRM21208C .724 PK=1PK .00 1 00000000 .00
GAUZE 2X2 NS 18.10 CS=25PK/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .7464 1 .00 3 00000000 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 496
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500157 GAUZE 4X4 X12PLY S 00249 NON21424 .0548 EA=1EA .00 1 00031110 14.00
GAUZE 4X4 X12 32.88 CS=600EA/CS 600 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500171 GAUZE4X4 16PLY S 00249 NON21428 .4205 EA=1EA .00 1 00031110 63.00
GAUZE4X4 16PL 53.82 CS=128EA/CS 128 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:Y MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2146224 GRANEE NEEDLE 00249 BAR9001C0212 22.57 EA=1EA .00 1 00000000 98.00
GRANEE NEEDLE 00043 9001C0212 225.70 BX=10EA/BX 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500031 GRIPPER 20GA X 1" 00249 PTX21286624 5.0675 EA=1EA .00 1 00000000 79.00
GRIPPER 20GA 00062 11-212866 60.81 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 31300025 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501304 GRIPPER NEEDLE 20 11/4 00249 PDI21286724 5.0675 EA=1EA .00 1 00000000 35.00
GRIPPER NEEDL 60.81 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001481 GUEDEL AIRWAY 100MM 00346 1-1504-100 .66 BX=1BX .00 1 00000000 14.00
GUEDEL AIRWAY 6.60 BX=10BX/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001478 GUEDEL AIRWAY 70MM 00346 1-1504-70 .66 BX=1BX .00 1 00000000 14.00
GUEDEL AIRWAY 6.60 BX=10BX/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001479 GUEDEL AIRWAY 80MM 00346 1-1504-80 .66 BX=1BX .00 1 00000000 14.00
GUEDEL AIRWAY 6.60 BX=10BX/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 497
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001480 GUEDEL AIRWAY 90MM 00346 1-1504-90 .66 BX=1BX .00 1 00000000 14.00
GUEDEL AIRWAY 6.60 BX=10BX/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000584 HANGING FILES 00052 ESS415215 3.40 BX=1BX .00 1 00000000 .00
HANGING FILES 3.40 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501000 HEEL PROTECTOR 00249 NON081440PH 4.91 EA=1EA .00 1 00000000 135.00
HEEL PROTECTO 00304 6115 4.91 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001266 HIBICLENS 16OZ. 00257 158057516 9.51 EA=1EA .00 1 00000000 .00
HIBICLENS 16O 114.12 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000642 HIGHLIGHTERS-GREEN 00499 UNV08862 .6658 EA=1EA .00 1 00000000 .00
HIGHLIGHTERS- 7.99 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000643 HIGHLIGHTERS-PINK 00052 UNV08865 .6658 EA=1EA .00 1 00000000 .00
HIGHLIGHTERS- 7.99 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000644 HIGHLIGHTERS-YELLOW 00118 UNV08861 .6658 EA=1EA .00 1 00000000 .00
HIGHLIGHTERS- 00361 UNV08861 7.99 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001311 HIP/KNEE KIT 00249 THE210301 41.73 EA=1EA .00 1 00000000 143.00
HIP/KNEE KIT 41.73 EA=1EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 498
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001111 HUMIDIFIER 500ML.W/ADAPTER 00107 04-2D0803 3.17 EA=1EA .00 1 00000000 .00
HUMIDIFIER 50 37.98 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001131 HUMIDIFIER W/ADAPTER 760ML. 00249 HUD3709 1.147 EA=1EA .00 1 00000000 .00
HUMIDIFIER W/ 11.47 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501426 I.V.CONN.EXTENSION SET 00044 7N8300 1.7517 EA=1EA .00 1 00000000 38.00
I.V.CONN.EXTE 00249 BHL7N8301 350.34 CS=200EA/CS 200 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001536 ICE BAGS 00661 S-7494 52.00 CS=1CS .00 1 00000000 .00
ICE BAGS 52.00 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500006 ICE PACK 00249 NON4420 .663 EA=1EA .00 1 00000000 32.00
ICE PACK 66.30 CS=100EA/CS 100 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001123 ID BANDS BLUE 00249 MDS133037B 46.07 BX=1BX .00 1 00000000 .00
ID BANDS BLUE 46.07 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001516 ID BANDS PURPLE DNR 00431 WBCDNA-8 42.95 BX=1BX .00 1 00000000 .00
ID BANDS PURP 42.95 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001274 ID BANDS RED 00249 MDS133037R 43.11 BX=1BX .00 1 00000000 .00
ID BANDS RED 00107 8592 43.11 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 499
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001118 ID BANDS RED ALLERGY 00257 518984516PDJ 24.10 BX=1BX .00 1 00000000 .00
ID BANDS RED 24.10 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001517 ID BANDS YELLOW FALL RISK 00431 WBCFRA-3 63.27 EA=1EA .00 1 00000000 .00
ID BANDS YELL 63.27 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500415 IMPER STOCKINETTE-LG 00249 1259000274 3.27 EA=1EA .00 1 00000000 40.00
IMPER STOCKIN 49.08 CS=15EA/CS 15 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500414 IMPER STOCKINETTE-M 00249 1259000273 2.08 EA=1EA .00 1 00000000 40.00
IMPER STOCKIN 31.25 CS=15EA/CS 15 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000738 IN-LINE AEROSOL H2O TRAPS 01304 45276 1.86 EA=1EA .00 1 00000000 12.00
IN-LINE AEROS 92.75 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000640 INK PENS BLACK 00118 BICGSF11BK 2.29 BX=1BX .00 1 00000000 .00
INK PENS BLAC 00361 382241 2.29 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000639 INK PENS BLUE 00499 UNV27411 1.55 BX=1BX .00 1 00000000 .00
INK PENS BLUE 1.55 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000638 INK PENS RED 00499 UNV27412 1.19 BX=1BX .00 1 00000000 .00
INK PENS RED 1.19 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 500
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001136 INSP.FILTERS/760 00394 4-074601-00 51.30 EA=1EA .00 1 00000000 .00
INSP.FILTERS/ 51.30 CS=1EA/CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001106 INSULIN SYRINGE 00249 SWD511110Z 28.06 BX=1BX .00 1 00000000 .00
INSULIN SYRIN 28.06 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001476 INSULIN SYRINGE LL 00249 SWD8100777Z .478 EA=1EA .00 1 00000000 .00
INSULIN SYRIN 28.68 BX=60EA/BX 60 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500011 INSYTE AUTOGUARD 24GA. 00249 BMG4251601Z 1.5854 EA=1EA .00 1 00000000 88.00
INSYTE AUTOGU 79.27 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001642 INTERMEC DURATHEM11 LABELS 00754 E15532 12.61 EA=1EA .00 1 00000000 .00
INTERMEC DURA 100.90 CS=8EA/CS 8 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500012 INTROCAN 22X1 00249 BMG4251628Z 1.5854 EA=1EA .00 1 00000000 88.00
INSYTE AUTOGU 00039 4251628-02 79.27 BX=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500013 INTROCAN 20X1 00249 BMG4251652Z 1.5854 EA=1EA .00 1 00000000 88.00
INSYTE AUTOGU 00039 4251652-02 79.27 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500016 INTROCAN 14G 00249 BMG4251717H 1.60 EA=1EA .00 1 00000000 39.00
INTROCAN 14G 1.60 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 501
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500015 INTROCAN 16G 00249 4052 .94 EA=1EA .00 1 00000000 39.00
INTROCAN 16G 46.95 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500014 INTROCAN 18G 00249 BMG4251687Z 1.5854 EA=1EA .00 1 00000000 88.00
INTROCAN 18G 79.27 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000628 INVISIBLE TAPE 00118 UNV83436 1.89 RL=1RL .00 1 00000000 .00
INVISIBLE TAP 00361 STP487908 1.89 RL=1RL/RL 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001596 IO NEEDLE ADULT 00437 V9001 120.00 EA=1EA .00 1 00000000 895.00
IO NEEDLE ADU 120.00 BX=1EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001597 IO NEEDLE PED. 00437 V9018 105.00 EA=1EA .00 1 00000000 895.00
IO NEEDLE PED 525.00 BX=5EA/BX 5 .00 2 00000000 .00
.......... 44(0272) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001598 IO PLACEMENT 00053 XX 305.00 EA=1EA .00 1 00000000 417.00
IO PLACEMENT 305.00 EA=1EA 1 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36680 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
80000290 IRRIGATION SYRINGE 00257 3583067000 .74 EA=1EA .00 1 00000000 .00
IRRIGATION SY 37.00 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 502
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500280 IRRIGATION TRAY 00249 DYND20102 .844 EA=1EA .00 1 00000000 45.00
IRRIGATION TR 16.88 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500281 IRRIGATION TRAY PISTON 00249 DYNC2303 1.7665 EA=1EA .00 1 00000000 54.00
IRRIGATION TR 35.33 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000144 ISOLATION GOWN 00249 NON27236XL 3.404 PK=1PK .00 1 00000000 .00
ISOLATION GOW 17.02 CS=5PK/CS 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000994 ISOLATION MASK-YELLOW 00249 NON27120 3.105 BX=1BX .00 1 00000000 .00
ISOLATION MAS 00218 4515A 18.63 CS=6BX/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501365 IV BASIC SOL. SET 2C8425 00044 2C8425 2.4533 EA=1EA .00 1 00000000 29.00
IV BASIC SOL. 00249 BHL2C8425 117.76 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501367 IV BURETROL ADD-ON SET 00044 2C7565 2.25 EA=1EA .00 1 00000000 30.00
IV BURETROL A 108.18 CS=48EA/CS 48 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501368 IV CATH EXT.SET 2N3374 00044 2N3374 1.95 EA=1EA .00 1 00000000 45.00
IV CATH EXT.S 00249 389.40 CS=200EA/CS 200 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501427 IV CONN CAP 00249 BHL7N8399 1.0858 EA=1EA .00 1 00000000 23.00
IV CONN CAP 217.15 CS=200EA/CS 200 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 503
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501371 IV CONT-FLO SET NON-VENTED 2C 00793 M46445690 4.371 EA=1EA .00 1 00031110 68.00
CONT-FLO SET 00249 BHL2C8537 131.13 CS=30EA/CS 30 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501372 IV CONT-FLO VENTED 2C8541 00044 2C8541 3.2833 EA=1EA .00 1 00000000 117.00
IV CONT-FLO V 157.60 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501373 IV DIAL-A-FLO EXT. 00103 S2-12 .83 EA=1EA .00 1 00000000 23.00
IV DIAL-A-FLO 50.00 CS=60EA/CS 60 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501369 IV FAT SET 00044 2C1106 1.99 EA=1EA .00 1 00000000 .00
IV FAT SET 95.45 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501370 IV FILTER SET 2H8671 00249 BHL2H8671 3.0496 EA=1EA .00 1 00000000 24.00
IV FILTER SET 146.38 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501374 IV NITRO-DRIP 2C8851 00044 2C8851 5.86 EA=1EA .00 1 00000000 .00
IV NITRO-DRIP 281.14 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501375 IV SECONDARY MED SET 2C746 00793 M77460030 1.1085 EA=1EA .00 1 00031110 12.00
IV SECONDARY 00249 BHL2C7461 44.34 CS=40EA/CS 40 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501534 IV SET MINI DRIP OR 2C854 00044 2C8546 3.2467 EA=1EA .00 1 00000000 117.00
IV SET MINI D 00249 BHL2C8546 155.84 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 504
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500984 IV START KIT 00249 DYND74271 .6652 EA=1EA .00 1 00000000 34.00
IV START KIT 00084 IV330 66.52 CS=100EA/CS 100 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500179 K-PADS 00249 070766N410CC 11.94 EA=1EA .00 1 00000000 203.00
K-PADS 119.43 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500114 KANGAROO DOUBLE FEEDIND BAG 00249 SWD773656 2.1893 EA=1EA .00 1 00000000 79.00
KANGAROO 65.68 CS=30EA/CS 30 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500113 KANGAROO WITH ICE POUCH 00443 8884773600 4.7357 EA=1EA .00 1 00000000 35.00
KANGAROO 142.07 CS=30EA/CS 30 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500176 KERLIX S 00249 PRM25865 .4374 EA=1EA .00 1 00000000 14.00
KERLIX S 43.74 CS=100EA/CS 100 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:Y MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500178 KERLIX SUPER 00249 3583004308 .77 EA=1EA .00 1 00000000 8.00
KERLIX SUPER 7.71 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000163 KLING 2" 00249 NON25492 1.3563 BG=1BG .00 1 00000000 .00
KLING 2" 10.85 CS=8BG/CS 8 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500159 KLING 2" S 00249 NON25496 .1221 EA=1EA .00 1 00000000 32.00
KLING 2" S 11.72 BX=96EA/BX 96 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 505
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000164 KLING 3" 00249 NON25493 1.9425 BG=1BG .00 1 00000000 .00
KLING 3" 15.54 CS=8BG/CS 8 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500160 KLING 3" S 00249 NON25497 .1435 EA=1EA .00 1 00000000 41.00
KLING 3" S 13.78 CS=96EA/CS 96 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000165 KLING 4" 00257 6904 1.56 BG=1BG .00 1 00000000 .00
KLING 4" 12.46 CS=8BG/CS 8 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500161 KLING 4" S 00249 NON25498 .1809 EA=1EA .00 1 00000000 52.00
KLING 4" S 17.37 CS=96EA/CS 96 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000166 KLING 6" 00257 6906 5.72 BG=1BG .00 1 00000000 .00
KLING 6" 5.72 BG=1BG/BG 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500162 KLING 6" S 00249 NON25499 .32 EA=1EA .00 1 00000000 59.00
KLING 6" S 15.36 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500377 KNEE HIGH LG 00249 MDS160664 4.8925 EA=1EA .00 1 00000000 153.00
KNEE HIGH LG 00432 2040009 58.71 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500376 KNEE HIGH MED 00249 MDS160644 4.8925 EA=1EA .00 1 00000000 153.00
KNEE HIGH MED 00432 204008 58.71 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 506
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500375 KNEE HIGH SM 00249 MDS160624 3.6942 EA=1EA .00 1 00000000 153.00
KNEE HIGH SM 44.33 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500378 KNEE HIGH XL 00432 204010 5.871 EA=1EA .00 1 00000000 153.00
KNEE HIGH XL 00249 MDS160684 58.71 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500485 KNEE IMMOB 16" LG 00249 ORT2410016 20.98 BX=1BX .00 1 00000000 322.00
KNEE IMMOB 16 20.98 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500484 KNEE IMMOB 16" MED 00420 1877-504-16 18.20 BX=1BX .00 1 00000000 725.00
KNEE IMMOB 16 18.20 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500483 KNEE IMMOB 16" UNIVERSAL 00249 ORT2410016 21.40 BX=1BX .00 1 00000000 725.00
KNEE IMMOB SM 21.40 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500486 KNEE IMMOB 16"XL 00420 187750616 18.20 BX=1BX .00 1 00000000 322.00
KNEE IMMOB 16 18.20 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500489 KNEE IMMOB 22" LG 00420 187750522 19.28 BX=1BX .00 1 00000000 322.00
KNEE IMMOB 22 19.28 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500488 KNEE IMMOB 22" MD 00420 187750422 20.54 BX=1BX .00 1 00000000 322.00
KNEE IMMOB 22 20.54 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 507
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500490 KNEE IMMOB 22"XL 00420 187750622 19.28 BX=1BX .00 1 00000000 322.00
KNEE IMMOB 22 19.28 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500487 KNEE IMMOB UNIVERSAL 22" 00249 ORT2411022 25.20 BX=1BX .00 1 00000000 322.00
KNEE IMMOB 22 25.20 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500860 KNEE SLEEVES SCD LARGE 00657 3583005489 33.38 EA=1EA .00 1 00000000 113.00
KNEE SLEEVES 166.91 CS=5EA/CS 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501045 KUMPE 5FR 40CM 00254 54038KA2 11.50 EA=1EA .00 1 00000000 124.00
KUMPE 5FR 40 00058 31-407 57.50 BX=5EA/BX 5 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501046 KUMPE 5FR 65CM 00254 56538KA2 11.50 EA=1EA .00 1 00000000 124.00
KUMPE 5FR 65C 00058 31-409 57.50 BX=5EA/BX 5 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000245 KY JELLY 2.7 00249 MDS032273Z 5.1317 BX=1BX .00 1 00000000 .00
KY JELLY 2.7 00062 24-3627D 30.79 CS=6BX/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000246 KY JELLY 4OZ. 00249 MDS032290Z .7825 EA=1EA .00 1 00000000 .00
KY JELLY 4OZ. 9.39 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001442 LAP CHOLE PACK 00249 DYNJS0310 34.1525 EA=1EA .00 1 00000000 210.00
LAP CHOLE PAC 136.61 CS=4EA/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 508
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2504033 LARGE ADULT BP CUFF 00249 MDS9914HP 4.272 EA=1EA .00 1 00000000 .00
LARGE ADULT B 21.36 PK=5EA/PK 5 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 4.272 1 .00 3 00000000 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001321 LASER LABELS AND ARM BANDS 00306 WBW61 66.75 PK=1PK .00 1 00000000 .00
LASER LABELS 00107 7263 267.00 CS=4PK/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000096 LEG BAG 00249 DYND12574H 1.98 EA=1EA .00 1 00000000 .00
LEG BAG 1.98 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001306 LEG SPLINT FEMORAL 14" 00585 79-72295 36.39 EA=1EA .00 1 00000000 311.00
LEG SPLINT FE 36.39 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000097 LEG STRAP 00249 1821-000316 3.07 EA=1EA .00 1 00000000 .00
LEG STRAP 30.74 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000619 LEGAL PADS -LETTER YELLOW 00052 UNV10630 1.2492 EA=1EA .00 1 00000000 .00
LEGAL PADS -L 00361 815080 14.99 PK=12EA/EA 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000618 LEGAL PADS-SMALL YELLOW 00052 UNV46200 .7908 EA=1EA .00 1 00000000 .00
LEGAL PADS-SM 00361 163832 9.49 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001299 LEMON GLYCERIN SWABSTICK 00249 MDS090600 2.313 BX=1BX .00 1 00000000 .00
LEMON GLYCERI 23.13 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 509
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001087 LETTER HEAD CCH 00783 CCH 94.10 BX=1BX .00 1 00000000 .00
LETTER HEAD C 941.00 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500108 LEVIN TUBE 10FR 00249 4130-085750 1.96 EA=1EA .00 1 00000000 29.00
LEVIN TUBE 10 98.00 CS=50EA/CS 50 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500109 LEVIN TUBE 12FR 00249 SWD265314H .1288 EA=1EA .00 1 00000000 29.00
LEVIN TUBE 12 6.44 EA=1EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500110 LEVIN TUBE 14FR 00249 4130-85752 .9158 EA=1EA .00 1 00000000 29.00
LEVIN TUBE 14 45.79 CS=50EA/CS 50 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000721 LG DISP VINYL NASAL MASK 01304 83312104EA 14.49 EA=1EA .00 1 00000000 44.00
LG DISP VINYL 14.49 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000724 LG/NARR DISP VINYL NASAL M 01304 73312123EA 14.49 EA=1EA .00 1 00000000 44.00
LG/NARR DISP 14.49 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000462 LIFE PAK 6,7,8 00356 804700-003 1.00 EA=1EA .00 1 00000000 .00
LIFE PAK 6,7, 10.04 BX=10BX/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000463 LIFE PAK 9,10 00356 11240000013 6.56 RL=1RL .00 1 00000000 .00
LIFE PAK 9,10 19.68 BX=3RL/BX 3 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 510
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501325 LIGAMAX EL5ML 00202 EL5ML 130.03 EA=1EA .00 1 00000000 1042.00
LIGAMAX EL5ML 00249 ETHEL5ML 390.09 BX=3EA/BX 3 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500154 LIMB HOLDER 00304 2532 6.69 EA=1EA .00 1 00000000 90.00
LIMB HOLDER 00249 NON243074 6.69 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000194 LOTION 00249 MSC095001 .1761 EA=1EA .00 1 00000000 .00
LOTION 16.91 CS=96EA/CS 96 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000768 LTV VENT CIRCUITS 00750 10820 5.48 EA=1EA .00 1 00000000 59.00
LTV VENT CIRC 137.00 CS=25EA/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500048 LUMBAR PUNT TRAY 00249 BXT4301CH 8.16 EA=1EA .00 1 00000000 115.00
LUMBAR PUNT. 8.16 EA=1EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001270 MAGNETIC INSTRUMENT PAD 00257 603425D001 3.63 CS=1CS .00 1 00000000 .00
MAGNETIC INST 108.92 CS=30CS/CS 30 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001443 MAJOR EXTREMITY PACK 00249 DYNJS0804 32.155 EA=1EA .00 1 00000000 328.00
MAJOR EXTREMI 128.62 CS=4EA/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501346 MAJOR LAP PACK (NEW) 00249 DYNJS0301 46.01 EA=1EA .00 1 00000000 352.00
MAJOR LAP PAC 92.02 CS=2EA/CS 2 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 511
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501124 MALE CATH TEXAS SMALL 00249 DYND12303H 1.51 EA=1EA .00 1 00000000 39.00
MALE CATH TEX 1.51 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000648 MARKER-BLACK 00052 AVE08888 .7908 EA=1EA .00 1 00000000 .00
MARKER-BLACK 9.49 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501263 MASTISOL 00249 FRN052348Z 1.6242 EA=1EA .00 1 00000000 20.00
MASTISOL 77.96 BX=48EA/BX 48 .00 2 00000000 .00
.......... 78(0250) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500536 MAX 30 INFLATION 00104 G31027 30.00 BX=1BX .00 1 00000000 277.00
MAX 30 INFLAT 00058 M0067101131 30.00 BX=1BX/BX 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000761 MED CONCENTR AD O2 MASK-SI 01304 301180 .55 EA=1EA .00 1 00000000 54.00
MED CONCENTR 27.50 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000722 MED/SMA DISP VINYL NASAL M 01304 73312105EA 14.49 EA=1EA .00 1 00000000 44.00
MED/SMA DISP 14.49 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2504022 MEDIHONEY 2X2 SHEET 00249 DER31815 37.445 EA=1EA .00 1 00031110 100.00
MEDIHONEY SHE 449.34 CS=12EA/CS 12 .00 2 00031220 .00
.......... 43(0270) INV.GL=41115091 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2504021 MEDIHONEY GEL 00249 DER31815 11.5733 EA=1EA .00 1 00031110 63.00
MEDIHONEY 138.88 CS=12EA/CS 12 .00 2 00031220 .00
.......... 43(0270) INV.GL=41115091 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 512
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001232 MEDIPORE DRESSING 00257 4509003562 9.04 BX=1BX .00 1 00000000 .00
MEDIPORE DRES 36.15 CS=4BX/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501560 MEDIPORE DRESSING 3566 00249 4509003566 .52 EA=1EA .00 1 00000000 7.00
MEDIPORE DRES 52.42 CS=100EA/CS 100 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501164 MEFIX 4" 00249 ALA311099H 7.02 BX=1BX .00 1 00000000 119.00
MEFIX 4" 7.02 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501189 MEFIX 6" 00249 ALA311599H 10.5125 BX=1BX .00 1 00000000 53.00
MEFIX 6" 10.5125 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001446 MERITZ PLUS 00249 MDS8840128 15.51 EA=1EA .00 1 00000000 .00
MERITZ PLUS 62.04 CS=4EA/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000755 METHACHOLINE CHALLE ASTHMA 01304 26773100 28.26 EA=1EA .00 1 00000000 90.00
METHACHOLINE 28.26 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500980 MIDSTREAM 00249 DYND30240 .6207 EA=1EA .00 1 00031110 56.00
MIDSTREAM 62.07 CS=100EA 100 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000466 MINDRAY RECORDING PAPER 00263 0683-00-0505-02 3.49 RL=1RL .00 1 00000000 .00
MINDRAY 34.90 BX=10RL/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 513
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501337 MINI ACCESS KIT 5FR. 00916 MAK501N/A 35.00 BX=1BX .00 1 00000000 78.00
MINI ACCESS K 35.00 BX=1BX/BX 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000704 MINI-HEART 30CC CONT NEBUL 01304 963100611EA 17.25 EA=1EA .00 1 00000000 74.00
MINI-HEART 30 17.25 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001590 MITTS 00573 2826 1.07 EA=1EA .00 1 00000000 .00
MITTS 12.80 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001116 MONOCRYL 4-0 Y845G 00249 ETHY845G 50.37 BX=1BX .00 1 00000000 .00
MONOCRYL 4-0 50.37 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001645 MONOFILIMENT 4-0 ETHY496G 00249 ETHY496G 46.63 BX=1BX .00 1 00000000 .00
MONOFILIMENT 46.63 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500196 MOUTHWASH 00249 CTR000413 .2013 EA=1EA .00 1 00000000 .00
MOUTHWASH 12.08 CS=60EA/CS 60 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001486 MULTI ABSORBER 00547 8003138 15.40 EA=1EA .00 1 00000000 .00
MULTI ABSORBE 92.37 CS=6EA/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000765 NASAL AIRWAY 00249 HUD1088 6.00 EA=1EA .00 1 00031110 69.00
300.00 CS=50EA/CS 50 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 514
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90000740 NASAL CANNULA EZ WRAP (EAR 01304 771016 .85 EA=1EA .00 1 00000000 .00
NASAL CANNULA 42.35 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001563 NASAL CANNULA W/25FT.TUBIN 01304 301-104 1.81 EA=1EA .00 1 00000000 35.00
NASAL CANNULA 45.32 CS=25EA/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501245 NASAL TAMPON 00249 440402 10.044 EA=1EA .00 1 00000000 63.00
NASAL TAMPON 00251 440402 100.44 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000706 NASOPHARYNGEAL AIRWAY 20FR 01304 76123120 4.02 EA=1EA .00 1 00000000 40.00
NASOPHARYNGEA 40.17 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000707 NASOPHARYNGEAL AIRWAY 22FR 01304 76123122 4.02 EA=1EA .00 1 00000000 40.00
NASOPHARYNGEA 40.17 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000708 NASOPHARYNGEAL AIRWAY 24FR 01304 763123124 5.61 EA=1EA .00 1 00000000 40.00
NASOPHARYNGEA 56.13 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000709 NASOPHARYNGEAL AIRWAY 26FR 01304 76123126 5.61 EA=1EA .00 1 00000000 40.00
NASOPHARYNGEA 56.13 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000710 NASOPHARYNGEAL AIRWAY 28FR 01304 76123128 5.61 EA=1EA .00 1 00000000 40.00
NASOPHARYNGEA 56.13 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 515
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90000711 NASOPHARYNGEAL AIRWAY 30FR 01304 562123130 2.64 EA=1EA .00 1 00000000 40.00
NASOPHARYNGEA 26.43 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000712 NASOPHARYNGEAL AIRWAY 32FR 01304 76123132 5.61 EA=1EA .00 1 00000000 40.00
NASOPHARYNGEA 56.13 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000713 NASOPHARYNGEAL AIRWAY 34FR 01304 76123134 5.61 EA=1EA .00 1 00000000 40.00
NASOPHARYNGEA 56.13 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000714 NASOPHARYNGEAL AIRWAY 36FR 01304 76123136 2.64 EA=1EA .00 1 00000000 40.00
NASOPHARYNGEA 26.43 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000766 NEBULIZER 00396 301200 1.1308 EA=1EA .00 1 00031110 42.00
NEBULIZER 00249 HCS4483 56.54 CS=50EA/CS 50 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000029 NEEDLE 25X2 00249 358381-200441 8.98 BX=1BX .00 1 00000000 .00
NEEDLE 25X2 8.98 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000564 NEEDLE COUNTER 00257 31142337 8.73 BX=1BX .00 1 00000000 .00
NEEDLE COUNTE 69.80 BX=8BX/BX 8 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500052 NEEDLE LOCK DEVICE 00044 2C7833 .50 EA=1EA .00 1 00000000 5.00
NEEDLE LOCK D 49.91 BX=100EA/BX 100 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 516
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000053 NG STRIP 00249 CURNASTUB50 .5182 EA=1EA .00 1 00000000 .00
NG STRIP 25.91 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000773 NIPPLE ADAPTORS 01304 26-33-2600 .66 EA=1EA .00 1 00000000 .00
NIPPLE ADAPTO 32.89 PK=50EA/PK 50 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501419 NITREX WIRES 00916 MAK001N 2.30 EA=1EA .00 1 00000000 71.00
NITREX WIRES 23.00 BX=10EA/BX 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500334 NONFENESTRATED TOWEL 00249 BXT3520Z .3412 EA=1EA .00 1 00000000 5.00
NONFENESTRATE 17.06 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001091 NOTEBOOK 1" 00052 UNV20962 3.1658 EA=1EA .00 1 00000000 .00
NOTEBOOK 1" 00361 374815 3.1658 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000677 NOTEBOOK 2" 00052 UNV20982 5.99 EA=1EA .00 1 00000000 .00
NOTEBOOK 2" 00361 648814 5.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001095 NOTEBOOK 3" 00052 UNV20992 7.99 EA=1EA .00 1 00000000 .00
NOTEBOOK 3" 00361 374819 7.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000678 NOTEBOOK-1.5" 00499 UNV20972 3.79 EA=1EA .00 1 00000000 .00
NOTEBOOK-1.5" 3.79 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 517
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001305 NOVO INSULIN NEEDLES 00249 NOV185275 57.63 BX=1BX .00 1 00000000 .00
NOVO INSULIN 57.63 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500265 NUGAUZE 1" 00249 NON255015 1.7183 EA=1EA .00 1 00000000 53.00
NUGAUZE 1" 20.62 CS=12EA 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000175 NUGAUZE 4X4 00257 3460007634 2.03 PK=1PK .00 1 00000000 .00
NUGAUZE 4X4 20.30 CS=10PK/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500267 NUGAUZE IDOFORM.50 00249 NON256125 1.5767 EA=1EA .00 1 00000000 53.00
NUGAUZE IDOFO 18.92 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500268 NUGAUZE IODOFORM 1" 00249 NON256015 1.9667 EA=1EA .00 1 00000000 135.00
NUGAUZE IODOF 23.60 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501200 NUGAUZE PACK IODOFORM 1/4 00249 NON256145 1.5092 BT=1BT .00 1 00000000 53.00
NUGAUZE PACK 18.11 CS=12BT/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500264 NUGAUZE PACKING 1/2 00249 NON255125 1.5708 EA=1EA .00 1 00000000 46.00
NUGAUZE PACKI 18.85 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501199 NUGAUZE PACKING 1/4 00249 NON255145 1.4358 BT=1BT .00 1 00000000 53.00
NUGAUZE PACKI 17.23 CS=12BT/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 518
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000305 NURSES CAP 00249 BRLB77-4502 2.794 BX=1BX .00 1 00000000 .00
NURSES CAP 13.97 CS=5BX/CS 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000847 O PLAIN 844H 00257 230000844H 107.66 BX=1BX .00 1 00000000 .00
O PLAIN 844H 107.66 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000798 O-PROLENE 8418H 00257 230008418H 91.04 BX=1BX .00 1 00000000 .00
O-PROLENE 841 91.04 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000801 O-PROLENE 8424H 00257 230008424H 71.43 BX=1BX .00 1 00000000 .00
O-PROLENE 842 71.43 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000823 O-SILK 680H 00249 ETH680H 50.52 BX=1BX .00 1 00000000 .00
O-SILK 680H 50.52 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000772 O2 SWIVELED/TAPERED NIPPLE 01304 301195 .26 EA=1EA .00 1 00000000 .00
O2 SWIVELED/T 13.20 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000756 O2 TUBING 7’ EXTENSION 00396 301145EA .3458 EA=1EA .00 1 00031110 20.00
O2 TUBING 7’ 00249 HCS4507 17.29 CS=50EA/CS 50 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501246 OB PADS PK 00249 NON241281 1.0146 PK=1PK .00 1 00000000 .00
OB PADS PK 24.35 CS=24PK/CS 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 519
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
890010 OBSERVATION HOUR .00 EA= .00 1 31110013 36.00
OBSERVATION H .00 .00 2 31220013 .00
.......... EJ(0762) INV.GL= EXP.GL= .00 .00 3 31300013 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0378 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
80001406 ODOR ELIMINATOR 00249 CRR101003 2.0608 EA=1EA .00 1 00000000 .00
ODOR ELIMINAT 98.92 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000234 ONE-STEP SAFETY LANCET 00249 SRG1SLN20010C 6.198 BX=1BX .00 1 00000000 .00
ONE-STEP SAFE 00062 75-200100N 92.97 CS=15BX/CS 15 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500274 OPSITE 10X5.50 00249 MMM1627Z 1.102 EA=1EA .00 1 00000000 155.00
OPSITE 10X5.5 22.04 BX=20EA/BX 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500275 OPSITE 4X5.50 00249 MSC2304 .5994 EA=1EA .00 1 00000000 54.00
OPSITE 4X5.50 29.97 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000620 PAPER CLIPS-JUMBO 00361 UNV72220 11.49 BX=1BX .00 1 00000000 .00
PAPER CLIPS-J 00118 UNV72220 11.49 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000621 PAPER CLIPS-SM. 00499 UNV72210 4.99 BX=1BX .00 1 00000000 .00
PAPER CLIPS-S 00118 UNV72210 4.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 520
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000417 PAT.BELONGING BAG 00249 NON026310 2.531 PK=1PK .00 1 00000000 .00
PAT.BELONGING 00062 99-BELB 25.31 CS=10PK/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
25014343 PATIENT BED PAD 00249 MDT8445B1 29.97 EA=1EA .00 1 00031110 100.00
PATIENT BED P 29.97 EA=1EA/EA 1 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501342 PATIENT CHAIR PAD 00249 MDT82145C6 15.53 EA=1EA .00 1 00000000 90.00
PATIENT CHAIR 93.18 CS=6EA/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001150 PDS 11 SUTURE Z497G 00257 23000Z497G 42.90 BX=1BX .00 1 00000000 .00
PDS 11 SUTURE 42.90 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000703 PED. W/ SWIVEL AEROSOL MAS 00249 HCS4631B .6654 EA=1EA .00 1 00000000 49.00
PED. W/ SWIVE 33.27 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501103 PED.MULTI-LUMEN CENTRAL CA 00249 ARWAK14553 46.732 EA=1EA .00 1 00000000 232.00
PED.MULTI-LUM 233.66 CS=5EA/CS 5 .00 2 00000000 .00
.......... 50(0278) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: C1751 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
90000690 PEDIACTIC O2 HIGH F10 NONR 01304 771130EA 3.52 EA=1EA .00 1 00000000 69.00
PEDIACTIC O2 3.52 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 521
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90000691 PEDIACTRIC MED CONCEN 02 M 01304 355222EA 1.25 EA=1EA .00 1 00000000 54.00
PEDIACTRIC ME 1.25 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000365 PEDIALYTE 00249 R-L59892Z 2.5275 EA=1EA .00 1 00000000 .00
PEDIALYTE 10.11 PK=4EA/PK 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000692 PEDIATRIC MULTI VENT OXYGE 01304 361089EA 2.61 EA=1EA .00 1 00000000 69.00
PEDIATRIC MUL 130.41 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000693 PEDIATRIC NASAL CANNULA 00249 HCS4518 .9772 EA=1EA .00 1 00031110 35.00
PEDIATRIC NAS 48.86 CS=50EA/CS 50 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501247 PEDIATRIC URINE BAG 00249 MDS190510 .509 EA=1EA .00 1 00000000 11.00
PEDIATRIC URI 25.45 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501067 PEDIATRIC WRIST SPLINT L 00249 IMP121816 30.25 EA=1EA .00 1 00000000 41.00
PEDIATRIC WRI 00123 79-87291 30.25 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501066 PEDIATRIC WRIST SPLINT R 00249 ORT19900RXXS 11.88 EA=1EA .00 1 00000000 41.00
PEDIATRIC WRI 00123 79-87281 11.88 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001498 PEDICAP 6 01304 507-PEDICAP 6 9.45 CS=1CS .00 1 00000000 26.00
PEDICAP 6 56.70 CS=6CS/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 522
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000360 PEG BOARD REC 00783 PBR .00 PK=1PK .00 1 00000000 .00
PEG BOARD REC .00 CS=10PK/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500496 PELVIC TRACTION BELT 00420 74302 11.45 EA=1EA .00 1 00000000 45.00
PELVIC TRACTI 11.45 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500498 PELVIC TRACTION BELT 00420 74104 11.45 BX=1BX .00 1 00000000 45.00
PELVIC TRACTI 11.45 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500440 PELVIC TRACTION BELT 34-38 00420 74303 9.66 BX=1BX .00 1 00000000 45.00
PELVIC TRACTI 9.66 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500441 PELVIC TRACTION BELT 38-42 00420 74304 9.66 BX=1BX .00 1 00000000 45.00
PELVIC TRACTI 9.66 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500442 PELVIC TRACTION BELT 42-46 00420 74305 9.66 BX=1BX .00 1 00000000 45.00
PELVIC TRACTI 9.66 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500443 PELVIC TRACTION BELT 46-52 00420 74306 9.66 BX=1BX .00 1 00000000 45.00
PELVIC TRACTI 9.66 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501127 PELVIC TRACTION BELT UNIVE 00420 1678-001 14.16 BX=1BX .00 1 00000000 45.00
PELVIC TRACTI 14.16 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 523
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000637 PENCILS 00118 UNV55400 .39 BX=1BX .00 1 00000000 .00
PENCILS .39 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
7000322 PERPHENAZINE 4MG 00074 4731550 1.0318 EA= .00 1 00000000 9.25
PERPHENAZINE 68084060201 103.18 100 .00 2 00000000 .00
.......... 78(0250) INV.GL= EXP.GL= 1.0318 1 .00 3 31300700 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001502 PHILLIP EKG PAPER 00249 GCO32016653 87.17 CS=1CS .00 1 00000000 .00
PHILLIP EKG P 87.17 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000346 PHYSICIAN ORDERS 00783 HFS14 49.50 BX=1BX .00 1 00000000 .00
PHYSICIAN ORD 495.00 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501421 PICC TRAY 00487 21-2904-24 50.40 EA=1EA .00 1 00000000 377.00
PICC TRAY 252.00 CS=5EA/CS 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000008 PILLOW 00249 PM1824-15 1.3483 EA=1EA .00 1 00000000 .00
PILLOW 16.18 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001528 PILLOWS REUSABLE 00249 MDT219683 3.69 EA=1EA .00 1 00000000 .00
PILLOWS REUSA 3.69 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500068 PLEUREVAC 00249 HUDA705008LF 59.6567 EA=1EA .00 1 00000000 527.00
PLEUREVAC 178.97 CS=3EA/CS 3 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 524
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90000769 POCKET CHAMBER 01304 317-621-210 7.52 EA=1EA .00 1 00000000 26.00
POCKET CHAMBE 75.15 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000626 POST-ITS 1 1/2X2 YELLOW 00499 UNV35662 .5242 EA=1PK .00 1 00000000 .00
POST-ITS 1 1/ 6.29 PK=12PK/PK 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000625 POST-ITS-3X3 YELLOW 00052 UNV35688 1.2492 EA=1PK .00 1 00000000 .00
POST-ITS-3X3 00361 562896 14.99 PK=12PK/PK 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500452 POST-OP SHOE MEN LG 00420 161123 7.65 EA=1EA .00 1 00000000 99.00
POST-OP SHOE 7.65 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500453 POST-OP SHOE MEN XL 00420 161124 6.05 EA=1EA .00 1 00000000 99.00
POST-OP SHOE 6.05 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500451 POST-OP SHOE MN MD 00249 ORT30400MM 7.55 EA=1EA .00 1 00000000 99.00
POST-OP SHOE 7.55 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500450 POST-OP SHOE MN S 00420 161121 6.84 EA=1EA .00 1 00000000 99.00
POST-OP SHOE 6.84 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501473 POST-OP SHOE PEDIATRIC 00420 8601-697-01 11.73 EA=1EA .00 1 00000000 99.00
POST-OP SHOE 11.73 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 525
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500446 POST-OP SHOE YOUTH 00420 860169702 11.73 EA=1EA .00 1 00000000 99.00
POST-OP SHOE 11.73 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500449 POST-OP WOMEN LG 00249 ORT30300WL 10.70 EA=1EA .00 1 00000000 99.00
POST-OP WOMEN 10.70 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500448 POST-OP WOMENS MD 00249 ORT30400WM 7.55 EA=1EA .00 1 00000000 99.00
POST-OP WOMEN 7.55 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500447 POST-OP WOMENS SM 00249 ORT30400WS 7.55 EA=1EA .00 1 00000000 99.00
POST-OP WOMEN 7.55 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001285 POSTERIOR ELBOW LG. 00585 79-71137 13.37 EA=1EA .00 1 00000000 39.00
POSTERIOR ELB 13.37 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001284 POSTERIOR ELBOW MD. 00585 79-71135 13.10 EA=1EA .00 1 00000000 39.00
POSTERIOR ELB 13.10 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001286 POSTERIOR ELBOW XL 00585 79-71138 13.37 EA=1EA .00 1 00000000 39.00
POSTERIOR ELB 13.37 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001386 POSTERIOR TIB/FIB LARGE 30 00123 79-72297 19.52 EA=1EA .00 1 00000000 39.00
POSTERIOR TIB 19.52 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 526
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001283 POSTERIOR TIBULA LG. 00249 SDJ7972283 23.28 EA=1EA .00 1 00000000 69.00
POSTERIOR TIB 23.28 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001282 POSTERIOR TIBULA SPLINT MD 00123 79-72285 20.16 EA=1EA .00 1 00000000 69.00
POSTERIOR TIB 20.16 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001312 POSTTERIOR TIB/FIB SMALL 00249 SDJ7972283 20.02 EA=1EA .00 1 00000000 69.00
POSTTERIOR TI 20.02 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000195 POWDER 00249 MSC095390 .4422 EA=1EA .00 1 00000000 .00
POWDER 15.92 CS=36EA/CS 36 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2146225 PPH STAPLE GUN 00249 BAR9001C0212 22.57 EA=1EA .00 1 00000000 924.00
PPH STAPLE GU 00043 9001C0212 225.70 BX=10EA/BX 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001376 PREFILLED NS SYRINGE 10ML 00257 723306546 7.94 BX=1BX .00 1 00000000 10.00
PREFILLED NS 238.14 CS=30BX/CS 30 .00 2 00000000 .00
.......... 78(0250) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000170 PROBE COVER CRITIKON 00257 1720008815 19.90 BX=1BX .00 1 00000000 .00
PROBE COVER C 19.90 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000242 PROBE COVER WELCH ALLYN 00062 75-05031 66.85 BX=1BX .00 1 00000000 .00
PROBE COVER W 00249 W-A05031750 66.85 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 527
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501146 PROCEDURE TRAY (PICC) 00487 21-2501-01 26.20 EA=1EA .00 1 00000000 377.00
PROCEDURE TRA 262.00 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001389 PROLENE 3-0 00257 230008665G 20.96 BX=1BX .00 1 00000000 .00
PROLENE 3-0 20.96 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001606 PROLENE 4-0 M8557 00257 23000M8557 181.48 BX=1BX .00 1 00000000 .00
PROLENE 4-0 M 181.48 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001250 PROLENE MESH ETHPVPS 00249 ETHPVPS 484.725 BX=1BX .00 1 00000000 2197.00
PROLENE MESH 969.45 BX=2EA/BX 2 .00 2 00000000 .00
.......... 50(0278) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: C1781 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2146227 PROLENE MESH PMII 3X6 00249 ETHPMII 78.815 EA=1EA .00 1 00000000 478.00
PRLENEMESHP3X 00043 9001C0212 472.89 BX=6EA/BX 6 .00 2 00000000 .00
.......... 50(0278) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: C1781 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
80001431 PRONOVA 6-0 00257 230003805H 288.34 BX=1BX .00 1 00000000 .00
PRONOVA 6-0 288.34 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001500 PROTEST BI TEST PACK 00452 PT-3-BITP 155.43 CS=1CS .00 1 00000000 .00
PROTEST BI TE 155.43 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 528
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001119 PROXIMATE LINEAR CUTTER TC 00249 TCR75 69.20 EA=1EA .00 1 00000000 173.00
PROXIMATE LIN 830.35 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500681 PULSE OXISENSOR ADULT 00263 0600-00-0121 10.9917 EA=1EA .00 1 00031110 234.00
PULSE OXISENS 00249 MM01859 263.80 CS=24EA/CS 24 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501620 PULSE OXISENSOR ADULT (OR) 00249 4110001001 8.98 EA=1EA .00 1 00000000 104.00
PULSE OXISENS 179.69 CS=20EA/CS 20 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500682 PULSE OXISENSOR PED. 00263 00600-00-0122 12.9765 EA=1EA .00 1 00031110 203.00
PULSE OXISENS 00249 MMO1860 259.53 CS=20EA/CS 20 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001447 PURPLE ID BAND 00257 518905033PDM 88.25 BX=1BX .00 1 00000000 .00
PURPLE ID BAN 88.25 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000464 PYXIS PAPER 00302 107071-01 1.95 RL=1RL .00 1 00000000 .00
PYXIS PAPER 97.65 PK=50RL/PK 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501098 QUIK -COMBO ELECTRODE ADUL 00295 11996000091 24.05 EA=1EA .00 1 00000000 179.00
QUIK -COMBO E 00249 PHY1199600091 24.05 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501178 QUIK-COMBO PEDIATRIC 00295 3010107-000 45.00 EA=1EA .00 1 00000000 194.00
QUIK-COMBO PE 00249 PHY19600093PK 45.00 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 529
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501544 QUIK-PACE ELECTRODES 00249 PHY996000017 26.085 EA=1EA .00 1 00031110 240.00
QUIK-PACE ELE 00295 11996-000017 26.085 EA=1EA/EA 1 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001644 RAPICIDE GLUT HIGH LEVEL 00249 SDCML020127 24.83 EA=1EA .00 1 00000000 .00
OPA 28 00248 ML02-0059 99.32 CS=4EA/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500202 RAZOR 00249 BRN1333Z .394 EA=1EA .00 1 00031110 10.00
RAZOR 00062 80-02 3.94 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001135 RE/X EXP FILTER/760 00394 G-060526-00 102.60 EA=1EA .00 1 00000000 .00
RE/X EXP FILT 102.60 CS=1EA/CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001535 READY BATH COMPLETE 00249 MSC095304 .7073 EA=1EA .00 1 00000000 .00
READY BATH CO 21.22 CS=30EA/CS 30 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500085 RED RUBBER 10FR 00249 DYND13510 .8275 EA=1EA .00 1 00000000 20.00
RED RUBBER 10 9.93 CS=12EA/CS 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500086 RED RUBBER 12 FR 00249 0620-94120 .87 EA=1EA .00 1 00000000 20.00
RED RUBBER 12 87.00 CS=100EA/CS 100 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500087 RED RUBBER 14FR 00249 0620-94140 .83 EA=1EA .00 1 00000000 20.00
RED RUBBER 14 82.75 CS=100EA/CS 100 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 530
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500088 RED RUBBER 16FR 00257 0620-94160 .80 EA=1EA .00 1 00000000 20.00
RED RUBBER 16 80.00 CS=100EA/CS 100 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500089 RED RUBBER 18FR 00249 0620-94180 .83 EA=1EA .00 1 00000000 20.00
RED RUBBER 18 82.75 CS=100EA/CS 100 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90002195 RESPIRONIC MED NASAL CONT 01304 73-302180 51.35 EA=1EA .00 1 00000000 44.00
RESPIRONIC ME 51.35 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90002199 RESPIRONICS LG GOLDS NAS M 01304 73-302356 57.00 EA=1EA .00 1 00000000 44.00
RESPIRONICS L 57.00 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90002197 RESPIRONICS LG NASAL CONT 01304 73-302188 41.44 EA=1EA .00 1 00000000 44.00
RESPIRONICS L 41.44 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90002198 RESPIRONICS MED GOLDS NAS 01304 73-302354 57.00 EA=1EA .00 1 00000000 44.00
RESPIRONICS M 57.00 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90002196 RESPIRONICS SM NASAL CONT 01304 73-302187 51.35 EA=1EA .00 1 00000000 44.00
RESPIRONICS S 51.35 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501253 RHINO ROCKET 00249 SGY11S05008AS 23.445 EA=1EA .00 1 00000000 63.00
RHINO ROCKET 93.78 BX=4EA/BX 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 531
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001044 RHYTHM STRIPS 00062 D3247P 53.25 BX=1BX .00 1 00000000 .00
RHYTHM STRIPS 00265 1234 532.50 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501255 RIB BELT FEMALE 00420 2722-008 .29 EA=1EA .00 1 00000000 98.00
RIB BELT FEMA 3.49 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501254 RIB BELT MALE 00420 2721-008 .29 EA=1EA .00 1 00000000 98.00
RIB BELT MALE 3.49 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000664 RUBBERBANDS 00499 UNV00432 9.99 BX=1BX .00 1 00000000 .00
RUBBERBANDS 9.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001262 SAFE SORB 00249 DYNDS1500B 1.2286 EA=1EA .00 1 00000000 .00
SAFE SORB 117.95 CS=96EA/CS 96 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000493 SAFETY GLASSES 00249 NON24770H 1.78 EA=1EA .00 1 00000000 .00
SAFETY GLASSE 1.78 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001215 SAFETY NEEDLE 18X11/2 00257 3.58382E+11 21.40 BX=1BX .00 1 00000000 .00
SAFETY NEEDLE 21.40 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001238 SAFETY NEEDLE 21X1 00249 B-D305764Z 15.175 BX=1BX .00 1 00000000 .00
SAFETY NEEDLE 15.175 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 532
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001239 SAFETY NEEDLE 22X1 00249 SWD850210Z 9.35 BX=1BX .00 1 00000000 .00
SAFETY NEEDLE 9.35 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001216 SAFETY NEEDLE 22X11/2 00249 B-D305763Z 15.175 BX=1BX .00 1 00000000 .00
SAFETY NEEDLE 15.175 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001217 SAFETY NEEDLE 23X1 00249 B-D305762Z 15.175 BX=1BX .00 1 00000000 .00
SAFETY NEEDLE 15.175 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001219 SAFETY NEEDLE 25X1 00249 B-D305916Z 11.075 BX=1BX .00 1 00000000 .00
SAFETY NEEDLE 11.075 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001218 SAFETY NEEDLE 25X11/2 00249 SYRS100257Z 21.84 BX=1BX .00 1 00000000 .00
SAFETY NEEDLE 21.84 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001221 SAFETY NEEDLE 25X5/8 00249 B-D305901Z 11.0775 BX=1BX .00 1 00000000 .00
SAFETY NEEDLE 11.0775 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001391 SAFETY NEEDLES 18X1 00249 SWD850810Z 12.82 BX=1BX .00 1 00000000 .00
SAFETY NEEDLE 12.82 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000235 SAFETY PINS 00257 286730392C .89 BG=1BG .00 1 00000000 .00
SAFETY PINS 10.62 BX=12BG/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 533
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500222 SAFETY SCALPEL 10 00249 MDS15310 1.707 EA=1EA .00 1 00000000 32.00
SAFETY SCALPE 17.07 BX=1BX/10 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500223 SAFETY SCALPEL 11 00249 MDS153111 1.301 EA=1EA .00 1 00000000 32.00
SAFETY SCALPE 13.01 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500224 SAFETY SCALPEL 15 00249 MDS15315 .8708 EA=1EA .00 1 00000000 14.00
SAFETY SCALPE 10.45 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500111 SALEM SUMP 16FR 00249 DYND72016H 2.87 EA=1EA .00 1 00000000 65.00
SALEM SUMP 16 2.87 EA=1EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500112 SALEM SUMP 18FR 00249 DYND72018H 3.47 EA=1EA .00 1 00000000 29.00
SALEM SUMP 18 3.47 EA=1EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001349 SALUTE INSTRUMENT 00467 113077 230.00 EA=1EA .00 1 00000000 .00
SALUTE INSTRU 1150.00 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000199 SCISSOR SHARP/BLUNT 00249 DYND04000 1.7904 EA=1EA .00 1 00000000 .00
SCISSOR SHARP 44.76 BX=25EA/BX 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501378 SENSI-TOUCH GLOVES 61/2 00249 MSG4065Z .2456 EA=1EA .00 1 00031110 12.00
SENSI-TOUCH G 12.28 BX=50EA/BX 50 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 534
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501379 SENSI-TOUCH GLOVES 7.0 00249 MSG4070Z .2456 EA=1EA .00 1 00031110 12.00
SENSI-TOUCH G 12.28 BX=50EA/BX 50 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501380 SENSI-TOUCH GLOVES 71/2 00249 MSG4075Z .2456 EA=1EA .00 1 00031110 12.00
SENSI-TOUCH G 12.28 BX=50EA/BX 50 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501381 SENSI-TOUCH GLOVES 8.0 00249 MSG4080Z .2456 EA=1EA .00 1 00031110 12.00
SENSI-TOUCH G 12.28 BX=50EA/BX 50 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501201 SHAMPOO 00249 MSC095006 .28 EA=1EA .00 1 00000000 .00
SHAMPOO 26.69 CS=96EA/CS 96 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001336 SHAMPOO CAP 00249 MSC095230 .9678 EA=1EA .00 1 00000000 .00
SHAMPOO CAP 38.71 CS=30EA/CS 40 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001060 SHARP CONT. LAB 00249 KDL31143665 5.0033 EA=1EA .00 1 00000000 .00
SHARP CONT. L 30.02 CS=6EA/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000040 SHARP CONT.17 GAL 00249 KDL8991 13.582 EA=1EA .00 1 00000000 .00
SHARP CONT.17 00062 68-8980C 67.91 CS=5EA/CS 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=41115109 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000041 SHARP CONT.NEEDLE 00249 3.58331E+11 .94 EA=1EA .00 1 00000000 .00
SHARP CONT.NE 75.20 CS=80EA/CS 80 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 535
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001034 SHARP CONTAINER HK 00249 BEH175020 113.12 CS=1CS .00 1 00000000 .00
SHARP CONTAIN 113.12 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000645 SHARPIE-BLACK FINE POINT 00499 SAN30001 11.99 EA=1EA .00 1 00000000 .00
SHARPIE-BLACK 11.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000646 SHARPIE-XTRA FINE POINT BL 00499 125443 .8158 EA=1EA .00 1 00000000 .00
SHARPIE-XTRA 9.79 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501203 SHAVING CREAM 00249 MSC095014 .5314 EA=1EA .00 1 00000000 .00
SHAVING CREAM 76.52 CS=144EA/CS 144 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000582 SHEET PROTECTOR TOP 00499 UNV-21125 13.99 BX=1BX .00 1 00000000 .00
SHEET PROTECT 13.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000306 SHOECOVER 00249 CRI2002 4.82 BX=1BX .00 1 00000000 .00
SHOECOVER 14.46 CS=3BX/CS 3 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500434 SHOULDER BRACE MENS SM 00420 78301 7.32 BX=1BX .00 1 00000000 128.00
SHOULDER BRAC 7.32 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500437 SHOULDER BRACE MENS XL 00249 ORT16100XL 13.71 BX=1BX .00 1 00000000 128.00
SHOULDER BRAC 13.71 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 536
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500433 SHOULDER BRACE WOMEN XL 00420 78404 7.24 BX=1BX .00 1 00000000 128.00
SHOULDER BRAC 7.24 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500436 SHOULDER MENS LG 00249 ORT16100L 12.77 BX=1BX .00 1 00000000 128.00
SHOULDER MENS 12.77 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500435 SHOULDER MENS MD 00249 ORT16100M 17.49 BX=1BX .00 1 00000000 128.00
SHOULDER MENS 17.49 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500432 SHOULDER WOMEN LG 00249 ORT16100L 12.28 BX=1BX .00 1 00000000 128.00
SHOULDER WOME 12.28 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500431 SHOULDER WOMEN MD 00420 78402 9.28 BX=1BX .00 1 00000000 128.00
SHOULDER WOME 9.28 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500430 SHOULDER WOMEN SM 00249 ORT16100S 19.49 BX=1BX .00 1 00000000 128.00
SHOULDER WOME 19.49 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001156 SILK 2-0 623H 00257 623H 41.36 BX=1BX .00 1 00000000 .00
SILK 2-0 623H 41.36 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501466 SILVERSORB 1" 00249 MSC9310EP 2.5333 BX=1BX .00 1 00031110 51.00
SILVERSORB 1" 76.00 BX=30EA/BX 30 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 537
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2330511 SIMPLE PROCEDURE ER .00 EA= .00 1 00000000 230.00
SIMPLE PROCED .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501458 SINGLE BASIN SET 00249 DYNJ06610A 3.8517 EA=1EA .00 1 00000000 24.00
SINGLE BASIN 23.11 CS=6EA/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500197 SITZ BATH 00249 DYND801020 1.619 EA=1EA .00 1 00000000 90.00
SITZ BATH 16.19 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500862 SKIN MARKERS 00249 DYNJSM01 .369 EA=1EA .00 1 00000000 20.00
SKIN MARKERS 18.45 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2504035 SMALL ADULT BP CUFF 00249 MDS9912HP 3.904 EA=1EA .00 1 00000000 .00
SMALL ADULT B 19.52 PK=5EA/PK 5 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 3.904 1 .00 3 00000000 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000723 SMALL DISPOS VINYL NASAL M 01304 73312102EA 14.49 EA=1EA .00 1 00000000 44.00
SMALL DISPOS 14.49 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001392 SODIUM CHLORIDE INJECTION 00257 4131118881 312.75 CS=1CS .00 1 00000000 .00
SODIUM CHLORI 312.75 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001501 SODIUM CHLORIDE INJECTION 00257 723306544 .48 EA=1EA .00 1 00000000 .00
SODIUM CHLORI 231.31 CS=480EA/CS 480 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 538
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001387 SONY COLOR FILM ACCESS LAB 00085 UPT210BL 260.00 BX=1BX .00 1 00000000 .00
SONY COLOR FI 260.00 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001240 SONY COLOR PRINT 2010 00435 UPC-2010 85.00 BX=1BX .00 1 00000000 .00
SONY COLOR PR 85.00 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001241 SONY COLOR PRINT 5010 00435 UPC-501 140.00 BX=1BX .00 1 00000000 .00
SONY COLOR PR 140.00 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000285 SORBASAN 4X4 00257 202079409218 4.17 EA=1EA .00 1 00000000 25.00
SORBASAN 4X4 41.70 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000465 SPACELAB PAPER 00249 SHE307438001 1.816 RL=1RL .00 1 00000000 .00
SPACELAB PAPE 18.16 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500182 SPECIMEN CUP STERILE 00249 DYND30330 .113 EA=1EA .00 1 00031110 23.00
SPECIMEN CUP 00084 ST6 11.30 CS=100EA/CS 100 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000174 SPONGE DRAINAGE 4X4 6PLY 00249 NON256000H 2.51 BX=1BX .00 1 00000000 .00
SPONGE DRAINA 2.51 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000177 SPONGES 4X4 NS 00249 PRM21412C 2.823 PK=1PK .00 1 00000000 .00
SPONGES 4X4 N 28.23 CS=10PK/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 539
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500055 SPRING WIRE GUIDE 00035 AW14735 9.87 EA=1EA .00 1 00000000 40.00
SPRING WIRE G 246.75 CS=25EA/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000632 STAPLE REMOVER 00499 UNV00700 .23 EA=1EA .00 1 00000000 .00
STAPLE REMOVE .23 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500201 STAPLER REM.TRAY 00249 DYNJ04058Z .7683 EA=1EA .00 1 00000000 16.00
STAPLER REM.T 9.22 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000631 STAPLES 00118 UNV79000 1.29 BX=1BX .00 1 00000000 .00
STAPLES 1.29 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001428 STATLOCK PICC PLUS 00257 PIC0220 4.33 EA=1EA .00 1 00000000 .00
STATLOCK PICC 216.73 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500272 STERI-STRIP .25 00249 NON250114Z .4006 EA=1EA .00 1 00000000 41.00
STERI-STRIP . 20.03 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500273 STERI-STRIP .50 00249 MMMR1547Z .8362 EA=1EA .00 1 00000000 35.00
STERI-STRIP . 41.81 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501260 STERI-STRIPS W8514 (OR) 00249 NON250114Z 1.0708 EA=1EA .00 1 00000000 18.00
STERI-STRIPS 53.54 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 540
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500534 STERILE GUIDE 18GA NEEDLES 00249 BAR9001C0212 22.652 EA=1EA .00 1 00000000 144.00
STERILE GUIDE 00043 9001C0212 226.52 BX=10EA/BX 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001400 STERIS HAND SANITIZER 00249 DBU118187 5.3854 EA=1EA .00 1 00000000 .00
STERIS 64.625 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=41115109 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001220 STETHOSCOPE ISOLATION 00249 MDS9543 2.34 EA=1EA .00 1 00000000 .00
STETHOSCOPE I 2.34 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001433 STIFF GUIDE WIRE 00035 GS3508 69.30 EA=1EA .00 1 00000000 .00
STIFF GUIDE W 346.50 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000413 STOCKINETTE 3" 00249 MDT221203 5.49 BX=1BX .00 1 00000000 .00
STOCKINETTE 3 5.49 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000412 STOCKINETTE 4" 00249 MDT221204 7.18 BX=1BX .00 1 00000000 .00
STOCKINETTE 4 7.18 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001181 STOMADHESIVE POWDER 00257 1638025510 3.20 EA=1EA .00 1 00000000 .00
STOMADHESIVE 3.20 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001180 STOMEHESIVE PASTE 00249 SQU183910 2.07 EA=1EA .00 1 00000000 .00
STOMEHESIVE P 2.07 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 541
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000183 STOOL CUPS 00249 DYND30510 .894 PK=1PK .00 1 00000000 .00
STOOL CUPS 22.35 CS=25PK/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500309 STOPCOCK 3-WAY 00249 MDXMX412SL 1.4022 EA=1EA .00 1 00000000 25.00
STOPCOCK 3-WA 70.11 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000586 STRAIGHT CUT END TAB FOLDE 00361 24110 27.99 BX=1BX .00 1 00000000 .00
STRAIGHT CUT 00118 SMD24110 27.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501366 STRAIGHT TYPE BLOOD SET 2C 00793 M46443160 3.5437 EA=1EA .00 1 00000000 110.00
STRAIGHT TYPE 00249 BHL2C8750H 106.31 CS=30EA/CS 30 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000342 STRAWS 00249 NON02325 3.7724 BX=1BX .00 1 00000000 .00
STRAWS 00380 1234 94.31 CS=25BX/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001340 STYROFOAM CUP 8OZ. 00692 318 17.45 CS=1CS .00 1 00000000 .00
STYROFOAM CUP 17.45 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500084 SUCTION CANNISTER 1200 00249 BXT65651395 1.668 EA=1EA .00 1 00031110 54.00
SUCTION CANNI 50.04 CS=30EA/CS 30 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500077 SUCTION CATH 10FR 00249 DYND41900 .28 EA=1EA .00 1 00031110 18.00
SUCTION CATH 28.47 CS=100EA/CS 100 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 542
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500078 SUCTION CATH 12FR 00249 DYND41901H 1.40 EA=1EA .00 1 00031110 18.00
SUCTION CATH 1.40 EA=1EA/EA 1 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500079 SUCTION CATH 14FR 00249 DYND41902H 1.40 EA=1EA .00 1 00031110 18.00
SUCTION CATH 1.40 EA=1EA/EA 1 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500080 SUCTION CATH 16FR 00249 DYND41903 .2242 EA=1EA .00 1 00031110 41.00
SUCTION CATH 22.42 CS=100EA/CS 100 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500081 SUCTION CATH 18FR 00249 DYND40904 .32 EA=1EA .00 1 00031110 18.00
SUCTION CATH 31.90 CS=100EA/CS 100 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500075 SUCTION CATH 6FR 00249 413085370 .58 EA=1EA .00 1 00031110 18.00
SUCTION CATH 58.00 CS=100EA/CS 100 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500076 SUCTION CATH 8FR 00249 DYND41908H 1.40 EA=1EA .00 1 00031110 18.00
SUCTION CATH 1.40 EA=1EA 1 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500082 SUCTION CATH TRAY 14FR 00249 DYND41442 1.2486 EA=1EA .00 1 00031110 68.00
SUCTION CATH 44.95 CS=36EA/CS 36 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000311 SUR.GLOVES ALOETOUCH 6.0 00249 MDS206060Z .93 EA=1EA .00 1 00000000 .00
SUR.GLOVES AL 46.50 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 543
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501397 SURE SEAL 00249 2610085200 11.73 BX=1BX .00 1 00000000 7.00
SURE SEAL 11.73 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000217 SURG.BLADES 10 00257 0723-371110 12.32 BX=1BX .00 1 00000000 .00
SURG.BLADES 1 12.32 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000218 SURG.BLADES 11 00257 0723-371111 13.685 BX=1BX .00 1 00000000 .00
SURG.BLADES 1 13.685 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000220 SURG.BLADES 15 00249 B-D371153Z 15.74 BX=1BX .00 1 00000000 .00
SURG.BLADES 1 15.74 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500316 SURG.GLOVES 81/2 00249 407008327 .89 EA=1EA .00 1 00031110 12.00
SURG.GLOVES 8 44.33 BX=50EA/BX 50 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500312 SURG.GLOVES ALOE-TOUCH 61/ 00249 MSG1065Z 1.3736 EA=1EA .00 1 00031110 12.00
SURG.GLOVES A 34.34 BX=25EA/BX 25 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500313 SURG.GLOVES ALOETOUCH 7 00249 MSG1070Z 1.4016 EA=1EA .00 1 00031110 12.00
SURG.GLOVES A 35.04 BX=25EA/BX 25 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500314 SURG.GLOVES ALOETOUCH 7.5 00249 MSG1075Z 1.3736 EA=1EA .00 1 00031110 12.00
SURG.GLOVES A 34.34 BX=25EA/BX 25 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 544
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500315 SURG.GLOVES ALOETOUCH 8.0 00249 MSG1080Z 1.4016 EA=1EA .00 1 00031110 12.00
SURG.GLOVES A 35.04 BX=25EA/BX 25 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000301 SURG.MASK (BLUE) 00249 NON27376 7.9217 BX=1BX .00 1 00000000 .00
SURG.MASK (BL 47.53 CS=6BX/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000304 SURGEON CAPS 00249 NON28626 7.80 BX=1BX .00 1 00000000 .00
SURGEON CAPS 39.00 CS=5BX/CS 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001696 SURGEON GLOVE 6.0 00249 MSG1060Z 1.4016 EA=1EA .00 1 00000000 .00
SURGEON GLOVE 35.04 BX=25EA/BX 25 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 1.4016 1 .00 3 00000000 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001520 SURGEON GLOVES LF,PF 7.0 00257 407008514 76.63 BX=1BX .00 1 00000000 .00
SURGEON GLOVE 76.63 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001519 SURGEON GLOVES LF,PF 71/2 00257 407008515 76.63 BX=1BX .00 1 00000000 .00
SURGEON GLOVE 76.63 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000300 SURGICAL GOWN XL 00249 DYNJP2307P 3.3658 EA=1EA .00 1 00000000 .00
SURGICAL GOWN 80.78 CS=24EA/CS 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500474 SURGICEL 2X3 00249 ETH1953Z 51.2333 EA=1EA .00 1 00000000 79.00
SURGICEL 2X3 614.80 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 545
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500473 SURGICEL 4X8 00249 1952 52.14 EA=1EA .00 1 00000000 143.00
SURGICEL 4X8 625.71 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500237 SUSPENSORY LG 00249 IMP091103 4.86 EA=1EA .00 1 00000000 21.00
SUSPENSORY L 4.86 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500236 SUSPENSORY MD 00249 IMP091102 4.86 EA=1EA .00 1 00000000 21.00
SUSPENSORY MD 4.86 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500238 SUSPENSORY XL 00249 723202612 4.36 EA=1EA .00 1 00000000 21.00
SUSPENSORY XL 4.36 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500200 SUTURE REM.TRAY 00249 DYND70900 .8146 EA=1EA .00 1 00000000 36.00
SUTURE REM.TR 40.73 CS=50EA/CS 50 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000036 SYRINGE 10CC 00249 B-D309604 12.975 BX=1BX .00 1 00000000 .00
SYRINGE 10CC 25.95 CS=2BX/CS 2 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000057 SYRINGE 20CC 00249 SYR120010 35.07 BX=1BX .00 1 00000000 .00
SYRINGE 20CC 00062 68-9661 35.07 CS=4BX/CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000060 SYRINGE 3CC 00249 SYR103010 6.7325 BX=1BX .00 1 00000000 .00
SYRINGE 3CC 00062 68-1610 53.86 CS=8BX/CS 8 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 546
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000035 SYRINGE 5CC 00249 SYR105010 8.5575 BX=1BX .00 1 00000000 .00
SYRINGE 5CC 34.23 CS=4BX/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000065 SYRINGE 60CC CT 00249 B-D309620Z 11.89 BX=1BX .00 1 00000000 .00
SYRINGE 60CC 11.89 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000064 SYRINGE 60CC LL 00249 B-D309653Z 11.89 BX=1BX .00 1 00000000 .00
SYRINGE 60CC 11.89 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501068 SYRINGE EAR 2OZ 00249 DYND70280 .4136 EA=1EA .00 1 00000000 11.00
SYRINGE EAR 2 20.68 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001377 SYRINGE PREFILLED NS 3ML 00257 723306544 7.62 BX=1BX .00 1 00000000 .00
SYRINGE PREFI 228.61 CS=30BX/CS 30 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000629 TAPE DISPENSER 00052 MMMC38 4.99 EA=1EA .00 1 00000000 .00
TAPE DISPENSE 00361 649245 4.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000876 TAPE MICROPORE 00249 NON260001D .4669 EA=1EA .00 1 00000000 .00
TAPE MICROPOR 67.24 CS=144EA/CS 144 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000995 TB MASK 00249 MMM1860 10.485 BX=1BX .00 1 00000000 .00
TB MASK 62.91 CS=6BX/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 547
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001300 TB MASK SMALL 00249 MMM1860S 10.485 BX=1BX .00 1 00000000 .00
TB MASK SMALL 62.91 CS=6BX/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001105 TB SYRINGE 00249 B-D305945Z 29.85 BX=1BX .00 1 00000000 .00
TB SYRINGE 29.85 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500992 TEGERDERM IV 00249 MSC2302 .2391 EA=1EA .00 1 00000000 23.00
TEGERDERM IV 23.91 BX=100EA/BX 100 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000117 TELEMETRY POUCH 00249 35960MC500 .79 EA=1EA .00 1 00000000 .00
TELEMETRY POU 39.65 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500289 TELFA 4X8 ADH 00257 3583005111 .55 EA=1EA .00 1 00000000 14.00
TELFA 4X8 AD 27.29 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500288 TELFA 3X4 NON-ADH. 00249 NON25710 1.0762 EA=1EA .00 1 00000000 14.00
TELFA 3X4 NON 53.81 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500287 TELFA 3X8 NON-ADH 00249 NON25720Z .0912 EA=1EA .00 1 00000000 6.00
TELFA 3X8 NON 4.56 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500533 TEMP SHARP HOLDER 00249 DYNJNDLNEST .643 EA=1EA .00 1 00000000 .00
TEMP SHARP HO 32.15 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 548
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000341 TERRI-WIPES 00249 NON260506 2.15 BX=1BX .00 1 00000000 .00
TERRI-WIPES 00062 10-DW501 21.50 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2599999 TEST ITEM 00249 TEST123 8.8878 EA=1 EA .00 1 00000000 .00
TEST ITEM 159.98 CS=18EA/CS 18 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 8.8878 1 .00 3 00000000 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1496372 THERAPEUTIC PROPHYLACTIC INJECTION .00 EA= .00 1 00031110 50.00
THERAPEUTIC P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96372 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2500381 THIGH HIGH LG 00432 204029 8.04 EA=1EA .00 1 00000000 115.00
THIGH HIGH LG 00249 MDS160860 40.20 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500380 THIGH HIGH MED 00249 MDS160844 8.1417 EA=1EA .00 1 00000000 115.00
THIGH HIGH ME 48.85 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500379 THIGH HIGH SM 00249 MDS160824 9.2567 EA=1EA .00 1 00000000 115.00
THIGH HIGH SM 55.54 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500382 THIGH HIGH XL 00249 MDS160884 9.785 EA=1EA .00 1 00000000 259.00
THIGH HIGH XL 58.71 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 549
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90000720 THOMAS ENDOTRACH TUBE HOLD 01304 780500EA 5.11 EA=1EA .00 1 00000000 .00
THOMAS ENDOTR 5.11 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000726 THOMAS ENDTRACH TUBE HOLD 01304 780400EA 5.11 EA=1EA .00 1 00000000 .00
THOMAS ENDTRA 5.11 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500869 THORACIC CATH STRAIGHT 32F 00249 570556 5.89 EA=1EA .00 1 00000000 30.00
THORACIC CATH 58.90 BX=10EA/BX 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500870 THORCIC CATH STRAIGHT 28FR 00249 570549 5.89 EA=1EA .00 1 00000000 30.00
THORCIC CATH 58.90 BX=10EA/BX 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501425 TIP STOPS 00249 GMO114555H 2.48 EA=1EA .00 1 00000000 15.00
TIP STOPS 2.48 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000192 TONGUE BLADE NON 00257 5937W0D3002 3.25 BX=1BX .00 1 00000000 .00
TONGUE BLADE 3.25 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000193 TONGUE BLADE S 00249 MDS202075 1.673 BX=1BX .00 1 00000000 .00
TONGUE BLADE 16.73 CS=1BX/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501235 TOOTHBRUSHES 00249 MDS136000 .0344 EA=1EA .00 1 00000000 .00
TOOTHBRUSHES 4.95 BX=144BX/BX 144 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 550
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501195 TOOTHPASTE 00249 NONTP6IZ .1101 EA=1EA .00 1 00000000 .00
TOOTHPASTE 15.86 CS=144EA/CS 144 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001334 TOURNIQUET 00249 DYND75020 170.30 BX=1BX .00 1 00000000 .00
TOURNIQUET 00462 ML14325 170.30 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500083 TRACH CLEANING TRAY 00249 DYND40589 1.8935 EA=1EA .00 1 00031110 50.00
TRACH CLEANIN 37.87 CS=20EA/CS 20 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000090 TRACH TUBE HOLDER 00249 1821000240 2.77 EA=1EA .00 1 00000000 .00
TRACH TUBE HO 27.65 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000702 TRACHEOSTOMY OXYGEN MASK 01304 355245 1.57 EA=1EA .00 1 00000000 60.00
TRACHEOSTOMY 78.25 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000188 TRANSPORE TAPE 1" 00249 MMM15271 6.394 BX=1BX .00 1 00000000 .00
TRANSPORE TAP 63.94 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000189 TRANSPORE TAPE 2" 00249 MMM15272 6.591 BX=1BX .00 1 00000000 .00
TRANSPORE TAP 65.91 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000336 TRASH BAGS 24X33 00249 HTBD4832RC 23.107 CS=1CS .00 1 00000000 .00
TRASH BAGS 24 00380 5595806 23.107 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=41115109 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 551
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90000337 TRASHBAGS 43X48 00249 HTBX7658AK 26.8075 CS=1CS .00 1 00000000 .00
TRASHBAGS 43X 00380 1298845 26.8075 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=41115109 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500044 TRIPLE LUM CATH 20FR. 00035 CDC-45703-P1A 104.87 EA=1EA .00 1 00000000 822.00
TRIPLE LUM CA 00249 ARWDC42703P1A 524.35 CS=5EA/CS 5 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: C1751 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2500871 TROCAR CATH 24FR 00249 3.58389E+11 15.30 EA=1EA .00 1 00000000 53.00
TROCAR CATH 2 152.97 BX=10EA/BX 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500872 TROCAR CATH 32FR 00249 561076 15.96 EA=1EA .00 1 00000000 53.00
TROCAR CATH 3 159.60 BX=10EA/BX 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000295 TUBING NON-CONDUCTIVE 00249 BXTN7100RL 8.305 BX=1BX .00 1 00000000 .00
TUBING NON-CO 8.305 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501249 TWIN-CATH MULTIPLE -LUMEN 00249 ARWIV01100H 4.17 EA=1EA .00 1 00000000 44.00
TWIN-CATH MUL 4.17 EA=1EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001383 ULTRA SONIC GEL 00249 MDS092010 12.79 EA=1EA .00 1 00000000 .00
ULTRA SONIC G 51.16 CS=4EA/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 552
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500986 UNDERPADS 00249 MSC281226 .0967 EA=1EA .00 1 00000000 11.00
UNDERPADS 00074 KC7176 14.50 CS=150EA/CS 150 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501039 UNIVERSAL ARM SLING 00249 ORT11010D 9.4125 EA=1EA .00 1 00000000 65.00
ARM SLING UNI 00432 1796-12-10 37.65 CS=4EA/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501117 UNNA BOOT (WHITE BOX) 00249 GHFUNNA4H 11.12 BX=1BX .00 1 00000000 98.00
UNNA BOOT (WH 11.12 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500402 UNNA BOOT MEDICO PASTE 00249 4927001053 6.85 BX=1BX .00 1 00000000 98.00
UNNA BOOT MED 68.51 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500999 URETHRAL CATH TRAY 00249 BRD772415 1.2295 EA=1EA .00 1 00031110 110.00
URETHRAL CATH 00062 21-802214 24.59 CS=20EA/CS 20 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500185 URINALS 00249 DYND80235S .3194 EA=1EA .00 1 00000000 14.00
URINALS 00084 910 15.33 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500262 URINE FILTER 00249 2748010713 .08 EA=1EA .00 1 00000000 8.00
URINE FILTER 20.70 BX=250EA/BX 250 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000063 URINE JAR 24HR 00249 DYND80024 .985 EA=1EA .00 1 00000000 .00
URINE JAR 24H 19.70 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 553
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500244 URINE TOLET MEASURE 00249 DYND36600 .2354 EA=1EA .00 1 00000000 45.00
URINE TOLET M 23.54 CS=100EA/CS 100 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500291 UROMETER 00249 DYND17403 6.262 EA=1EA .00 1 00000000 212.00
UROMETER 62.62 CS=10EA/CS 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000023 VAC NEEDLE 21GA 00249 358381-216041 5.55 BX=1BX .00 1 00000000 .00
VAC NEEDLE 21 5.55 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501287 VAGINAL PACKING 00249 4684010026 5.05 EA=1EA .00 1 00000000 30.00
VAGINAL PACKI 121.24 CS=24EA/CS 24 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500276 VASELINE GAUZE 3X9 00249 CUR251390Z .3744 EA=1EA .00 1 00000000 12.00
VASELINE GAUZ 18.72 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001338 VASELINE LIP THERAPY 00257 123302831HP .92 EA=1EA .00 1 00000000 .00
VASELINE LIP 22.11 BX=24EA/BX 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000248 VASELINE TUBE 00249 MSC095034 1.8383 EA=1EA .00 1 00000000 .00
VASELINE TUBE 22.06 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001529 VENTILATOR CIRCUITS PEEP 00750 10820 110.00 EA=1EA .00 1 00000000 .00
VENTILATOR CI 110.00 CS=1EA/CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 554
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90000725 VENTISURE AD CO2 RESUS BAG 01304 3015582 25.63 EA=1EA .00 1 00000000 221.00
VENTISURE AD 410.12 CS=16EA/CS 16 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000744 VENTISURE DIS INFANT RESUS 01304 76750 81.75 EA=1EA .00 1 00000000 221.00
VENTISURE DIS 81.75 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000743 VENTISURE DISP PED RESUS B 01304 3015580EA 32.20 EA=1EA .00 1 00000000 221.00
VENTISURE DIS 32.20 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500153 VEST REST LG 00249 MDT828024 6.4783 EA=1EA .00 1 00031110 99.00
VEST REST LG 38.87 CS=6EA/CS 6 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500152 VEST REST MD 00249 MDT828022 6.4783 EA=1EA .00 1 00000000 99.00
VEST REST MD 38.87 CS=6EA/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500151 VEST REST SM 00249 MDT828020 6.115 EA=1EA .00 1 00031110 99.00
VEST REST SM 36.69 CS=6EA/CS 6 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501290 VEST RESTRAINT XL 00249 52557991628 8.49 EA=1EA .00 1 00000000 99.00
VEST RESTRAIN 84.88 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001582 VICRYL 0 EJ10G 00249 ETHEJ10G 424.01 BX=1BX .00 1 00000000 185.00
VICRYL 0 EJ1 424.01 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 555
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001364 VICRYL 0 J603H 00257 23000J603H 55.44 BX=1BX .00 1 00000000 .00
VICRYL 0 J603 55.44 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001700 VOMIT BAG 00249 NON80328 10.0917 PK=1PK .00 1 00000000 .00
VOMIT BAG 60.55 CS=6PK/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 10.0917 1 .00 3 00000000 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500253 WAFER 1.50 00249 SQU125258 .901 EA=1EA .00 1 00000000 39.00
WAFER 1.50 9.01 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500254 WAFER 1.75 00249 SQU125259 .901 EA=1EA .00 1 00000000 39.00
WAFER 1.75 9.01 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500255 WAFER 2.25 00249 1638125260 .908 EA=1EA .00 1 00000000 39.00
WAFER 2.25 00072 125260 9.08 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500256 WAFER 2.75 00249 SQU125261 .901 EA=1EA .00 1 00000000 39.00
WAFER 2.75 00072 125261 9.01 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500252 WAFER SURFIT 1.25 00249 SQU125257 .901 EA=1EA .00 1 00000000 39.00
WAFER SURFIT 9.01 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500890 WALKING BOOT PNEUMATIC LG. 00249 ORT28610L 85.12 BX=1BX .00 1 00000000 344.00
WALKING BOOT 00123 O1F-L 85.12 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 556
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500889 WALKING BOOT PNEUMATIC MED 00249 ORT28610M 85.12 BX=1BX .00 1 00000000 344.00
WALKING BOOT 00123 O1F-M 85.12 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500891 WALKING BOOT PNEUMATIC SM. 00249 ORT28610S 66.28 BX=1BX .00 1 00000000 344.00
WALKING BOOT 66.28 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500864 WARMING BLANKETS-ER/ICU 00093 243 7.049 EA=1EA .00 1 00000000 119.00
WARMING BLANK 00249 CSZ82243 70.49 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500863 WARMING BLANKETS-SURGERY 00093 443 9.719 EA=1EA .00 1 00000000 119.00
WARMING BLANK 00249 CSZ82443 97.19 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90002040 WASTE BAGS 00048 81904 30.69 EA=1EA .00 1 00000000 .00
WASTE BAGS 30.69 EA=1EA 1 .00 2 00000000 .00
.......... 55(0300) INV.GL=41115041 EXP.GL= .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000338 WATER SOLUBLE BG 00249 NON02800 7.405 PK=1PK .00 1 00000000 .00
WATER SOLUBLE 29.62 CS=4PK/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001027 WHITE-OUT 00052 PAP-56401 24.99 EA=1EA .00 1 00000000 .00
WHITE-OUT 00361 131383 24.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500557 WIRE GUIDE 145CM 00264 G09607 44.38 EA=1EA .00 1 00000000 128.00
WIRE GUIDE 14 44.38 EA=1EA/EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 557
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000318 WRAP 24 00249 GEM3124 45.00 PK=1PK .00 1 00000000 .00
WRAP 24 45.00 CS=1PK/CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000317 WRAP 36 00249 GEM3136 19.9933 PK=1PK .00 1 00000000 .00
WRAP 36 59.98 CS=3PK/CS 3 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000307 WRAP 54 00249 GEM4154 40.68 PK=1PK .00 1 00000000 .00
WRAP 54 40.68 CS=1PK/PK 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501037 WRIST SPLINT R 00432 1769-02 8.33 EA=1EA .00 1 00000000 92.00
WRIST SPLINT 00249 ORT18000R 8.33 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501036 WRIST SPLINT COCKUP L 00432 1769-03 8.33 EA=1EA .00 1 00000000 92.00
WRIST SPLINT 00249 ORT18000L 8.33 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500278 XEROFORM 4X4 00249 CUR253440Z .9864 EA=1EA .00 1 00000000 9.00
XEROFORM 4X4 24.66 BX=25EA/BX 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500277 XEROFORM 5X9 00249 CUR253590WZ .729 EA=1EA .00 1 00000000 16.00
XEROFORM 5X9 36.45 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500297 YANK.SUCTION W/TUBING 00249 16080034910 1.41 EA=1EA .00 1 00031110 171.00
YANK.SUCTION 28.11 CS=20EA/CS 20 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 558
TIME: 08:24 ITEM MASTER LIST DEPT# 011 INTENSIVE CARE H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500296 YANKAUER SUCTION 00249 DYND50130 .258 EA=1EA .00 1 00031110 171.00
YANKAUER SUCT 12.90 CS=50EA/CS 50 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000359 YELLOW/WHITE CHARGE LABELS 00107 7228 127.60 BX=1BX .00 1 00000000 .00
YELLOW LABLES 127.60 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001683 ZEBRA THERMAL RIBBON NS 00107 7589 12.95 EA=1EA .00 1 00000000 .00
ZEBRA THERMAL 12.95 EA=1EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 12.95 1 .00 3 00000000 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500391 ZIM-FLEX CAST TAPE 4" 00420 889704 7.78 EA=1EA .00 1 00000000 70.00
ZIM-FLEX CAST 77.77 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 559
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501040 ARM SLING L 00432 1796-13-10 3.72 EA=1EA .00 1 00000000 65.00
ARM SLING L 37.16 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000615 1 X 2 5/8 WHITE LABLES 816 00499 UNV80201 9.99 PK=1PK .00 1 00000000 .00
1 X 2 5/8 WHI 9.99 PK=1PK/PK 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000614 1"X 2 5/8 CLEAR LABELS 866 00499 AVE8660 23.99 PK=1PK .00 1 00000000 .00
1"X 2 5/8 CLE 23.99 PK=1PK/PK 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000739 1.2 GAL CAP ROOM HUMIDIFIE 01304 4714100HF 31.91 EA=1EA .00 1 00000000 93.00
1.2 GAL CAP R 31.91 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000754 100FT ROLL-SEG 6"-COR TUB 01304 301150 11.70 EA=1EA .00 1 00000000 69.00
100FT ROLL-SE 11.70 RL=1EA/RL 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500512 2WAY CATH 12FR. FOLEY 5CC 00249 S512 4.3092 EA=1EA .00 1 00000000 44.00
2WAY CATH 12F 51.71 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500513 2WAY CATH 14FR 5CC BALLON 00249 DYND11501 4.3092 EA=1EA .00 1 00000000 44.00
2WAY CATH 14F 51.71 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500514 2WAY CATH 16FR 5CC BALLON 00249 DYND11502 4.3092 EA=1EA .00 1 00000000 44.00
2WAY CATH 16F 51.71 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 560
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500499 2WAY CATH 16FR FOLEY 30CC 00249 S186 4.91 EA=1EA .00 1 00000000 35.00
2WAY CATH 16F 58.89 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500515 2WAY CATH 18FR 5CC BALLON 00249 DYND11503 4.3092 EA=1EA .00 1 00000000 44.00
2WAY CATH 18F 51.71 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500500 2WAY CATH 18FR FOLEY 30CC 00249 S618 4.91 EA=1EA .00 1 00000000 35.00
2WAY CATH 18F 58.89 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500516 2WAY CATH 20FR 5CC BALLON 00249 S520 1.31 EA=1EA .00 1 00000000 44.00
2WAY CATH 20F 15.66 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500501 2WAY CATH 20FR FOLEY 30CC 00249 S620 4.91 EA=1EA .00 1 00000000 35.00
2WAY CATH 20F 58.89 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500517 2WAY CATH 22FR 5CC BALLON 00249 DYND11504 4.3092 EA=1EA .00 1 00000000 44.00
2WAY CATH 22F 51.71 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500502 2WAY CATH 22FR FOLEY 30CC 00249 S622 1.18 EA=1EA .00 1 00000000 35.00
2WAY CATH 22F 14.13 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500518 2WAY CATH 24FR 5CC BALLON 00249 S524 1.31 EA=1EA .00 1 00000000 44.00
2WAY CATH 24F 15.66 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 561
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500503 2WAY CATH 24FR FOLEY 30CC 00249 S624 1.18 EA=1EA .00 1 00000000 35.00
2WAY CATH 24F 14.13 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500519 2WAY CATH 26FR 5CC BALLON 00249 S526 1.31 EA=1EA .00 1 00000000 44.00
2WAY CATH 26F 15.66 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500520 2WAY CATH 28FR 5CC BALLON 00249 S528 .28 EA=1EA .00 1 00000000 44.00
2WAY CATH 28F 3.40 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500504 2WAY CATH 28FR FOLEY 30CC 00249 S628 .28 EA=1EA .00 1 00000000 35.00
2WAY CATH 28F 3.40 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500521 2WAY CATH 30FR 5CC BALLON 00249 265730 .28 EA=1EA .00 1 00000000 44.00
2WAY CATH 30F 3.40 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500505 2WAY CATH 30FR FOLEY 30CC 00249 S630 1.21 EA=1EA .00 1 00000000 35.00
2WAY CATH 30F 14.49 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001016 3-0 VICRYL J416H 00257 23000J416H 44.995 BX=1BX .00 1 00000000 .00
3-0 VICRYL J4 44.995 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000759 340 ML HUMIDIFIER W/ ADAPT 01304 36-003-40 1.01 EA=1EA .00 1 00000000 12.00
340 ML HUMIDI 20.12 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 562
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500506 3WAY CATH 16FR 30CC 00249 DYND11572 7.3233 EA=1EA .00 1 00000000 63.00
3WAY CATH 16F 87.88 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500507 3WAY CATH 18FR 30CC 00249 DYND11573 7.3233 EA=1EA .00 1 00000000 63.00
3WAY CATH 18F 87.88 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500508 3WAY CATH 20FR 00249 PS720 3.70 EA=1EA .00 1 00000000 63.00
3WAY CATH 20F 44.37 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500509 3WAY CATH 22FR 30CC 00249 DYND11575 7.3233 EA=1EA .00 1 00000000 63.00
3WAY CATH 22F 87.88 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500510 3WAY CATH 24FR 00249 06200167L24 8.82 EA=1EA .00 1 00000000 63.00
3WAY CATH 24F 105.78 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500511 3WAY CATH 26FR 00249 2D2655 2.85 EA=1EA .00 1 00000000 63.00
3WAY CATH 26F 34.20 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000764 760ML NEB W/ADAPTER (HUMI 01304 04-3D0808 3.29 EA=1EA .00 1 00000000 78.00
760ML NEB W/ 39.51 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500471 ABDOMIBAL BINDER 60-75 IN 00249 1821000818 22.06 EA=1EA .00 1 00000000 166.00
ABDOMIBAL BIN 22.06 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 563
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500468 ABDOMINAL BINDER 12" 00249 MDS169028 17.66 EA=1EA .00 1 00000000 166.00
ABDOMINAL BIN 17.66 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500470 ABDOMINAL BINDER 58-442 00249 58442 11.90 EA=1EA .00 1 00000000 166.00
ABDOMINAL BIN 11.90 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500467 ABDOMINAL BINDER 9" 00249 MDS169022 12.69 EA=1EA .00 1 00000000 166.00
ABDOMINAL BIN 12.69 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500469 ABDOMNIAL BINDER 9"58432 00249 58432 9.52 EA=1EA .00 1 00000000 166.00
ABDOMNIAL BIN 9.52 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501141 ABDUCTION PILLOW 00249 17.09 EA=1EA .00 1 00000000 185.00
ABDUCTION PIL 102.52 CS=6EA/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500985 ACUDYNE SWABSTICKS 00249 MDS093901ZZ .2044 EA=1EA .00 1 00000000 .00
ACUDYNE SWABS 10.22 BX=50/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501001 ADAPTIC 3X3 00249 CUR250330Z .2074 EA=1EA .00 1 00000000 8.00
ADAPTIC 3X3 10.37 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501002 ADAPTIC 3X8 00249 CUR250381Z .5342 EA=1EA .00 1 00000000 32.00
ADAPTIC 3X8 12.82 BX=24EA/BX 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:Y MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 564
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000326 ADHERENT DRAPE 92-0500 2.22 EA=1EA .00 1 00000000 .00
ADHERENT DRAP 55.51 BX=25EA/BX 25 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001228 ADHESIVE MEDICAL SPRAY 00257 3158007730 11.41 EA=1EA .00 1 00000000 .00
ADHESIVE MEDI 45.62 BX=4EA/BX 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2330507 ADMIN INFLUENZA VACCINE .00 EA= .00 1 00000000 61.00
ADMIN INFLUEN .00 .00 2 00000000 .00
.......... EL(0771) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0008 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
80001003 ADMISSION KIT 00249 DYKD2002A 2.4525 EA=1EA .00 1 00000000 .00
ADMISSION KIT 29.43 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000762 ADULT AEROSOL MASK 00396 301-170EA .4968 EA=1EA .00 1 00031110 49.00
ADULT AEROSOL 00249 HCS4630B 24.84 CS=50EA/CS 50 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000763 ADULT NASAL CANNULA 7’ 00396 301-100EA .4694 EA=1EA .00 1 00031110 35.00
ADULT NASAL C 00249 HCS4514 23.47 CS=50EA/CS 50 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000760 ADULT NON-REBREATHER 01304 301181 .7226 EA=1EA .00 1 00031110 69.00
ADULT NON-REB 36.13 CS=50EA/CS 50 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 565
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501339 ADULT SLIPPERS XXL 00249 MDT211218XXLI 1.0215 EA=1EA .00 1 00031110 7.50
ADULT SLIPPER 00304 6239LG 49.03 CS=48EA/CS 48 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500039 ADULT WIPES 00249 MSC263810 1.5171 EA=1EA .00 1 00031110 16.00
ADULT WIPES 00062 10-710 36.41 CS=24EA/CS 24 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001537 AERO CHAMBERS 01304 317-621-210 101.46 CS=1CS .00 1 00031110 150.00
AERO CHAMBERS 101.46 CS=1CS 1 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501021 AIRCAST LEFT 00123 02BLK 25.41 EA=1EA .00 1 00000000 425.00
AIRCAST LEFT 00249 ARC02BLK 25.41 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501022 AIRCAST RIGHT 00123 02BRK 31.46 EA=1EA .00 1 00000000 425.00
AIRCAST RIGHT 00249 ARC02BRK 31.46 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500142 AIRWAY 100MM 00249 DYND60425 .2267 EA=1EA .00 1 00031110 32.00
AIRWAY 100MM 2.72 BX=12EA/BX 12 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500143 AIRWAY 110MM 0249 5568122006 .3233 EA=1EA .00 1 00031110 14.00
AIRWAY 110MM 3.88 BX=12EA/BX 12 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500137 AIRWAY 40MM 00249 6697-002041 .18 EA=1EA .00 1 00031110 14.00
AIRWAY 40MM 2.21 BX=12EA/BX 12 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 566
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500138 AIRWAY 60MM 00249 DYND60410 .2267 EA=1EA .00 1 00031110 14.00
AIRWAY 60MM 2.72 BX=12EA/BX 12 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500139 AIRWAY 70MM 00249 6697412071 .21 EA=1EA .00 1 00031110 14.00
AIRWAY 70MM 2.52 BX=12EA/BX 12 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500140 AIRWAY 80MM 00249 DYND60415 .2267 EA=1EA .00 1 00031110 14.00
AIRWAY 80MM 2.72 BX=12EA/BX 12 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500141 AIRWAY 90MM 00249 6697412091 .21 EA=1EA .00 1 00031110 14.00
AIRWAY 90MM 2.52 BX=12EA/BX 12 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000209 ALCOHOL 00249 MDS098003Z .9875 EA=1EA .00 1 00000000 .00
ALCOHOL 11.85 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000001 ALCOHOL PREP 00249 KDL5750 1.0175 BX=1BX .00 1 00000000 .00
ALCOHOL PREP 00074 KC5033 20.35 CS=20BX/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001276 ALLEN WRIST SPLINT LG. 00123 79-71047 18.20 EA=1EA .00 1 00000000 41.00
ALLEN WRIST S 00249 ORT33600L 18.20 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001275 ALLEN WRIST SPLINT SM. 00249 SDJ7971043 9.74 EA=1EA .00 1 00000000 41.00
ALLEN WRIST S 9.74 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 567
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000367 ALLERGIC TO LABEL 00783 59704578 48.06 BX=1BX .00 1 00000000 .00
ALLERGIC TO L 48.06 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501526 ALOE VESTA BODY WASH &SHAM 00249 MSC095348 .3583 EA=1EA .00 1 00000000 .00
ALOE VESTA BO 00062 82-0994 17.20 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001499 AMBU BAG ADULT 00396 520-612-000 13.28 EA=1EA .00 1 00031110 65.00
AMBU BAG ADUL 00249 CPRM1116 79.68 CS=6EA/CS 6 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001432 AMPLATZ WIRE 00058 46-525 40.654 EA=1EA .00 1 00000000 102.00
AMPLATZ WIRE 203.27 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500374 ANKLE BRACE LG 00420 176705 15.18 EA=1EA .00 1 00000000 161.00
ANKLE BRACE L 15.18 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500373 ANKLE BRACE MED 00420 176704 15.66 EA=1EA .00 1 00000000 161.00
ANKLE BRACE M 15.66 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500372 ANKLE BRACE SM 00420 176703 13.50 EA=1EA .00 1 00000000 161.00
ANKLE BRACE S 13.50 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001185 AQUACEL AG 4X4 00257 1638177902 10.39 EA=1EA .00 1 00000000 14.00
AQUACEL AG 4X 103.86 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 568
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500069 ARM BOARD INFANT 00249 NON24288H .60 EA=1EA .00 1 00000000 20.00
ARM BOARD INF .60 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501038 ARM SLING CHILD 00249 ORT11400SD 5.86 BX=1BX .00 1 00000000 65.00
ARM SLING S 23.44 BX=4EA/BX 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500071 ARMBOARD 18" 00249 NON24291H 1.42 EA=1EA .00 1 00000000 20.00
ARMBOARD 18" 1.42 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500070 ARMBOARD 9" 00249 5189450010 .39 EA=1EA .00 1 00000000 20.00
ARMBOARD 9" 39.00 CS=100EA/CS 100 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500038 ART LINE ARM BD 00249 18686010 6.00 EA=1EA .00 1 00000000 45.00
ART LINE ARM 120.06 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000736 ASMAPLANT STAND PEAK FLOW 01304 26111300 10.00 EA=1EA .00 1 00000000 48.00
ASMAPLANT STA 100.00 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001028 ATRAC-TAIN CREAM 5OZ TUBE 00249 COL1814 5.1238 EA=1EA .00 1 00000000 25.00
ATRAC-TAIN CR 61.485 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500404 BANDAGE ACE 2" 00249 MDS046002 .2944 EA=1EA .00 1 00000000 5.00
BANDAGE ACE 2 14.72 BX=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 569
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500405 BANDAGE ACE 3" 00249 MDS046003 .3758 EA=1EA .00 1 00000000 7.00
BANDAGE ACE 3 18.79 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500406 BANDAGE ACE 4" 00249 MDS087004LF .4236 EA=1EA .00 1 00000000 9.00
BANDAGE ACE 4 21.18 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500407 BANDAGE ACE 6" 00249 MDS046006 .7446 EA=1EA .00 1 00000000 14.00
BANDAGE ACE 6 37.23 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001277 BANDAID 1" 00249 NON25600 1.10 BX=1BX .00 1 00000000 .00
BANDAID 1" 13.20 CS=12BX/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001678 BANDAID 2" 00249 NON25504 2.3242 BX=1BX .00 1 00000000 .00
BANDAID 2" 27.89 CS=12BX/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001176 BARALYME 00299 32-55-001-0006 94.75 CS=1CS .00 1 00000000 .00
BARALYME 94.75 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001179 BARRIER WIPES 00257 1638037439 5.79 BX=1BX .00 1 00000000 .00
BARRIER WIPES 5.79 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500150 BASIN 7QT 00249 DYND80347 .2964 EA=1EA .00 1 00000000 14.00
BASIN 7QT 00062 93-H36210 14.82 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 570
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001093 BATTERY 9V 00249 DRCPC1604Z .6988 EA=1EA .00 1 00000000 .00
BATTERY 9V 00361 810694 8.386 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001092 BATTERY AAA 00249 DRCPC2400Z .1982 EA=1EA .00 1 00000000 .00
BATTERY AAA 4.756 BX=24EA/BX 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001309 BATTERY C 00249 DRCPC1400Z .4588 EA=1EA .00 1 00000000 .00
BATTERY C 5.505 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001310 BATTERY D 00249 DRCPC1300Z .605 EA=1EA .00 1 00000000 .00
BATTERY D 7.26 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001020 BATTERY-AA 00249 DRCPC1500 .1963 EA=1EA .00 1 00000000 .00
BATTERY-AA 00052 EVEE91SBP36H 28.26 CS=144EA/CS 144 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
4111334 BB TRANSFUSE BLOOD PRODUCT .00 EA= 1.00 1 00000000 1063.00
TRANSFUSE BLD .00 .00 2 00000000 .00
....P..... 6B(0391) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36430 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2500003 BEDPAN 00249 DYND80245 .4694 EA=1EA .00 1 00000000 36.00
BEDPAN 00062 541-5072-0000 23.47 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 571
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500004 BEDPAN FRACTURE 00249 DYNC8521 .5696 EA=1EA .00 1 00000000 39.00
BEDPAN FRACTU 13.67 CS=24EA/CS 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500556 BENSON WIRE 180CM 00104 G01431 11.50 EA=1EA .00 1 00000000 128.00
BENSON WIRE 1 00058 49-147 11.50 EA=1EA/EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000072 BIO-HAZ BAG 6X9 00249 DYND30261 4.715 PK=1PK .00 1 00000000 .00
BIO-HAZ BAG 6 00084 SB69BZ 47.15 CS=10PK/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500472 BIO-PATCH DRESSING 00249 J-J4150Z 7.50 EA=1EA .00 1 00000000 115.00
BIO-PATCH DRE 75.00 BX=10EA/BX 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000339 BIOHAZARD BAG 17X17 00249 NON151717 56.12 CS=1CS .00 1 00000000 .00
BIOHAZARD BAG 56.12 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000340 BIOHAZARD BAG 40X46 00249 HTBA8046ZR 55.20 CS=1CS .00 1 00000000 .00
BIOHAZARD BAG 00146 14-828-89 55.20 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001332 BIOHAZARD BAGS 24X33 00249 NON122433 5.748 RL=1RL .00 1 00000000 .00
BIOHAZARD BAG 57.48 CS=10RL/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001345 BIOPSY SKIN PUNCH 2MM 00285 DD-2MM 25.00 BX=1BX .00 1 00000000 20.00
BIOPSY SKIN P 25.00 BX=1BX 1 .00 2 00000000 .00
.......... 44(0272) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 572
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001344 BIOPSY SKIN PUNCH 4MM 00285 DD-4MM 25.00 BX=1BX .00 1 00000000 20.00
BIOPSY SKIN P 25.00 BX=1BX 1 .00 2 00000000 .00
.......... 44(0272) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001404 BLOOD GAS CARTRIDGE 00316 945-713 807.84 EA=1EA .00 1 00000000 .00
BLOOD GAS CAR 807.84 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001459 BLUNT FILL NEEDLE 00249 B-D305180 6.601 BX=1BX .00 1 00000000 .00
BLUNT FILL NE 66.01 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001638 BLUNT FILTER NEEDLE 00249 B-D305211Z 19.90 BX=1BX .00 1 00000000 .00
BLUNT FILTER 19.90 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001503 BP CUFF ISOLATION 00328 39203 3.82 EA=1EA .00 1 00000000 .00
BP CUFF ISOLA 76.32 BX=20EA/BX 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500033 BUTTERFLY 19GA X7/8 00249 45900101 .54 EA=1EA .00 1 00000000 16.00
BUTTERFLY 19G 26.95 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500034 BUTTERFLY 25GA X1/2 00249 B-D367298Z .5814 EA=1EA .00 1 00000000 36.00
BUTTERFLY 25G 29.07 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501518 BUTTERFLY SETS 21GA. 00249 723367296 .59 EA=1EA .00 1 00000000 16.00
BUTTERFLY SET 29.67 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 573
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2146226 C-QUR/TACSHIELD MESH 4X6 00249 BAR9001C0212 .00 EA=1EA .00 1 00000000 2325.00
CQURTASMESH4X 00043 9001C0212 .00 BX=10EA/BX 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: C1781 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
80000653 CALCULATOR TAPE-2 1/4 00499 UNV35715 .9992 EA=1EA .00 1 00000000 .00
CALCULATOR TA 11.99 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2330498 CARDIAC MONITORING .00 EA= .00 1 00000000 361.00
CARDIAC MONIT .00 .00 2 00000000 .00
.......... CP(0730) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 93041 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330499 CARDIOVERSION .00 EA= .00 1 00000000 745.00
CARDIOVERSION .00 .00 2 00000000 .00
.......... 7L(0482) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 92960 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2500056 CARRA-KLENZ 00249 CRR102060 2.7892 EA=1EA .00 1 00000000 144.00
CARRA-KLENZ 33.47 CS=12EA/CS 12 .00 2 00000000 .00
.......... 78(0250) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500408 CAST PADDING 2" 00420 889002 .60 EA=1EA .00 1 00000000 9.00
CAST PADDING 12.00 BG=20EA/BG 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500409 CAST PADDING 3" 00249 MDS067003Z 1.5917 BG=1BG .00 1 00000000 12.00
CAST PADDING 19.10 BG=12/BG 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 574
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500410 CAST PADDING 4" 00249 MDS067004Z 1.8808 EA=1EA .00 1 00000000 20.00
CAST PADDING 22.57 BG=12EA/BG 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500411 CAST PADDING 5" 00420 889005 3.29 EA=1EA .00 1 00000000 24.00
CAST PADDING 65.79 BG=20EA/BG 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000974 CASTILE SOAP 00249 MDS001005H .76 EA=1EA. .00 1 00000000 .00
CASTILE SOAP .76 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501223 CATH 10FR PED 00249 DYND11710 3.65 EA=1EA .00 1 00031110 44.00
CATH 10FR PED 43.77 BX=12EA/BX 12 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500531 CATH 16FR 5CC COUDE 00249 DYND11216 4.2158 EA=1EA .00 1 00000000 49.00
CATH 16FR 5CC 50.59 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: C1758 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2500529 CATH 22FR 30CC TELFON 3WA 00249 0167V22S 12.77 EA=1EA .00 1 00000000 44.00
CATH 22FR 30 153.20 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500532 CATH 22FR 5CC COUDE 00249 0168L22 1.22 EA=1EA .00 1 00000000 49.00
CATH 22FR 5CC 14.69 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: C1758 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 575
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500530 CATH 24FR 30CC TEFLON 3WAY 00249 0167V24 12.77 EA=1EA .00 1 00000000 63.00
CATH 24FR 30C 153.20 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501222 CATH 8FR PED 00249 DYND11708 3.18 EA=1EA .00 1 00031110 44.00
CATH 8FR PED 38.14 BX=12EA/BX 12 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501014 CATH FOLEY 2WAY 26 FR 00249 5626 1.21 EA=1EA .00 1 00000000 35.00
CATH FOLEY 2W 14.49 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500526 CATH FOLEY 2WAY 30FR 30CC 00249 0166SI30 10.65 EA=1EA .00 1 00000000 35.00
CATH FOLEY 2W 127.80 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500522 CATH FOLEY 30CC 16FR SILVE 00249 06200166S116 11.22 EA=1EA .00 1 00000000 35.00
CATH FOLEY 30 134.61 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500523 CATH FOLEY 30CC 18FR SILVE 00249 06200166S118 11.22 EA=1EA .00 1 00000000 35.00
CATH FOLEY 30 134.61 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500524 CATH FOLEY 30CC 20FR SILVE 00249 06200166S120 11.22 EA=1EA .00 1 00000000 35.00
CATH FOLEY 30 134.61 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500525 CATH FOLEY 30CC 22FR SILVE 00249 06200166S122 11.51 EA=1EA .00 1 00000000 35.00
CATH FOLEY 30 138.07 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 576
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500528 CATH FOLEY 30CC 30FR SILVE 00249 016SS128 10.65 EA=1EA .00 1 00000000 44.00
CATH FOLEY 30 127.80 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500527 CATH FOLEY 5CC 28FR SILVER 00249 01655I30 10.65 EA=1EA .00 1 00000000 44.00
CATH FOLEY 5C 127.80 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500095 CATH MALE LG TEXAS 00249 RCH33304 .816 EA=1EA .00 1 00000000 39.00
CATH MALE LG 24.48 BX=30EA/BX 30 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500094 CATH MALE MED TEXAS 00249 DYND12302 .6288 EA=1EA .00 1 00000000 39.00
CATH MALE MED 15.72 CS=25EA/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500976 CATH PLUG 00249 76 .32 EA=1EA .00 1 00000000 6.00
CATH PLUG 80.24 CS=250EA/CS 250 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000977 CATH STRIP 00249 DERCS50Z 1.4352 EA=1EA .00 1 00000000 .00
CATH STRIP 71.76 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500996 CATH TRAY ADD-A FOLEY 00249 DYND11020 8.696 EA=1EA .00 1 00000000 288.00
CATH TRAY ADD 86.96 CS=10EA/CS 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501114 CATH. PED. 6FR. 00249 DYND11706 3.18 EA=1EA .00 1 00000000 44.00
CATH. PED. 6F 38.14 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 577
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001523 CAVICIDE 00249 MAP131150 5.5956 EA=1EA .00 1 00000000 .00
CAVICIDE 67.1466 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2330500 CENTRAL LINE INSERTION .00 EA= .00 1 00000000 985.00
CENTRAL LINE .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36556 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2500050 CENTRAL VENOUS SET 00310 CS04300 21.50 EA=1EA .00 1 00000000 232.00
CENTRAL VENOU 107.48 CS=5EA/CS 5 .00 2 00000000 .00
.......... 50(0278) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: C1751 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2501227 CERVICAL RIGID COLLAR PED. 00420 167601 11.88 EA=1EA .00 1 00000000 183.00
CERVICAL RIGI 11.88 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501225 CERVICAL RIGID COLLAR TALL 00432 167605 14.10 EA=1EA .00 1 00000000 183.00
CERVICAL RIGI 14.10 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501226 CERVICAL RIGID REGULAR 00432 1676-04-00 14.10 EA=1EA .00 1 00000000 412.00
CERVICAL RIGI 14.10 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000689 CHINSTRAP FOR BIPSP/CPSP 01304 73302175 18.90 EA=1EA .00 1 00000000 59.00
CHINSTRAP FOR 18.90 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 578
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501423 CHLORAPREP 26ML. 00249 MDF260815 5.6012 EA=1EA .00 1 00000000 122.00
CHLORAPREP 26 140.03 CS=25EA/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001493 CHLORASCRUB SWABS 00249 NPKB10800z 10.43 BX=1BX .00 1 00000000 .00
CHLORASCRUB S 10.43 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500426 CLAVICAL SPL. S 00420 73512 6.03 BX=1BX .00 1 00000000 49.00
CLAVICAL SPL. 6.03 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500428 CLAVICLE SPL.LG 00249 SDJ7985007 6.18 BX=1BX .00 1 00000000 49.00
CLAVICLE SPL. 6.18 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500427 CLAVICLE SPL.MD 00420 73513 6.60 BX=1BX .00 1 00000000 49.00
CLAVICLE SPL. 6.60 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500429 CLAVICLE SPL.XL 00420 73515 8.27 BX=1BX .00 1 00000000 49.00
CLAVICLE SPL. 8.27 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000767 COACH INCENTIVE SPIROMETER 00249 DHD221200 4.8017 EA=1EA .00 1 00000000 30.00
COACH INCENTI 57.62 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL=41115017 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500393 COBAN 1" 00249 4509001581 .51 EA=1EA .00 1 00031110 12.00
COBAN 1" 3.04 CS=6EA/CS 6 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 579
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501420 COBAN 2 COMPRESSION SYSTEM 00249 4509002094 13.00 BX=1BX .00 1 00000000 40.00
COBAN 2 COMPR 104.02 CS=8BX/CS 8 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501585 COBAN 2" 00249 MDS089002 1.3964 EA=1EA .00 1 00000000 35.00
COBAN 2" 50.27 CS=36EA/CS 36 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:Y MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500395 COBAN 3" 00249 MDS089003 1.8392 EA=1EA .00 1 00031110 59.00
COBAN 3" 44.14 CS=24EA/CS 24 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:Y MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500396 COBAN 4" 00249 MDS089004 2.3061 EA=1EA .00 1 00031110 79.00
COBAN 4" 41.51 CS=18EA/CS 18 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:Y MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500886 COBAN STERILE 4" 00249 MMM1584S 1.6194 EA=1EA .00 1 00000000 35.00
COBAN STERILE 29.15 CS=18EA/CS 18 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500423 COLLAR LG 00249 ORT13100L 3.45 BX=1BX .00 1 00000000 99.00
COLLAR LG 3.45 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500422 COLLAR MD 00249 ORT13100M 2.58 BX=1BX .00 1 00000000 223.00
COLLAR MD 2.58 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500421 COLLAR SM 00249 ORT13100S 3.22 BX=1BX .00 1 00000000 99.00
COLLAR SM 3.22 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 580
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500424 COLLAR UNIVERSAL 00420 73705 3.50 BX=1BX .00 1 00000000 99.00
COLLAR UNIVER 3.50 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500425 COLLAR X-LONG 00420 73706 3.50 BX=1BX .00 1 00000000 99.00
COLLAR X-LONG 3.50 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001280 COLLES FOREARM L LG. 00249 ORT33300LL 7.05 EA=1EA .00 1 00000000 18.00
COLLES FOREAR 7.05 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001278 COLLES FOREARM L MD. 00249 ORT33300LM 6.81 EA=1EA .00 1 00000000 18.00
COLLES FOREAR 6.81 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001279 COLLES FOREARM R LG. 00249 ORT33300RL 7.20 EA=1EA .00 1 00000000 18.00
COLLES FOREAR 7.20 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001277 COLLES FOREARM RIGHT MD. 00249 ORT33300RM 6.81 EA=1EA .00 1 00000000 18.00
COLLES FOREAR 6.81 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001362 COLLES FOREARM SMALL LEFT 00249 ORT33300LS 6.06 EA=1EA .00 1 00000000 18.00
COLLES FOREAR 6.06 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500158 COMBINE DRESSING SURGIPAD 00249 NON21453 .083 EA=1EA .00 1 00000000 2.00
COMBINE DRESS 19.92 CS=240EA/CS 240 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 581
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2330513 COMPLEX PROCEDURE .00 EA= .00 1 00000000 985.00
COMPLEX PROCE .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001521 COMPLY 3983MM 00249 3983MM 106.71 BX=1BX .00 1 00000000 .00
COMPLY 3983M 106.71 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2330502 CONSCIOUS SEDATION .00 EA= .00 1 00000000 525.00
CONSCIOUS SED .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99144 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
80000352 COPY PAPER 00118 4COPY 3.45 RM=1RM .00 1 00000000 .00
COPY PAPER 00361 135848 34.50 CS=10RM/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000569 COPY PAPER-14" 00499 HAM10329-01 12.99 RM=1RM .00 1 00000000 .00
COPY PAPER-14 12.99 RM=1RM/RM 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000573 COPY PAPER-BLUE 00052 UNV11202 12.99 RM=1RM .00 1 00000000 .00
COPY PAPER-BL 12.99 RM=1RM/RM 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000570 COPY PAPER-GOLDENROD 00499 UNV11205 5.44 RM=1RM .00 1 00000000 .00
COPY PAPER-GO 5.44 RM=1RM/RM 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 582
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000575 COPY PAPER-GREEN 00499 UNV11203 10.49 RM=1RM .00 1 00000000 .00
COPY PAPER-GR 10.49 RM=1RM/RM 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000576 COPY PAPER-PINK 00499 UNV11204 4.03 RM=1RM .00 1 00000000 .00
COPY PAPER-PI 4.03 RM=1RM/RM 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000572 COPY PAPER-YELLOW 00499 UNV11201 12.99 RM=1RM .00 1 00000000 .00
COPY PAPER-YE 12.99 RM=1RM/RM 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000571 COPY PAPRER-BUFF 00499 UNV11206 5.27 RM=1RM .00 1 00000000 .00
COPY PAPRER-B 5.27 RM=1RM/RM 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001076 CORRECTION TAPE 00118 BICWOETP21 3.145 EA=1EA .00 1 00000000 .00
CORRECTION TA 6.29 EA=2EA/EA 2 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000975 COTTON TIP 6" STERILE 00249 MDS202000 1.666 BX=1BX .00 1 00000000 .00
COTTON TIP 6" 16.66 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000007 COTTONBALLS 00249 MDS21461 1.0015 BG=1BG .00 1 00000000 .00
COTTONBALLS 00062 13-3170 20.03 CS=20BG/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2330497 CPR .00 EA= .00 1 00000000 718.00
CPR .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 92950 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 583
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500459 CRADLE BOOT 00249 5.95551E+11 17.89 EA=1EA .00 1 00000000 49.00
CRADLE BOOT 17.89 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001023 CRITIKON PAPER ER 00760 E9050JC 25.00 BX=1BX .00 1 00000000 .00
CRITIKON PAPE 25.00 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001140 CRITIKON PAPER OR 00760 E9050K 25.00 BX=1BX .00 1 00000000 .00
CRITIKON PAPE 25.00 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500480 CRUTCHES ADULT 5’10"-6’6" 00249 MDSV80534 12.5617 EA=1EA .00 1 00000000 75.00
CRUTCHES ADUL 75.37 CS=6EA/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500481 CRUTCHES ADULT 5’2"TO 5’10 00249 MDSV80535 9.4213 EA=1EA .00 1 00000000 169.00
CRUTCHES ADUL 75.37 CS=8EA/CS 8 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500479 CRUTCHES XLONG 6’6"-7 2" 00249 9.84 EA=1EA .00 1 00000000 75.00
CRUTCHES XLON 59.03 CS=6EA/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500482 CRUTCHES YOUTH 4’6"TO 5’2" 00249 MDSV80536 9.9063 EA=1EA .00 1 00000000 75.00
CRUTCHES YOUT 79.25 CS=8EA/CS 8 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001550 CUFF 1 TUBE L ADULT LG.972 00328 99872 5.21 EA=1EA .00 1 00000000 .00
CUFF 1 TUBE L 104.20 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 584
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001627 CUFF ADULT SINGLE MDS9723D 00249 MDS9723DM 5.01 EA=1EA .00 1 00000000 .00
CUFF ADULT SI 25.07 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001626 CUFF CHILD SINGLE MDS9721D 00249 MDS9911HP 3.554 EA=1EA .00 1 00000000 .00
CUFF CHILD SI 17.77 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001552 CUFF DUAL ADULT LONG 3929 00328 39294 3.75 EA=1EA .00 1 00000000 .00
CUFF DUAL ADU 75.00 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001621 CUFF DUAL ADULT MDS9713DM 00249 MDS9713DM 3.82 EA=1EA .00 1 00000000 .00
CUFF DUAL ADU 19.08 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001581 CUFF DUAL ADULT MDS9713HP 00328 99593 5.52 EA=1EA .00 1 00000000 .00
CUFF DUAL ADU 110.48 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001554 CUFF DUAL CHILD 39296 00328 39296 4.14 EA=1EA .00 1 00000000 .00
CUFF DUAL CHI 82.80 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001624 CUFF DUAL CHILD MDS9711CM 00249 MDS9711DM 3.75 EA=1EA .00 1 00000000 .00
CUFF DUAL CHI 18.76 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001623 CUFF DUAL INFANT MDS9710DM 00249 MDS9710DM 3.23 EA=1EA .00 1 00000000 .00
CUFF DUAL INF 16.15 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 585
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001553 CUFF DUAL L.ADULT MDS9714H 00328 39291 5.05 EA=1EA .00 1 00000000 .00
CUFF DUAL L.A 101.04 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001622 CUFF DUAL LG ADULT MDS9714 00249 MDS9714DM 4.11 EA=1EA .00 1 00000000 .00
CUFF DUAL LG 20.53 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001625 CUFF INFANT SINGLE MDS9720 00249 MDS9720DM 4.83 EA=1EA .00 1 00000000 .00
CUFF INFANT S 24.17 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001628 CUFF LG.ADULT SING.MDS9724 00249 MDS9724DM 5.53 EA=1EA .00 1 00000000 .00
CUFF LG.ADULT 27.65 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001551 CUFF S.ADULT LONG MDS9723H 00249 MDS9723HPL 5.108 EA=1EA .00 1 00000000 .00
CUFF S.ADULT 25.54 PK=5EA/PK 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001546 CUFF SINGLE ADULT MDS9913HP 00249 MDS9913HP 2.954 EA=1EA .00 1 00000000 .00
CUFF SINGLE A 14.77 PK=5EA/PK 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001548 CUFF SINGLE CHILD MDS9911HP 00249 MDS9911HP 3.558 EA=1EA .00 1 00000000 .00
CUFF SINGLE C 17.79 PK=5EA/PK 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001549 CUFF SINGLE INFANT MDS9720 00249 MDS9720HP 3.23 EA=1EA .00 1 00000000 .00
CUFF SINGLE I 16.15 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 586
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001545 CUFF SINGLE L.ADULT MDS9914HP 00249 MDS9914HP 4.272 EA=1EA .00 1 00000000 .00
CUFF SINGLE L 21.36 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001547 CUFF SINGLE SM.ADULT MDS9912HP 00249 MDS9912HP 3.904 EA=1EA .00 1 00000000 .00
CUFF SINGLE S 19.52 CS=5EA/CS 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500002 CULTURE SWAB 00249 B-D220109 1.1872 EA=1EA .00 1 00031110 18.00
CULTURE SWAB 00146 220109 59.36 BG=50EA/BG 50 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001341 CUP 16OZ. 00692 2373 40.77 CS=1CS .00 1 00000000 .00
CUP 16OZ. 40.77 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000343 CUP SOUFFLE 00249 NON024220 1.53 PK=1PK .00 1 00000000 .00
CUP SOUFFLE 30.60 CS=20PK/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000345 CUPS 5OZ 00249 NON03005 1.9224 PK=1PK .00 1 00000000 .00
CUPS 5OZ 00062 63-0351 48.06 CS=25PK/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000344 CUPS MED PLASTIC 00249 DYND80000 .523 PK=1PK .00 1 00000000 .00
CUPS MED PLAS 26.15 CS=50PK/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000187 CURAD CLOTH TAPE 2" 00249 1538-2 5.40 BX=1BX .00 1 00000000 .00
DURAPORE TAPE 64.79 CS=12BX/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 587
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001424 CUSTOM CD 00089 XX 1.05 BX=1BX .00 1 00000000 .00
CUSTOM CD 1.05 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001487 CUSTOM HOLTER KITS 00111 S0A2R5ABKW 4.35 EA=1EA .00 1 00000000 .00
CUSTOM HOLTER 4.35 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501403 CVP DRESSING TRAY 00249 DYND75223 2.7213 EA=1EA .00 1 00000000 169.00
CVP DRESSING 108.85 CS=40EA/CS 40 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 31300025 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000100 CYSTO BLADDER 00249 07062C4040 3.31 EA=1EA .00 1 00000000 .00
CYSTO BLADDER 159.05 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501575 CYTOLOGY BRUSH 00756 158R 11.50 EA=1EA .00 1 00000000 79.00
CYTOLOGY BRUS 230.00 BX=20BX/BX 20 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000101 DEFIB PAD 00249 4509-02346N 4.00 EA=1EA .00 1 00000000 .00
DEFIB PAD 39.95 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001261 DEFOAMER 00522 3238 13.99 BT=1BT .00 1 00000000 .00
DEFOAMER 13.99 BT=1BT 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000979 DENTIPS 00249 MDS096502 32.75 BX=1BX .00 1 00000000 .00
DENTIPS 65.50 CS=2BX/CS 2 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 588
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000181 DENTURE CUPS 00249 DYND70293 .9024 PK=1PK .00 1 00000000 .00
DENTURE CUPS 22.56 CS=25PK/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501202 DEODRANT 00249 MSC095010 .2293 EA=1EA .00 1 00000000 .00
DEODRANT 00062 D82-752 22.01 CS=96EA/CS 96 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500494 DERMABOND 00249 ETHDHVM12 15.6108 EA=1EA .00 1 00000000 103.00
DERMABOND 00202 DHVM12 187.33 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001096 DESK CALENDAR PD/WALL BK 00499 7.99 EA=1EA .00 1 00000000 .00
DESK CALENDAR 7.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000630 DESK STAPLER 00118 UNV43119 5.99 EA=1EA .00 1 00000000 .00
DESK STAPLER 5.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500009 DIAPER ADULT 00249 FITULTRALG 7.175 BG=1BG .00 1 00000000 70.00
DIAPER ADULT 00062 10-VB013 28.70 CS=4PK/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500010 DIAPER ADULTXL 00249 FITPLUSXLG 7.6875 PK=1PK .00 1 00000000 31.00
DIAPER ADULTX 30.75 CS=4PK/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501395 DIAPERS PULL-UP LG. 00249 MSC23505 6.2775 PK=1PK .00 1 00000000 31.00
DIAPERS PULL- 25.11 CS=4PK/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 589
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501394 DIAPERS PULL-UP MED 00249 MSC23005 6.2775 PK=1PK .00 1 00000000 31.00
DIAPERS PULL 25.11 CS=4PK/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501396 DIAPERS PULL-UP XL 00249 MSC23600 6.2775 PK=1PK .00 1 00000000 31.00
DIAPERS PULL- 25.11 CS=4PK/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001405 DIGITAL THERMOMETER 00257 3596916814 4.72 EA=1EA .00 1 00000000 .00
DIGITAL THERM 113.28 CS=24EA/CS 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000461 DINAMAP PAPER 00257 8156 24.00 BX=1BX .00 1 00000000 .00
DINAMAP PAPER 24.00 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
890009 DIRECT ADMIT OBSERVA .00 EA= .00 1 00000000 162.00
DIRECT ADMIT .00 .00 2 00000000 .00
.......... EJ(0762) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0379 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2500250 DISP. VAGINAL SPECULUM 00249 W-A59001Z 1.4058 EA=1EA .00 1 00000000 81.00
DISP. VAGINAL 33.74 BX=24EA/BX 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000688 DISPOSABLE HEADSTRAP FOR B 01304 73312106 4.78 EA=1EA .00 1 00000000 59.00
DISPOSABLE HE 47.80 PK=10EA/PK 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 590
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500251 DONUT CUSHION 00249 2867-351819 1.34 EA=1EA .00 1 00000000 59.00
DONUT CUSHION 1.34 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500258 DRAIN BAG 1.50 00249 401933 1.16 EA=1EA .00 1 00000000 18.00
DRAIN BAG 1.5 11.62 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500260 DRAIN BAG 2.25 00249 SQU401935 .651 EA=1EA .00 1 00000000 18.00
DRAIN BAG 2.2 00072 401513 6.51 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500261 DRAIN BAG 2.75 00249 SQU401936 .651 EA=1EA .00 1 00000000 18.00
DRAIN BAG 2.7 00072 401936 6.51 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500098 DRAINAGE BAG 00249 DYND15205 2.3995 EA=1EA .00 1 00000000 30.00
DRAINAGE BAG 47.99 CS=20EA/CS 20 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500259 DRAINBAG 1.75 00249 SQU401512 .523 EA=1EA .00 1 00000000 18.00
DRAINBAG 1.7 5.23 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500257 DRAINBAG 1.25 00249 401510 1.65 EA=1EA .00 1 00000000 18.00
DRAINBAG 1.25 16.49 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501030 DRAPE LOWER EXTREMITY 00249 DYNJP8002 4.93 EA=1EA .00 1 00000000 46.00
DRAPE LOWER E 59.16 CS=12EA/CS 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 591
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500299 DRAPE SHEET 00249 DYNJP2419 1.96 EA=1EA .00 1 00000000 45.00
DRAPE SHEET 23.52 CS=12EA/CS 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501069 DRAPE UNDER BUTTOCK 00249 1259001229 .99 EA=1EA .00 1 00000000 110.00
DRAPE UNDER B 53.43 CS=54EA/CS 54 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001451 DUAL LUER LOCK M/FEM. 00249 BHL2C6250 .1788 EA=1EA .00 1 00000000 .00
DUAL LUER LOC 90.13 CS=504EA/CS 504 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500283 DUODERM 4X4 00249 SQU187660 1.912 EA=1EA .00 1 00000000 14.00
DUODERM 4X4 9.56 BX=5EA/BX 5 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500284 DUODERM 8X8 00249 1638187662 10.19 EA=1EA .00 1 00000000 49.00
DUODERM 8X8 50.93 BX=5EA/BX 5 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000186 DURAPORE TAPE 1" 00249 MMM15382 6.394 BX=1BX .00 1 00000000 .00
DURAPORE TAPE 63.94 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501059 DURAPREP 00249 4509008630 5.297 EA=1EA .00 1 00000000 30.00
DURAPREP 105.94 CS=20EA/CS 20 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501267 DYNA-HEX4 4OZ. 00249 MDS098710 1.7058 EA=1EA .00 1 00031110 25.00
DYNA-HEX4 4 81.88 CS=48EA/CS 48 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 592
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500124 E TRACH TUBE UNCUFFED 4.5 00277 4130-86226 1.04 EA=1EA .00 1 00031110 25.00
E TRACH TUBE 10.39 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500129 E,TRACH TUBE 6.0 00249 4130-086109 1.58 EA=1EA .00 1 00031110 25.00
E,TRACH TUBE 15.84 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001316 E-TRAP 00372 711099 11.00 EA=1EA .00 1 00000000 .00
E-TRAP 00414 711099 275.00 CS=25EA/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500134 E. TRACH TUBE 8.0 00249 4130086113 2.16 EA=1EA .00 1 00031110 25.00
E. TRACH TUBE 21.56 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500136 E. TRACH TUBE CUFF 10.0 00249 4130-086117 4.01 EA=1EA .00 1 00031110 35.00
E. TRACH TUBE 40.11 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500132 E. TRACH TUBE CUFF 7.5 00249 4130-086112 1.026 EA=1EA .00 1 00031110 25.00
E. TRACH TUBE 10.26 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500128 E.TRACH TUBE 5.5 00249 4130-086108 3.42 EA=1EA .00 1 00031110 35.00
E.TRACH TUBE 34.22 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500127 E.TRACH TUBE CUFF 5.0 00249 4130-86107 1.92 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 19.16 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 593
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500130 E.TRACH TUBE CUFF 6.5 00249 DYND43065 1.568 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 15.68 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500131 E.TRACH TUBE CUFF 7.0 00249 DYND43070 2.21 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 22.10 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500133 E.TRACH TUBE CUFF 8.5 00249 4130-086114 4.01 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 40.11 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500135 E.TRACH TUBE CUFF 9.0 00249 4130-086115 2.68 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 26.76 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500120 E.TRACH TUBE UNCUFF 2.5 00249 4130-086222 1.33 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 13.27 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500121 E.TRACH TUBE UNCUFFED 3.0 00249 4130-086223 1.04 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 10.39 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500122 E.TRACH TUBE UNCUFFED 3.5 00249 4130-86224 1.04 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 10.39 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500123 E.TRACH TUBE UNCUFFED 4.0 00249 4130-86225 1.04 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 10.39 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 594
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500126 E.TRACH TUBE UNCUFFED 5.5 00249 4130-86228 1.04 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 10.39 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001229 EAKIN SEAL COHESIVE 00257 1638839001 3.82 EA=1EA .00 1 00000000 .00
EAKIN SEAL CO 38.24 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001599 EAR CURETTES BLUE 00257 819004888 36.69 BX=1BX .00 1 00000000 .00
EAR CURETTES 36.69 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001600 EAR CURETTES GREEN 00257 819001222 36.69 BX=1BX .00 1 00000000 .00
EAR CURETTES 36.69 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001601 EAR CURETTES WHITE 00257 819009555 36.69 BX=1BX .00 1 00000000 .00
EAR CURETTES 36.69 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500988 EGG CRATE 00249 NON081962H 29.66 EA=1EA .00 1 00000000 200.00
EGG CRATE 29.66 EA=IEA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001133 EKG RECORDING PAPER 00929 9402-024 48.34 EA=1EA .00 1 00000000 .00
EKG RECORDING 48.34 CS=1EA/CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001134 EKG RECORDING TABS 00929 120 49.00 EA=1EA .00 1 00000000 .00
EKG RECORDING 49.00 CS=1EA/CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 595
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001120 ELASTIC NET 2" 00249 NONNET02 10.13 BX=1BX .00 1 00000000 .00
ELASTIC NET 2 10.13 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001121 ELASTIC NET 3" 00257 4304058440 6.15 BX=1BX .00 1 00000000 .00
ELASTIC NET 3 6.15 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001236 ELASTIC NET 4 00249 NONNET04 12.41 BX=1BX .00 1 00000000 .00
ELASTIC NET 4 12.41 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001237 ELASTIC NET 6 00249 NONNET06 17.09 BX=1BX .00 1 00000000 .00
ELASTIC NET 6 17.09 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000401 ELASTIC NET 7" 00249 NONNET07 19.78 BX=1BX .00 1 00000000 .00
ELASTIC NET 7 19.78 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000116 ELECTRODE ADULT 00249 MMM2560 5.785 PK=1PK .00 1 00000000 .00
ELECTRODE ADU 115.70 CS=20PK/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001102 ELECTRODE EMPI 2" 00551 198928-001 .53 EA=1EA .00 1 00000000 39.00
ELECTRODE EMP .52 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000115 ELECTRODE INFANT 00249 MDS611303AH 1.31 PK=1PK .00 1 00000000 .00
ELECTRODE INF 1.31 PK=1EA/PK 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 596
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500180 EMESIS BASIN 00249 DYND80321 .061 EA=1EA .00 1 00000000 5.00
EMESIS BASIN 15.24 CS=250EA/CS 250 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001126 EMPI ELECTRODES 6000 SERIE 00551 199485-001 16.15 EA=1EA .00 1 00000000 59.00
EMPI ELECTROD 16.15 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2504020 EMPI FLEECE PADS 00249 4509001581 .51 EA=1EA .00 1 00031110 214.00
EMPI FLEEC PA 3.04 CS=6EA/CS 6 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501137 ENDO POUCH 10MM 00249 ETHPOUCH 52.15 EA=1EA .00 1 00000000 .00
ENDO POUCH 10 00202 POUCH 312.90 BX=6EA/BX 6 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500005 ENEMA SET 00249 DYND-70100 .766 EA=1EA .00 1 00000000 68.00
ENEMA SET 36.77 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001157 ENVELOPES W/O WINDOWS CCH 00393 123 17.99 BX=1BX .00 1 00000000 .00
ENVELOPES W/ 17.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001194 ENVELOPES WINDOW CCH 00393 1234 52.99 BX=1BX .00 1 00000000 .00
ENVELOPES WIN 52.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000679 ENVELOPES-#10 PAYROLL 00107 8003 49.00 BX=1BX .00 1 00000000 .00
ENVELOPES-#10 49.00 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 597
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000581 ENVELOPES-BROWN CLASP 10X1 00052 UNV35267 23.99 BX=1BX .00 1 00000000 .00
ENVELOPES-BRO 23.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000580 ENVELOPES-BROWN CLASP 9X12 00052 UNV35264 19.99 BX=1BX .00 1 00000000 .00
ENVELOPES-BRO 00361 187021 19.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001385 EPIDURAL TRAY 00530 332256 16.05 EA=1EA .00 1 00000000 .00
EPIDURAL TRAY 160.47 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501333 EPISTAT NASAL CATH KIT 00251 15-27030 71.92 EA=1EA .00 1 00000000 503.00
EPISTAT NASAL 71.92 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500990 ER LACERATION TRAY 00249 DYNJ03000 3.5338 EA=1EA .00 1 00000000 133.00
ER LACERATION 00062 11-4523 56.54 CS=16EA/CS 16 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500866 ESMARK BANDAGE 4X9 00249 5868055514 2.58 EA=1EA .00 1 00000000 35.00
ESMARK BANDAG 51.55 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000119 ESOPH. STETH 18FR 00249 DTXM1024215 4.4488 EA=1EA .00 1 00000000 .00
ESOPH. STETH 111.22 BX=25EA/BX 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500125 ETRACH TUBE UNCUFFED 5.0 00249 4130-86227 1.04 EA=1EA .00 1 00031110 25.00
ETRACH TUBE U 10.39 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 598
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000205 EXAM GLOVE NITRILE LG. 00249 T-X925030 3.254 BX=1BX .00 1 00000000 .00
EXAM GLOVE NI 00062 11-2523 32.54 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000204 EXAM GLOVE NITRILE MED. 00249 T-X925020 3.254 BX=1BX .00 1 00000000 .00
EXAM GLOVE NI 00062 11-2522 32.54 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000203 EXAM GLOVE NITRILE SM. 00249 T-X925010 3.254 BX=1BX .00 1 00000000 .00
EXAM GLOVE NI 00062 11-2521 32.54 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000332 EXAM GLOVES LG S 00249 MDS194136Z .2234 EA=1EA .00 1 00000000 .00
EXAM GLOVES L 22.34 BX=100EA/BX 100 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001615 EXAM PAPER 00249 NON23322 1.8092 RL=1RL .00 1 00000000 .00
EXAM PAPER 21.71 CS=12RL/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2330518 EXTERNAL PACEMAKER .00 EA= .00 1 00000000 525.00
EXTERNAL PACE .00 .00 2 00000000 .00
.......... 7L(0482) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 92953 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2504004 EXUDERM 2X2 00249 MSC5522 .765 EA=1EA .00 1 00000000 18.00
EXUDERM 2X2 7.65 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 599
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501139 EXUDERM 4X4 00249 MSC5544 1.504 EA=1EA .00 1 00000000 26.00
EXUDERM 4X4 15.04 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500173 EYE PAD SMALL 00249 NON21600Z .0632 EA=1EA .00 1 00000000 11.00
EYE PAD SMALL 3.16 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000737 EZPAP THERAPY SYS PRESS PO 01304 26230747 15.00 EA=1EA .00 1 00031110 100.00
EZPAP THERAPY 150.00 CS=10EA/CS 10 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500216 FACIAL TISSUE 00249 NON243275 .1347 BX=1BX .00 1 00031110 5.00
FACIAL TISSUE 00062 13-200 26.94 CS=200BX/CS 200 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501510 FALL RISK KIT LARGE 00249 6238Y 3.69 EA=1EA .00 1 00000000 146.00
FALL RISK KIT 00304 6237Y 3.69 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501509 FALL RISK KIT REGULAR 00249 6236Y 19.37 EA=1EA .00 1 00000000 146.00
FALL RISK KIT 19.37 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501511 FALL RISK SLIPPERS LARGE 00249 516306250L 5.08 EA=1EA .00 1 00000000 38.00
FALL RISK SLI 5.08 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501512 FALL RISK SLIPPERS MEDIUM 00249 516306250M 4.93 EA=1EA .00 1 00000000 86.00
FALL RISK SLI 4.93 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 600
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501514 FALL RISK SLIPPERS SMALL 00249 516306250S 5.17 EA=1EA .00 1 00000000 86.00
FALL RISK SLI 124.08 CS=24EA/CS 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501508 FALL RISK SOCKS STANDARD 00249 MDTPS4B03FPY .96 EA=1EA .00 1 00000000 .00
FALL RISK SOC 00304 6239Y 46.08 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501507 FALL RISK SOCKS LARGE 00249 MDTPS4B04FPY .9906 EA=1EA .00 1 00031110 10.00
FALL RISK SOC 00304 6239LY 47.55 CS=48EA/CS 48 .00 2 00031111 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000656 FASTENERS-2" 00499 UNV81002 2.69 EA=1EA .00 1 00000000 .00
FASTENERS-2" 2.69 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000666 FASTENERS-SELF ADHESIVE 00361 SMD68220 17.99 BX=1BX .00 1 00000000 .00
FASTENERS-SEL 00118 SMD68220 17.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001258 FAX CART.TN430 00052 IVRTN430 49.99 EA=1EA .00 1 00000000 .00
FAX CART.TN43 00361 IVRTN430 49.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000623 FAX CARTRIDGE TN420 00361 IVRTN420 47.99 EA=1EA .00 1 00000000 .00
BRTTN420 47.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500293 FECAL INCONT.COLLECTION 00249 9822 5.06 EA=1EA .00 1 00000000 30.00
FECAL INCONT. 50.62 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 601
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500105 FEEDING TUBE 8FR 00249 BRD0036410H .56 EA=1EA .00 1 00000000 16.00
FEEDING TUBE .56 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500146 FEEDING TUBE INFANT 5FR‘ 00249 BRD0036400H .57 EA=1EA .00 1 00000000 16.00
FEEDING TUBE .57 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501231 FEMALE CATH KIT 00249 DYND10805 1.5424 EA=1EA .00 1 00000000 23.00
FEMALE CATH K 38.56 CS=25EA/CS 25 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001382 FEMORAL LEG SPLINT 25" 00585 79-72295 36.39 EA=1EA .00 1 00000000 311.00
FEMORAL LEG S 36.39 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500333 FENESTRATED TOWEL 00249 DYA4409Z .2098 EA=1EA .00 1 00000000 5.00
FENESTRATED T 10.49 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000585 FILE FOLDER STANDARD 00052 UNV12113 8.29 BX=1BX .00 1 00000000 .00
FILE FOLDER S 00361 744100 8.29 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001635 FILTER NEEDLE 18GA.X11/2 00257 3.58381E+11 22.50 BX=1BX .00 1 00000000 .00
FILTER NEEDLE 22.50 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001204 FINGER SPLINT 00249 ZIM254801700 1.9183 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 23.02 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 602
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001205 FINGER SPLINT 00420 66-0025-002-00 2.41 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 28.93 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001206 FINGER SPLINT 00420 66-0017-001-00 1.17 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 13.98 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001207 FINGER SPLINT 00249 ZIM254801500 3.1617 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 18.97 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001208 FINGER SPLINT 00420 00-2548-016-00 .88 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 5.28 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001209 FINGER SPLINT 00420 00-2548-017-00 .94 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 5.63 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001210 FINGER SPLINT PLASTALUME 00420 00-2548-015-00 .97 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 5.82 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001211 FINGER SPLINT PLASTALUME 00420 00-2548-018-00 1.02 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 6.09 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500292 FLATUS BAG 00249 3583145524 1.20 EA=1EA .00 1 00000000 23.00
FLATUS BAG 59.81 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 603
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500106 FLEXIFLO 8FR 00249 5520-000473 14.69 EA=1EA .00 1 00000000 158.00
FLEXIFLO 8FR 146.90 CS=10EA/CS 10 .00 2 00000000 .00
.......... 44(0272) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001230 FLEXISENSOR ADULT 00719 0998-00-0076-05 51.46 PK=1PK .00 1 00000000 .00
FLEXISENSOR A 154.38 PK=3PK/PK 3 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000067 FLEXISENSOR ADULT BANDAGE 00719 0683-00-0409-02 103.08 BX=1BX .00 1 00000000 .00
FLEXISENSOR A 103.08 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001112 FLOW SELECTOR,STANDARD 01304 715-PM1000 28.38 EA=1EA .00 1 00000000 .00
FLOW SELECTOR 28.38 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501303 FLOW TRON 00033 DVT10 17.29 EA=1EA .00 1 00031110 254.00
FLOW TRON 00249 MDS601MD 17.29 EA=1EA/EA 1 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000303 FOG FREE MASK GREEN 00249 NON27378A 7.8617 BX=1BX .00 1 00000000 .00
FOG FREE MASK 47.17 CS=6BX/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000302 FOG FREE MASK W/ SHIELD OR 00249 NON27710 8.95 BX=1BX .00 1 00000000 .00
FOG FREE MASK 53.70 CS=6BX/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2330516 FOLEY CATH INSERTION .00 EA= .00 1 00000000 185.00
FOLEY CATH IN .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 51702 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 604
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500091 FOLEY TRAY 14FR 00249 DYND160414 21.036 EA=1EA .00 1 00000000 128.00
FOLEY TRAY 14 210.36 CS=10EA/CS 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500092 FOLEY TRAY 16FR 00249 BRD800361 6.725 CS=1EA .00 1 00000000 288.00
FOLEY TRAY 16 00062 27-802016 67.25 CS=10EA/CS 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500093 FOLEY TRAY 18FR 00249 BRD800362 6.725 EA=1EA .00 1 00000000 288.00
FOLEY TRAY 18 67.25 CS=10EA/CS 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501636 FOLEY TRAY URINE METER 16F 00249 0620303316A 18.94 EA=1EA .00 1 00000000 131.00
FOLEY TRAY UR 189.41 CS=10EA/CS 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501637 FOLEY TRAY URINE METER 18F 00249 0620303318A 18.94 EA=1EA .00 1 00000000 .00
FOLEY TRAY UR 189.41 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001591 FOLEY TRICOT STAT LOK 00257 0620FOL0102 3.01 EA=1EA .00 1 00000000 .00
FOLEY TRICOT 75.31 CS=25EA/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001292 FOREARM PADDED LT,LG. 00585 79-71977 4.26 EA=1EA .00 1 00000000 18.00
FOREARM PADDE 4.26 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001291 FOREARM PADDED RT,LG. 00585 79-71987 4.26 EA=1EA .00 1 00000000 18.00
FOREARM PADDE 4.26 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 605
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001317 FOREARM SPLINT LEFT 00585 79-71973 4.26 EA=1EA .00 1 00000000 .00
FOREARM SPLIN 4.26 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001398 FOREARM SPLINT LEFT 00585 79-71972 4.36 EA=1EA .00 1 00000000 .00
FOREARM SPLIN 4.36 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001302 FOREARM SPLINT LEFT MED. 00585 79-71975 4.32 EA=1EA .00 1 00000000 18.00
FOREARM SPLIN 4.32 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001281 FOREARM SPLINT R 00585 79-71985 4.32 EA=1EA .00 1 00000000 18.00
FOREARM SPLIN 4.32 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001490 FROG FINGER SPLINT 13/4" 00522 VC5407 22.00 EA=1EA .00 1 00000000 18.00
FROG FINGER S 22.00 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001488 FROG FINGER SPLINT 21/4 00522 VC5406 22.00 EA=1EA .00 1 00000000 18.00
FROG FINGER S 22.00 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001489 FROG FINGER SPLINT 3" 00522 VC5408 22.00 EA=1EA .00 1 00000000 18.00
FROG FINGER S 22.00 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500403 GAIT TRANSFER BELT 00249 MDT828203 3.5983 EA=1EA .00 1 00000000 35.00
GAIT TRANSFER 21.59 CS=6EA/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 606
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501390 GASTROSTOMY TUBE 00058 51364 23.37 EA=1EA .00 1 00000000 163.00
GASTROSTOMY T 00249 DYND70320 23.37 EA=1EA/EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500172 GAUZE 2X2 8PLY S 00249 PRM21224H 1.94 EA=1EA .00 1 00031110 2.00
GAUZE 2X2 8PL 1.94 BX=1BX 1 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 1.94 1 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500157 GAUZE 4X4 X12PLY S 00249 NON21424 .0548 EA=1EA .00 1 00031110 14.00
GAUZE 4X4 X12 32.88 CS=600EA/CS 600 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500171 GAUZE4X4 16PLY S 00249 NON21428 .4205 EA=1EA .00 1 00031110 63.00
GAUZE4X4 16PL 53.82 CS=128EA/CS 128 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:Y MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2146224 GRANEE NEEDLE 00249 BAR9001C0212 22.57 EA=1EA .00 1 00000000 98.00
GRANEE NEEDLE 00043 9001C0212 225.70 BX=10EA/BX 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500031 GRIPPER 20GA X 1" 00249 PTX21286624 5.0675 EA=1EA .00 1 00000000 79.00
GRIPPER 20GA 00062 11-212866 60.81 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 31300025 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501304 GRIPPER NEEDLE 20 11/4 00249 PDI21286724 5.0675 EA=1EA .00 1 00000000 35.00
GRIPPER NEEDL 60.81 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001481 GUEDEL AIRWAY 100MM 00346 1-1504-100 .66 BX=1BX .00 1 00000000 14.00
GUEDEL AIRWAY 6.60 BX=10BX/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 607
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001478 GUEDEL AIRWAY 70MM 00346 1-1504-70 .66 BX=1BX .00 1 00000000 14.00
GUEDEL AIRWAY 6.60 BX=10BX/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001479 GUEDEL AIRWAY 80MM 00346 1-1504-80 .66 BX=1BX .00 1 00000000 14.00
GUEDEL AIRWAY 6.60 BX=10BX/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001480 GUEDEL AIRWAY 90MM 00346 1-1504-90 .66 BX=1BX .00 1 00000000 14.00
GUEDEL AIRWAY 6.60 BX=10BX/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000584 HANGING FILES 00052 ESS415215 3.40 BX=1BX .00 1 00000000 .00
HANGING FILES 3.40 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501000 HEEL PROTECTOR 00249 NON081440PH 4.91 EA=1EA .00 1 00000000 135.00
HEEL PROTECTO 00304 6115 4.91 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001266 HIBICLENS 16OZ. 00257 158057516 9.51 EA=1EA .00 1 00000000 .00
HIBICLENS 16O 114.12 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000642 HIGHLIGHTERS-GREEN 00499 UNV08862 .6658 EA=1EA .00 1 00000000 .00
HIGHLIGHTERS- 7.99 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000643 HIGHLIGHTERS-PINK 00052 UNV08865 .6658 EA=1EA .00 1 00000000 .00
HIGHLIGHTERS- 7.99 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 608
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000644 HIGHLIGHTERS-YELLOW 00118 UNV08861 .6658 EA=1EA .00 1 00000000 .00
HIGHLIGHTERS- 00361 UNV08861 7.99 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001311 HIP/KNEE KIT 00249 THE210301 41.73 EA=1EA .00 1 00000000 143.00
HIP/KNEE KIT 41.73 EA=1EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001111 HUMIDIFIER 500ML.W/ADAPTER 00107 04-2D0803 3.17 EA=1EA .00 1 00000000 .00
HUMIDIFIER 50 37.98 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001131 HUMIDIFIER W/ADAPTER 760ML. 00249 HUD3709 1.147 EA=1EA .00 1 00000000 .00
HUMIDIFIER W/ 11.47 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
890032 HYDRATION ADD HOURS .00 EA= .00 1 00000000 107.00
HYDRATION ADD .00 .00 2 00000000 .00
.......... 3I(0260) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96361 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890031 HYDRATION INITIAL HR .00 EA= .00 1 00000000 212.00
HYDRATION INI .00 .00 2 00000000 .00
.......... 3I(0260) INV.GL= EXP.GL= .00 .00 3 31300008 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96360 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2501426 I.V.CONN.EXTENSION SET 00044 7N8300 1.7517 EA=1EA .00 1 00000000 38.00
I.V.CONN.EXTE 00249 BHL7N8301 350.34 CS=200EA/CS 200 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 609
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001536 ICE BAGS 00661 S-7494 52.00 CS=1CS .00 1 00000000 .00
ICE BAGS 52.00 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500006 ICE PACK 00249 NON4420 .663 EA=1EA .00 1 00000000 32.00
ICE PACK 66.30 CS=100EA/CS 100 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001123 ID BANDS BLUE 00249 MDS133037B 46.07 BX=1BX .00 1 00000000 .00
ID BANDS BLUE 46.07 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001516 ID BANDS PURPLE DNR 00431 WBCDNA-8 42.95 BX=1BX .00 1 00000000 .00
ID BANDS PURP 42.95 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001274 ID BANDS RED 00249 MDS133037R 43.11 BX=1BX .00 1 00000000 .00
ID BANDS RED 00107 8592 43.11 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001118 ID BANDS RED ALLERGY 00257 518984516PDJ 24.10 BX=1BX .00 1 00000000 .00
ID BANDS RED 24.10 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001517 ID BANDS YELLOW FALL RISK 00431 WBCFRA-3 63.27 EA=1EA .00 1 00000000 .00
ID BANDS YELL 63.27 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2330524 IM INJECTION .00 EA= .00 1 00000000 113.00
IM INJECTION .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96372 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 610
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500415 IMPER STOCKINETTE-LG 00249 1259000274 3.27 EA=1EA .00 1 00000000 40.00
IMPER STOCKIN 49.08 CS=15EA/CS 15 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500414 IMPER STOCKINETTE-M 00249 1259000273 2.08 EA=1EA .00 1 00000000 40.00
IMPER STOCKIN 31.25 CS=15EA/CS 15 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000738 IN-LINE AEROSOL H2O TRAPS 01304 45276 1.86 EA=1EA .00 1 00000000 12.00
IN-LINE AEROS 92.75 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
890040 INFLUENZA ADMINISTRTATION .00 EA= .00 1 00000000 61.00
INFLUENZA ADM .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0008 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
80000640 INK PENS BLACK 00118 BICGSF11BK 2.29 BX=1BX .00 1 00000000 .00
INK PENS BLAC 00361 382241 2.29 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000639 INK PENS BLUE 00499 UNV27411 1.55 BX=1BX .00 1 00000000 .00
INK PENS BLUE 1.55 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000638 INK PENS RED 00499 UNV27412 1.19 BX=1BX .00 1 00000000 .00
INK PENS RED 1.19 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 611
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001136 INSP.FILTERS/760 00394 4-074601-00 51.30 EA=1EA .00 1 00000000 .00
INSP.FILTERS/ 51.30 CS=1EA/CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001106 INSULIN SYRINGE 00249 SWD511110Z 28.06 BX=1BX .00 1 00000000 .00
INSULIN SYRIN 28.06 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001476 INSULIN SYRINGE LL 00249 SWD8100777Z .478 EA=1EA .00 1 00000000 .00
INSULIN SYRIN 28.68 BX=60EA/BX 60 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500011 INSYTE AUTOGUARD 24GA. 00249 BMG4251601Z 1.5854 EA=1EA .00 1 00000000 88.00
INSYTE AUTOGU 79.27 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001642 INTERMEC DURATHEM11 LABELS 00754 E15532 12.61 EA=1EA .00 1 00000000 .00
INTERMEC DURA 100.90 CS=8EA/CS 8 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2330512 INTERMEDIATE PROCEDURE .00 EA= .00 1 00000000 709.00
INTERMEDIATE .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500012 INTROCAN 22X1 00249 BMG4251628Z 1.5854 EA=1EA .00 1 00000000 88.00
INSYTE AUTOGU 00039 4251628-02 79.27 BX=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500013 INTROCAN 20X1 00249 BMG4251652Z 1.5854 EA=1EA .00 1 00000000 88.00
INSYTE AUTOGU 00039 4251652-02 79.27 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 612
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500016 INTROCAN 14G 00249 BMG4251717H 1.60 EA=1EA .00 1 00000000 39.00
INTROCAN 14G 1.60 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500015 INTROCAN 16G 00249 4052 .94 EA=1EA .00 1 00000000 39.00
INTROCAN 16G 46.95 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500014 INTROCAN 18G 00249 BMG4251687Z 1.5854 EA=1EA .00 1 00000000 88.00
INTROCAN 18G 79.27 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2330517 INTUBATION BY PHYSICIAN .00 EA= .00 1 00000000 461.00
INTUBATION BY .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 31500 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
80000628 INVISIBLE TAPE 00118 UNV83436 1.89 RL=1RL .00 1 00000000 .00
INVISIBLE TAP 00361 STP487908 1.89 RL=1RL/RL 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000290 IRRIGATION SYRINGE 00257 3583067000 .74 EA=1EA .00 1 00000000 .00
IRRIGATION SY 37.00 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500280 IRRIGATION TRAY 00249 DYND20102 .844 EA=1EA .00 1 00000000 45.00
IRRIGATION TR 16.88 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 613
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500281 IRRIGATION TRAY PISTON 00249 DYNC2303 1.7665 EA=1EA .00 1 00000000 54.00
IRRIGATION TR 35.33 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000144 ISOLATION GOWN 00249 NON27236XL 3.404 PK=1PK .00 1 00000000 .00
ISOLATION GOW 17.02 CS=5PK/CS 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000994 ISOLATION MASK-YELLOW 00249 NON27120 3.105 BX=1BX .00 1 00000000 .00
ISOLATION MAS 00218 4515A 18.63 CS=6BX/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501365 IV BASIC SOL. SET 2C8425 00044 2C8425 2.4533 EA=1EA .00 1 00000000 29.00
IV BASIC SOL. 00249 BHL2C8425 117.76 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501367 IV BURETROL ADD-ON SET 00044 2C7565 2.25 EA=1EA .00 1 00000000 30.00
IV BURETROL A 108.18 CS=48EA/CS 48 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501368 IV CATH EXT.SET 2N3374 00044 2N3374 1.95 EA=1EA .00 1 00000000 45.00
IV CATH EXT.S 00249 389.40 CS=200EA/CS 200 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2330531 IV CONCURRENT INFUSION .00 EA= .00 1 00000000 215.00
IV CONCURRENT .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96368 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 614
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501427 IV CONN CAP 00249 BHL7N8399 1.0858 EA=1EA .00 1 00000000 23.00
IV CONN CAP 217.15 CS=200EA/CS 200 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501371 IV CONT-FLO SET NON-VENTED 2C 00793 M46445690 4.371 EA=1EA .00 1 00031110 68.00
CONT-FLO SET 00249 BHL2C8537 131.13 CS=30EA/CS 30 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501372 IV CONT-FLO VENTED 2C8541 00044 2C8541 3.2833 EA=1EA .00 1 00000000 117.00
IV CONT-FLO V 157.60 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501373 IV DIAL-A-FLO EXT. 00103 S2-12 .83 EA=1EA .00 1 00000000 23.00
IV DIAL-A-FLO 50.00 CS=60EA/CS 60 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501369 IV FAT SET 00044 2C1106 1.99 EA=1EA .00 1 00000000 .00
IV FAT SET 95.45 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501370 IV FILTER SET 2H8671 00249 BHL2H8671 3.0496 EA=1EA .00 1 00000000 24.00
IV FILTER SET 146.38 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2330504 IV HEPLOCK ONLY .00 EA= .00 1 00000000 57.00
IV HEPLOCK ON .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 615
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1350011 IV HYDRATION EA ADDTL HOUR .00 EA= .00 1 00000000 161.00
IV HYDRATION .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300013 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96361 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330532 IV HYDRATION INT HOU .00 EA= .00 1 00000000 265.00
IV HYDRATION .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96360 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1350033 IV INFUSION ADDL SEQ INFUSION UP TO .00 EA= .00 1 00000000 135.00
IV INFUSION A .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300013 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96367 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890029 IV INFUSION CONCUREN .00 EA= .00 1 00000000 220.00
IV INFUSION C .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96368 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330529 IV INFUSION EA ADDITIONAL HOUR .00 EA= .00 1 00000000 221.00
IV INFUSION E .00 .00 2 00000000 .00
.......... 3I(0260) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96366 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330528 IV INFUSION INT .00 EA= .00 1 00000000 473.00
IV INFUSION I .00 .00 2 00000000 .00
.......... 3I(0260) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96365 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890030 IV INFUSION STOPSTAR .00 EA= .00 1 00000000 90.00
IV INFUSION S .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96367 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 616
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1350008 IV PUSH EA ADDTL NEW DRUG .00 EA= .00 1 00000000 106.00
IV PUSH EA AD .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300013 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96375 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1350009 IV PUSH EA ADDTL SAME DRUG .00 EA= .00 1 00000000 198.00
IV PUSH EA AD .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300013 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96376 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1350007 IV PUSH INITIAL DRUG .00 EA= .00 1 00000000 231.00
IV PUSH INITI .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300013 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96374 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2501375 IV SECONDARY MED SET 2C746 00793 M77460030 1.1085 EA=1EA .00 1 00031110 12.00
IV SECONDARY 00249 BHL2C7461 44.34 CS=40EA/CS 40 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501534 IV SET MINI DRIP OR 2C854 00044 2C8546 3.2467 EA=1EA .00 1 00000000 117.00
IV SET MINI D 00249 BHL2C8546 155.84 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500984 IV START KIT 00249 DYND74271 .6652 EA=1EA .00 1 00000000 34.00
IV START KIT 00084 IV330 66.52 CS=100EA/CS 100 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500179 K-PADS 00249 070766N410CC 11.94 EA=1EA .00 1 00000000 203.00
K-PADS 119.43 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 617
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500114 KANGAROO DOUBLE FEEDIND BAG 00249 SWD773656 2.1893 EA=1EA .00 1 00000000 79.00
KANGAROO 65.68 CS=30EA/CS 30 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500113 KANGAROO WITH ICE POUCH 00443 8884773600 4.7357 EA=1EA .00 1 00000000 35.00
KANGAROO 142.07 CS=30EA/CS 30 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500176 KERLIX S 00249 PRM25865 .4374 EA=1EA .00 1 00000000 14.00
KERLIX S 43.74 CS=100EA/CS 100 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:Y MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500178 KERLIX SUPER 00249 3583004308 .77 EA=1EA .00 1 00000000 8.00
KERLIX SUPER 7.71 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000163 KLING 2" 00249 NON25492 1.3563 BG=1BG .00 1 00000000 .00
KLING 2" 10.85 CS=8BG/CS 8 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500159 KLING 2" S 00249 NON25496 .1221 EA=1EA .00 1 00000000 32.00
KLING 2" S 11.72 BX=96EA/BX 96 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000164 KLING 3" 00249 NON25493 1.9425 BG=1BG .00 1 00000000 .00
KLING 3" 15.54 CS=8BG/CS 8 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500160 KLING 3" S 00249 NON25497 .1435 EA=1EA .00 1 00000000 41.00
KLING 3" S 13.78 CS=96EA/CS 96 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 618
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000165 KLING 4" 00257 6904 1.56 BG=1BG .00 1 00000000 .00
KLING 4" 12.46 CS=8BG/CS 8 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500161 KLING 4" S 00249 NON25498 .1809 EA=1EA .00 1 00000000 52.00
KLING 4" S 17.37 CS=96EA/CS 96 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000166 KLING 6" 00257 6906 5.72 BG=1BG .00 1 00000000 .00
KLING 6" 5.72 BG=1BG/BG 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500162 KLING 6" S 00249 NON25499 .32 EA=1EA .00 1 00000000 59.00
KLING 6" S 15.36 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500377 KNEE HIGH LG 00249 MDS160664 4.8925 EA=1EA .00 1 00000000 153.00
KNEE HIGH LG 00432 2040009 58.71 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500376 KNEE HIGH MED 00249 MDS160644 4.8925 EA=1EA .00 1 00000000 153.00
KNEE HIGH MED 00432 204008 58.71 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500375 KNEE HIGH SM 00249 MDS160624 3.6942 EA=1EA .00 1 00000000 153.00
KNEE HIGH SM 44.33 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500378 KNEE HIGH XL 00432 204010 5.871 EA=1EA .00 1 00000000 153.00
KNEE HIGH XL 00249 MDS160684 58.71 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 619
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500485 KNEE IMMOB 16" LG 00249 ORT2410016 20.98 BX=1BX .00 1 00000000 322.00
KNEE IMMOB 16 20.98 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500484 KNEE IMMOB 16" MED 00420 1877-504-16 18.20 BX=1BX .00 1 00000000 725.00
KNEE IMMOB 16 18.20 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500483 KNEE IMMOB 16" UNIVERSAL 00249 ORT2410016 21.40 BX=1BX .00 1 00000000 725.00
KNEE IMMOB SM 21.40 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500486 KNEE IMMOB 16"XL 00420 187750616 18.20 BX=1BX .00 1 00000000 322.00
KNEE IMMOB 16 18.20 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500489 KNEE IMMOB 22" LG 00420 187750522 19.28 BX=1BX .00 1 00000000 322.00
KNEE IMMOB 22 19.28 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500488 KNEE IMMOB 22" MD 00420 187750422 20.54 BX=1BX .00 1 00000000 322.00
KNEE IMMOB 22 20.54 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500490 KNEE IMMOB 22"XL 00420 187750622 19.28 BX=1BX .00 1 00000000 322.00
KNEE IMMOB 22 19.28 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500487 KNEE IMMOB UNIVERSAL 22" 00249 ORT2411022 25.20 BX=1BX .00 1 00000000 322.00
KNEE IMMOB 22 25.20 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 620
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500860 KNEE SLEEVES SCD LARGE 00657 3583005489 33.38 EA=1EA .00 1 00000000 113.00
KNEE SLEEVES 166.91 CS=5EA/CS 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501045 KUMPE 5FR 40CM 00254 54038KA2 11.50 EA=1EA .00 1 00000000 124.00
KUMPE 5FR 40 00058 31-407 57.50 BX=5EA/BX 5 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501046 KUMPE 5FR 65CM 00254 56538KA2 11.50 EA=1EA .00 1 00000000 124.00
KUMPE 5FR 65C 00058 31-409 57.50 BX=5EA/BX 5 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000245 KY JELLY 2.7 00249 MDS032273Z 5.1317 BX=1BX .00 1 00000000 .00
KY JELLY 2.7 00062 24-3627D 30.79 CS=6BX/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000246 KY JELLY 4OZ. 00249 MDS032290Z .7825 EA=1EA .00 1 00000000 .00
KY JELLY 4OZ. 9.39 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001442 LAP CHOLE PACK 00249 DYNJS0310 34.1525 EA=1EA .00 1 00000000 210.00
LAP CHOLE PAC 136.61 CS=4EA/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001321 LASER LABELS AND ARM BANDS 00306 WBW61 66.75 PK=1PK .00 1 00000000 .00
LASER LABELS 00107 7263 267.00 CS=4PK/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000096 LEG BAG 00249 DYND12574H 1.98 EA=1EA .00 1 00000000 .00
LEG BAG 1.98 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 621
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001306 LEG SPLINT FEMORAL 14" 00585 79-72295 36.39 EA=1EA .00 1 00000000 311.00
LEG SPLINT FE 36.39 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000097 LEG STRAP 00249 1821-000316 3.07 EA=1EA .00 1 00000000 .00
LEG STRAP 30.74 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000619 LEGAL PADS -LETTER YELLOW 00052 UNV10630 1.2492 EA=1EA .00 1 00000000 .00
LEGAL PADS -L 00361 815080 14.99 PK=12EA/EA 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000618 LEGAL PADS-SMALL YELLOW 00052 UNV46200 .7908 EA=1EA .00 1 00000000 .00
LEGAL PADS-SM 00361 163832 9.49 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001299 LEMON GLYCERIN SWABSTICK 00249 MDS090600 2.313 BX=1BX .00 1 00000000 .00
LEMON GLYCERI 23.13 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001087 LETTER HEAD CCH 00783 CCH 94.10 BX=1BX .00 1 00000000 .00
LETTER HEAD C 941.00 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500108 LEVIN TUBE 10FR 00249 4130-085750 1.96 EA=1EA .00 1 00000000 29.00
LEVIN TUBE 10 98.00 CS=50EA/CS 50 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500109 LEVIN TUBE 12FR 00249 SWD265314H .1288 EA=1EA .00 1 00000000 29.00
LEVIN TUBE 12 6.44 EA=1EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 622
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500110 LEVIN TUBE 14FR 00249 4130-85752 .9158 EA=1EA .00 1 00000000 29.00
LEVIN TUBE 14 45.79 CS=50EA/CS 50 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000721 LG DISP VINYL NASAL MASK 01304 83312104EA 14.49 EA=1EA .00 1 00000000 44.00
LG DISP VINYL 14.49 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000724 LG/NARR DISP VINYL NASAL M 01304 73312123EA 14.49 EA=1EA .00 1 00000000 44.00
LG/NARR DISP 14.49 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000462 LIFE PAK 6,7,8 00356 804700-003 1.00 EA=1EA .00 1 00000000 .00
LIFE PAK 6,7, 10.04 BX=10BX/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000463 LIFE PAK 9,10 00356 11240000013 6.56 RL=1RL .00 1 00000000 .00
LIFE PAK 9,10 19.68 BX=3RL/BX 3 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501325 LIGAMAX EL5ML 00202 EL5ML 130.03 EA=1EA .00 1 00000000 1042.00
LIGAMAX EL5ML 00249 ETHEL5ML 390.09 BX=3EA/BX 3 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500154 LIMB HOLDER 00304 2532 6.69 EA=1EA .00 1 00000000 90.00
LIMB HOLDER 00249 NON243074 6.69 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000194 LOTION 00249 MSC095001 .1761 EA=1EA .00 1 00000000 .00
LOTION 16.91 CS=96EA/CS 96 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 623
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001270 MAGNETIC INSTRUMENT PAD 00257 603425D001 3.63 CS=1CS .00 1 00000000 .00
MAGNETIC INST 108.92 CS=30CS/CS 30 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001443 MAJOR EXTREMITY PACK 00249 DYNJS0804 32.155 EA=1EA .00 1 00000000 328.00
MAJOR EXTREMI 128.62 CS=4EA/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501346 MAJOR LAP PACK (NEW) 00249 DYNJS0301 46.01 EA=1EA .00 1 00000000 352.00
MAJOR LAP PAC 92.02 CS=2EA/CS 2 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501124 MALE CATH TEXAS SMALL 00249 DYND12303H 1.51 EA=1EA .00 1 00000000 39.00
MALE CATH TEX 1.51 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000648 MARKER-BLACK 00052 AVE08888 .7908 EA=1EA .00 1 00000000 .00
MARKER-BLACK 9.49 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501263 MASTISOL 00249 FRN052348Z 1.6242 EA=1EA .00 1 00000000 20.00
MASTISOL 77.96 BX=48EA/BX 48 .00 2 00000000 .00
.......... 78(0250) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500536 MAX 30 INFLATION 00104 G31027 30.00 BX=1BX .00 1 00000000 277.00
MAX 30 INFLAT 00058 M0067101131 30.00 BX=1BX/BX 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000761 MED CONCENTR AD O2 MASK-SI 01304 301180 .55 EA=1EA .00 1 00000000 54.00
MED CONCENTR 27.50 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 624
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90000722 MED/SMA DISP VINYL NASAL M 01304 73312105EA 14.49 EA=1EA .00 1 00000000 44.00
MED/SMA DISP 14.49 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2504022 MEDIHONEY 2X2 SHEET 00249 DER31815 37.445 EA=1EA .00 1 00031110 100.00
MEDIHONEY SHE 449.34 CS=12EA/CS 12 .00 2 00031220 .00
.......... 43(0270) INV.GL=41115091 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2504021 MEDIHONEY GEL 00249 DER31815 11.5733 EA=1EA .00 1 00031110 63.00
MEDIHONEY 138.88 CS=12EA/CS 12 .00 2 00031220 .00
.......... 43(0270) INV.GL=41115091 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001232 MEDIPORE DRESSING 00257 4509003562 9.04 BX=1BX .00 1 00000000 .00
MEDIPORE DRES 36.15 CS=4BX/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501560 MEDIPORE DRESSING 3566 00249 4509003566 .52 EA=1EA .00 1 00000000 7.00
MEDIPORE DRES 52.42 CS=100EA/CS 100 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501164 MEFIX 4" 00249 ALA311099H 7.02 BX=1BX .00 1 00000000 119.00
MEFIX 4" 7.02 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501189 MEFIX 6" 00249 ALA311599H 10.5125 BX=1BX .00 1 00000000 53.00
MEFIX 6" 10.5125 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001446 MERITZ PLUS 00249 MDS8840128 15.51 EA=1EA .00 1 00000000 .00
MERITZ PLUS 62.04 CS=4EA/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 625
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90000755 METHACHOLINE CHALLE ASTHMA 01304 26773100 28.26 EA=1EA .00 1 00000000 90.00
METHACHOLINE 28.26 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500980 MIDSTREAM 00249 DYND30240 .6207 EA=1EA .00 1 00031110 56.00
MIDSTREAM 62.07 CS=100EA 100 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000466 MINDRAY RECORDING PAPER 00263 0683-00-0505-02 3.49 RL=1RL .00 1 00000000 .00
MINDRAY 34.90 BX=10RL/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501337 MINI ACCESS KIT 5FR. 00916 MAK501N/A 35.00 BX=1BX .00 1 00000000 78.00
MINI ACCESS K 35.00 BX=1BX/BX 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001590 MITTS 00573 2826 1.07 EA=1EA .00 1 00000000 .00
MITTS 12.80 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001116 MONOCRYL 4-0 Y845G 00249 ETHY845G 50.37 BX=1BX .00 1 00000000 .00
MONOCRYL 4-0 50.37 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500196 MOUTHWASH 00249 CTR000413 .2013 EA=1EA .00 1 00000000 .00
MOUTHWASH 12.08 CS=60EA/CS 60 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001486 MULTI ABSORBER 00547 8003138 15.40 EA=1EA .00 1 00000000 .00
MULTI ABSORBE 92.37 CS=6EA/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 626
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90000765 NASAL AIRWAY 00249 HUD1088 6.00 EA=1EA .00 1 00031110 69.00
300.00 CS=50EA/CS 50 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000740 NASAL CANNULA EZ WRAP (EAR 01304 771016 .85 EA=1EA .00 1 00000000 .00
NASAL CANNULA 42.35 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001563 NASAL CANNULA W/25FT.TUBIN 01304 301-104 1.81 EA=1EA .00 1 00000000 35.00
NASAL CANNULA 45.32 CS=25EA/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501245 NASAL TAMPON 00249 440402 10.044 EA=1EA .00 1 00000000 63.00
NASAL TAMPON 00251 440402 100.44 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000766 NEBULIZER 00396 301200 1.1308 EA=1EA .00 1 00031110 42.00
NEBULIZER 00249 HCS4483 56.54 CS=50EA/CS 50 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000029 NEEDLE 25X2 00249 358381-200441 8.98 BX=1BX .00 1 00000000 .00
NEEDLE 25X2 8.98 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000564 NEEDLE COUNTER 00257 31142337 8.73 BX=1BX .00 1 00000000 .00
NEEDLE COUNTE 69.80 BX=8BX/BX 8 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500052 NEEDLE LOCK DEVICE 00044 2C7833 .50 EA=1EA .00 1 00000000 5.00
NEEDLE LOCK D 49.91 BX=100EA/BX 100 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 627
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000053 NG STRIP 00249 CURNASTUB50 .5182 EA=1EA .00 1 00000000 .00
NG STRIP 25.91 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000773 NIPPLE ADAPTORS 01304 26-33-2600 .66 EA=1EA .00 1 00000000 .00
NIPPLE ADAPTO 32.89 PK=50EA/PK 50 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501419 NITREX WIRES 00916 MAK001N 2.30 EA=1EA .00 1 00000000 71.00
NITREX WIRES 23.00 BX=10EA/BX 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500334 NONFENESTRATED TOWEL 00249 BXT3520Z .3412 EA=1EA .00 1 00000000 5.00
NONFENESTRATE 17.06 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001091 NOTEBOOK 1" 00052 UNV20962 3.1658 EA=1EA .00 1 00000000 .00
NOTEBOOK 1" 00361 374815 3.1658 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000677 NOTEBOOK 2" 00052 UNV20982 5.99 EA=1EA .00 1 00000000 .00
NOTEBOOK 2" 00361 648814 5.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001095 NOTEBOOK 3" 00052 UNV20992 7.99 EA=1EA .00 1 00000000 .00
NOTEBOOK 3" 00361 374819 7.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000678 NOTEBOOK-1.5" 00499 UNV20972 3.79 EA=1EA .00 1 00000000 .00
NOTEBOOK-1.5" 3.79 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 628
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001305 NOVO INSULIN NEEDLES 00249 NOV185275 57.63 BX=1BX .00 1 00000000 .00
NOVO INSULIN 57.63 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500265 NUGAUZE 1" 00249 NON255015 1.7183 EA=1EA .00 1 00000000 53.00
NUGAUZE 1" 20.62 CS=12EA 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000175 NUGAUZE 4X4 00257 3460007634 2.03 PK=1PK .00 1 00000000 .00
NUGAUZE 4X4 20.30 CS=10PK/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500267 NUGAUZE IDOFORM.50 00249 NON256125 1.5767 EA=1EA .00 1 00000000 53.00
NUGAUZE IDOFO 18.92 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500268 NUGAUZE IODOFORM 1" 00249 NON256015 1.9667 EA=1EA .00 1 00000000 135.00
NUGAUZE IODOF 23.60 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501200 NUGAUZE PACK IODOFORM 1/4 00249 NON256145 1.5092 BT=1BT .00 1 00000000 53.00
NUGAUZE PACK 18.11 CS=12BT/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500264 NUGAUZE PACKING 1/2 00249 NON255125 1.5708 EA=1EA .00 1 00000000 46.00
NUGAUZE PACKI 18.85 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501199 NUGAUZE PACKING 1/4 00249 NON255145 1.4358 BT=1BT .00 1 00000000 53.00
NUGAUZE PACKI 17.23 CS=12BT/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 629
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000305 NURSES CAP 00249 BRLB77-4502 2.794 BX=1BX .00 1 00000000 .00
NURSES CAP 13.97 CS=5BX/CS 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000772 O2 SWIVELED/TAPERED NIPPLE 01304 301195 .26 EA=1EA .00 1 00000000 .00
O2 SWIVELED/T 13.20 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000756 O2 TUBING 7’ EXTENSION 00396 301145EA .3458 EA=1EA .00 1 00031110 20.00
O2 TUBING 7’ 00249 HCS4507 17.29 CS=50EA/CS 50 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501246 OB PADS PK 00249 NON241281 1.0146 PK=1PK .00 1 00000000 .00
OB PADS PK 24.35 CS=24PK/CS 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2310007 OBSERVATION AUTO OBS .00 EA= .00 1 31110013 110.00
OBSERVATION R .00 .00 2 31220013 .00
.......... EJ(0762) INV.GL= EXP.GL= .00 .00 3 31300013 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99218 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
890010 OBSERVATION HOUR .00 EA= .00 1 31110013 36.00
OBSERVATION H .00 .00 2 31220013 .00
.......... EJ(0762) INV.GL= EXP.GL= .00 .00 3 31300013 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0378 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
80001406 ODOR ELIMINATOR 00249 CRR101003 2.0608 EA=1EA .00 1 00000000 .00
ODOR ELIMINAT 98.92 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 630
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000234 ONE-STEP SAFETY LANCET 00249 SRG1SLN20010C 6.198 BX=1BX .00 1 00000000 .00
ONE-STEP SAFE 00062 75-200100N 92.97 CS=15BX/CS 15 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500274 OPSITE 10X5.50 00249 MMM1627Z 1.102 EA=1EA .00 1 00000000 155.00
OPSITE 10X5.5 22.04 BX=20EA/BX 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500275 OPSITE 4X5.50 00249 MSC2304 .5994 EA=1EA .00 1 00000000 54.00
OPSITE 4X5.50 29.97 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000620 PAPER CLIPS-JUMBO 00361 UNV72220 11.49 BX=1BX .00 1 00000000 .00
PAPER CLIPS-J 00118 UNV72220 11.49 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000621 PAPER CLIPS-SM. 00499 UNV72210 4.99 BX=1BX .00 1 00000000 .00
PAPER CLIPS-S 00118 UNV72210 4.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2330519 PARACENTESIS .00 EA= .00 1 00000000 473.00
PARACENTESIS .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 49080 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
80000417 PAT.BELONGING BAG 00249 NON026310 2.531 PK=1PK .00 1 00000000 .00
PAT.BELONGING 00062 99-BELB 25.31 CS=10PK/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 631
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
25014343 PATIENT BED PAD 00249 MDT8445B1 29.97 EA=1EA .00 1 00031110 100.00
PATIENT BED P 29.97 EA=1EA/EA 1 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501342 PATIENT CHAIR PAD 00249 MDT82145C6 15.53 EA=1EA .00 1 00000000 90.00
PATIENT CHAIR 93.18 CS=6EA/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001150 PDS 11 SUTURE Z497G 00257 23000Z497G 42.90 BX=1BX .00 1 00000000 .00
PDS 11 SUTURE 42.90 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501103 PED.MULTI-LUMEN CENTRAL CA 00249 ARWAK14553 46.732 EA=1EA .00 1 00000000 232.00
PED.MULTI-LUM 233.66 CS=5EA/CS 5 .00 2 00000000 .00
.......... 50(0278) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: C1751 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
80000365 PEDIALYTE 00249 R-L59892Z 2.5275 EA=1EA .00 1 00000000 .00
PEDIALYTE 10.11 PK=4EA/PK 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501247 PEDIATRIC URINE BAG 00249 MDS190510 .509 EA=1EA .00 1 00000000 11.00
PEDIATRIC URI 25.45 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501067 PEDIATRIC WRIST SPLINT L 00249 IMP121816 30.25 EA=1EA .00 1 00000000 41.00
PEDIATRIC WRI 00123 79-87291 30.25 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 632
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501066 PEDIATRIC WRIST SPLINT R 00249 ORT19900RXXS 11.88 EA=1EA .00 1 00000000 41.00
PEDIATRIC WRI 00123 79-87281 11.88 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001498 PEDICAP 6 01304 507-PEDICAP 6 9.45 CS=1CS .00 1 00000000 26.00
PEDICAP 6 56.70 CS=6CS/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000360 PEG BOARD REC 00783 PBR .00 PK=1PK .00 1 00000000 .00
PEG BOARD REC .00 CS=10PK/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500496 PELVIC TRACTION BELT 00420 74302 11.45 EA=1EA .00 1 00000000 45.00
PELVIC TRACTI 11.45 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500498 PELVIC TRACTION BELT 00420 74104 11.45 BX=1BX .00 1 00000000 45.00
PELVIC TRACTI 11.45 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500440 PELVIC TRACTION BELT 34-38 00420 74303 9.66 BX=1BX .00 1 00000000 45.00
PELVIC TRACTI 9.66 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500441 PELVIC TRACTION BELT 38-42 00420 74304 9.66 BX=1BX .00 1 00000000 45.00
PELVIC TRACTI 9.66 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500442 PELVIC TRACTION BELT 42-46 00420 74305 9.66 BX=1BX .00 1 00000000 45.00
PELVIC TRACTI 9.66 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 633
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500443 PELVIC TRACTION BELT 46-52 00420 74306 9.66 BX=1BX .00 1 00000000 45.00
PELVIC TRACTI 9.66 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501127 PELVIC TRACTION BELT UNIVE 00420 1678-001 14.16 BX=1BX .00 1 00000000 45.00
PELVIC TRACTI 14.16 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000637 PENCILS 00118 UNV55400 .39 BX=1BX .00 1 00000000 .00
PENCILS .39 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001502 PHILLIP EKG PAPER 00249 GCO32016653 87.17 CS=1CS .00 1 00000000 .00
PHILLIP EKG P 87.17 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000346 PHYSICIAN ORDERS 00783 HFS14 49.50 BX=1BX .00 1 00000000 .00
PHYSICIAN ORD 495.00 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501421 PICC TRAY 00487 21-2904-24 50.40 EA=1EA .00 1 00000000 377.00
PICC TRAY 252.00 CS=5EA/CS 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000008 PILLOW 00249 PM1824-15 1.3483 EA=1EA .00 1 00000000 .00
PILLOW 16.18 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001528 PILLOWS REUSABLE 00249 MDT219683 3.69 EA=1EA .00 1 00000000 .00
PILLOWS REUSA 3.69 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 634
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2330508 PNEUMOCOCCAL VACCINE ADMINISTRATION .00 EA= .00 1 00000000 788.00
ADMIN PNEUMOC .00 .00 2 00000000 .00
.......... EL(0771) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0009 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
7043203 PNEUVOVAX (PNEUMOCOCCAL 23) 0.5ML VI00074 5111877 8.155 EA= .00 1 00000000 435.00
PNEUMOCOCCAL 0006483702 81.55 1 .00 2 00000000 .00
.......... 78(0250) INV.GL= EXP.GL= .00 .00 3 31300070 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90732 FC/CPT2 CODES: /S0195
------------------------------------------------------------------------------------------------------------------------------------
90000769 POCKET CHAMBER 01304 317-621-210 7.52 EA=1EA .00 1 00000000 26.00
POCKET CHAMBE 75.15 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2330495 PORT-A-CATH BLOOD DRAW .00 EA= .00 1 00000000 51.00
PORT-A-CATH B .00 .00 2 00000000 .00
.......... 56(0301) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36591 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
80000626 POST-ITS 1 1/2X2 YELLOW 00499 UNV35662 .5242 EA=1PK .00 1 00000000 .00
POST-ITS 1 1/ 6.29 PK=12PK/PK 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000625 POST-ITS-3X3 YELLOW 00052 UNV35688 1.2492 EA=1PK .00 1 00000000 .00
POST-ITS-3X3 00361 562896 14.99 PK=12PK/PK 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500452 POST-OP SHOE MEN LG 00420 161123 7.65 EA=1EA .00 1 00000000 99.00
POST-OP SHOE 7.65 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 635
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500453 POST-OP SHOE MEN XL 00420 161124 6.05 EA=1EA .00 1 00000000 99.00
POST-OP SHOE 6.05 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500451 POST-OP SHOE MN MD 00249 ORT30400MM 7.55 EA=1EA .00 1 00000000 99.00
POST-OP SHOE 7.55 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500450 POST-OP SHOE MN S 00420 161121 6.84 EA=1EA .00 1 00000000 99.00
POST-OP SHOE 6.84 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501473 POST-OP SHOE PEDIATRIC 00420 8601-697-01 11.73 EA=1EA .00 1 00000000 99.00
POST-OP SHOE 11.73 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500446 POST-OP SHOE YOUTH 00420 860169702 11.73 EA=1EA .00 1 00000000 99.00
POST-OP SHOE 11.73 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500449 POST-OP WOMEN LG 00249 ORT30300WL 10.70 EA=1EA .00 1 00000000 99.00
POST-OP WOMEN 10.70 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500448 POST-OP WOMENS MD 00249 ORT30400WM 7.55 EA=1EA .00 1 00000000 99.00
POST-OP WOMEN 7.55 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500447 POST-OP WOMENS SM 00249 ORT30400WS 7.55 EA=1EA .00 1 00000000 99.00
POST-OP WOMEN 7.55 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 636
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001285 POSTERIOR ELBOW LG. 00585 79-71137 13.37 EA=1EA .00 1 00000000 39.00
POSTERIOR ELB 13.37 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001284 POSTERIOR ELBOW MD. 00585 79-71135 13.10 EA=1EA .00 1 00000000 39.00
POSTERIOR ELB 13.10 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001286 POSTERIOR ELBOW XL 00585 79-71138 13.37 EA=1EA .00 1 00000000 39.00
POSTERIOR ELB 13.37 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001386 POSTERIOR TIB/FIB LARGE 30 00123 79-72297 19.52 EA=1EA .00 1 00000000 39.00
POSTERIOR TIB 19.52 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001283 POSTERIOR TIBULA LG. 00249 SDJ7972283 23.28 EA=1EA .00 1 00000000 69.00
POSTERIOR TIB 23.28 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001282 POSTERIOR TIBULA SPLINT MD 00123 79-72285 20.16 EA=1EA .00 1 00000000 69.00
POSTERIOR TIB 20.16 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001312 POSTTERIOR TIB/FIB SMALL 00249 SDJ7972283 20.02 EA=1EA .00 1 00000000 69.00
POSTTERIOR TI 20.02 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000195 POWDER 00249 MSC095390 .4422 EA=1EA .00 1 00000000 .00
POWDER 15.92 CS=36EA/CS 36 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 637
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2146225 PPH STAPLE GUN 00249 BAR9001C0212 22.57 EA=1EA .00 1 00000000 924.00
PPH STAPLE GU 00043 9001C0212 225.70 BX=10EA/BX 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001376 PREFILLED NS SYRINGE 10ML 00257 723306546 7.94 BX=1BX .00 1 00000000 10.00
PREFILLED NS 238.14 CS=30BX/CS 30 .00 2 00000000 .00
.......... 78(0250) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
7000804 PREVNAR 13 00074 4555389 169.487 EA= .00 1 00000000 843.40
PREVNAR 13 0005197102 1694.87 10 .00 2 00000000 .00
.......... 78(0250) INV.GL= EXP.GL= .00 .00 3 31300070 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90670 FC/CPT2 CODES: /S0195
------------------------------------------------------------------------------------------------------------------------------------
80000170 PROBE COVER CRITIKON 00257 1720008815 19.90 BX=1BX .00 1 00000000 .00
PROBE COVER C 19.90 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000242 PROBE COVER WELCH ALLYN 00062 75-05031 66.85 BX=1BX .00 1 00000000 .00
PROBE COVER W 00249 W-A05031750 66.85 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501146 PROCEDURE TRAY (PICC) 00487 21-2501-01 26.20 EA=1EA .00 1 00000000 377.00
PROCEDURE TRA 262.00 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2146227 PROLENE MESH PMII 3X6 00249 ETHPMII 78.815 EA=1EA .00 1 00000000 478.00
PRLENEMESHP3X 00043 9001C0212 472.89 BX=6EA/BX 6 .00 2 00000000 .00
.......... 50(0278) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: C1781 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 638
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001431 PRONOVA 6-0 00257 230003805H 288.34 BX=1BX .00 1 00000000 .00
PRONOVA 6-0 288.34 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001500 PROTEST BI TEST PACK 00452 PT-3-BITP 155.43 CS=1CS .00 1 00000000 .00
PROTEST BI TE 155.43 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001119 PROXIMATE LINEAR CUTTER TC 00249 TCR75 69.20 EA=1EA .00 1 00000000 173.00
PROXIMATE LIN 830.35 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500681 PULSE OXISENSOR ADULT 00263 0600-00-0121 10.9917 EA=1EA .00 1 00031110 234.00
PULSE OXISENS 00249 MM01859 263.80 CS=24EA/CS 24 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501620 PULSE OXISENSOR ADULT (OR) 00249 4110001001 8.98 EA=1EA .00 1 00000000 104.00
PULSE OXISENS 179.69 CS=20EA/CS 20 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500682 PULSE OXISENSOR PED. 00263 00600-00-0122 12.9765 EA=1EA .00 1 00031110 203.00
PULSE OXISENS 00249 MMO1860 259.53 CS=20EA/CS 20 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001447 PURPLE ID BAND 00257 518905033PDM 88.25 BX=1BX .00 1 00000000 .00
PURPLE ID BAN 88.25 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000464 PYXIS PAPER 00302 107071-01 1.95 RL=1RL .00 1 00000000 .00
PYXIS PAPER 97.65 PK=50RL/PK 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 639
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501098 QUIK -COMBO ELECTRODE ADUL 00295 11996000091 24.05 EA=1EA .00 1 00000000 179.00
QUIK -COMBO E 00249 PHY1199600091 24.05 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501178 QUIK-COMBO PEDIATRIC 00295 3010107-000 45.00 EA=1EA .00 1 00000000 194.00
QUIK-COMBO PE 00249 PHY19600093PK 45.00 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501544 QUIK-PACE ELECTRODES 00249 PHY996000017 26.085 EA=1EA .00 1 00031110 240.00
QUIK-PACE ELE 00295 11996-000017 26.085 EA=1EA/EA 1 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001644 RAPICIDE GLUT HIGH LEVEL 00249 SDCML020127 24.83 EA=1EA .00 1 00000000 .00
OPA 28 00248 ML02-0059 99.32 CS=4EA/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500202 RAZOR 00249 BRN1333Z .394 EA=1EA .00 1 00031110 10.00
RAZOR 00062 80-02 3.94 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001135 RE/X EXP FILTER/760 00394 G-060526-00 102.60 EA=1EA .00 1 00000000 .00
RE/X EXP FILT 102.60 CS=1EA/CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001535 READY BATH COMPLETE 00249 MSC095304 .7073 EA=1EA .00 1 00000000 .00
READY BATH CO 21.22 CS=30EA/CS 30 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500085 RED RUBBER 10FR 00249 DYND13510 .8275 EA=1EA .00 1 00000000 20.00
RED RUBBER 10 9.93 CS=12EA/CS 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 640
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500086 RED RUBBER 12 FR 00249 0620-94120 .87 EA=1EA .00 1 00000000 20.00
RED RUBBER 12 87.00 CS=100EA/CS 100 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500087 RED RUBBER 14FR 00249 0620-94140 .83 EA=1EA .00 1 00000000 20.00
RED RUBBER 14 82.75 CS=100EA/CS 100 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500088 RED RUBBER 16FR 00257 0620-94160 .80 EA=1EA .00 1 00000000 20.00
RED RUBBER 16 80.00 CS=100EA/CS 100 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500089 RED RUBBER 18FR 00249 0620-94180 .83 EA=1EA .00 1 00000000 20.00
RED RUBBER 18 82.75 CS=100EA/CS 100 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501253 RHINO ROCKET 00249 SGY11S05008AS 23.445 EA=1EA .00 1 00000000 63.00
RHINO ROCKET 93.78 BX=4EA/BX 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001044 RHYTHM STRIPS 00062 D3247P 53.25 BX=1BX .00 1 00000000 .00
RHYTHM STRIPS 00265 1234 532.50 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501255 RIB BELT FEMALE 00420 2722-008 .29 EA=1EA .00 1 00000000 98.00
RIB BELT FEMA 3.49 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501254 RIB BELT MALE 00420 2721-008 .29 EA=1EA .00 1 00000000 98.00
RIB BELT MALE 3.49 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 641
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000664 RUBBERBANDS 00499 UNV00432 9.99 BX=1BX .00 1 00000000 .00
RUBBERBANDS 9.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001262 SAFE SORB 00249 DYNDS1500B 1.2286 EA=1EA .00 1 00000000 .00
SAFE SORB 117.95 CS=96EA/CS 96 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000493 SAFETY GLASSES 00249 NON24770H 1.78 EA=1EA .00 1 00000000 .00
SAFETY GLASSE 1.78 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001215 SAFETY NEEDLE 18X11/2 00257 3.58382E+11 21.40 BX=1BX .00 1 00000000 .00
SAFETY NEEDLE 21.40 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001238 SAFETY NEEDLE 21X1 00249 B-D305764Z 15.175 BX=1BX .00 1 00000000 .00
SAFETY NEEDLE 15.175 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001239 SAFETY NEEDLE 22X1 00249 SWD850210Z 9.35 BX=1BX .00 1 00000000 .00
SAFETY NEEDLE 9.35 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001216 SAFETY NEEDLE 22X11/2 00249 B-D305763Z 15.175 BX=1BX .00 1 00000000 .00
SAFETY NEEDLE 15.175 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001217 SAFETY NEEDLE 23X1 00249 B-D305762Z 15.175 BX=1BX .00 1 00000000 .00
SAFETY NEEDLE 15.175 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 642
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001219 SAFETY NEEDLE 25X1 00249 B-D305916Z 11.075 BX=1BX .00 1 00000000 .00
SAFETY NEEDLE 11.075 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001218 SAFETY NEEDLE 25X11/2 00249 SYRS100257Z 21.84 BX=1BX .00 1 00000000 .00
SAFETY NEEDLE 21.84 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001221 SAFETY NEEDLE 25X5/8 00249 B-D305901Z 11.0775 BX=1BX .00 1 00000000 .00
SAFETY NEEDLE 11.0775 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001391 SAFETY NEEDLES 18X1 00249 SWD850810Z 12.82 BX=1BX .00 1 00000000 .00
SAFETY NEEDLE 12.82 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000235 SAFETY PINS 00257 286730392C .89 BG=1BG .00 1 00000000 .00
SAFETY PINS 10.62 BX=12BG/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500222 SAFETY SCALPEL 10 00249 MDS15310 1.707 EA=1EA .00 1 00000000 32.00
SAFETY SCALPE 17.07 BX=1BX/10 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500223 SAFETY SCALPEL 11 00249 MDS153111 1.301 EA=1EA .00 1 00000000 32.00
SAFETY SCALPE 13.01 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500224 SAFETY SCALPEL 15 00249 MDS15315 .8708 EA=1EA .00 1 00000000 14.00
SAFETY SCALPE 10.45 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 643
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500111 SALEM SUMP 16FR 00249 DYND72016H 2.87 EA=1EA .00 1 00000000 65.00
SALEM SUMP 16 2.87 EA=1EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500112 SALEM SUMP 18FR 00249 DYND72018H 3.47 EA=1EA .00 1 00000000 29.00
SALEM SUMP 18 3.47 EA=1EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001349 SALUTE INSTRUMENT 00467 113077 230.00 EA=1EA .00 1 00000000 .00
SALUTE INSTRU 1150.00 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000199 SCISSOR SHARP/BLUNT 00249 DYND04000 1.7904 EA=1EA .00 1 00000000 .00
SCISSOR SHARP 44.76 BX=25EA/BX 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501378 SENSI-TOUCH GLOVES 61/2 00249 MSG4065Z .2456 EA=1EA .00 1 00031110 12.00
SENSI-TOUCH G 12.28 BX=50EA/BX 50 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501379 SENSI-TOUCH GLOVES 7.0 00249 MSG4070Z .2456 EA=1EA .00 1 00031110 12.00
SENSI-TOUCH G 12.28 BX=50EA/BX 50 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501380 SENSI-TOUCH GLOVES 71/2 00249 MSG4075Z .2456 EA=1EA .00 1 00031110 12.00
SENSI-TOUCH G 12.28 BX=50EA/BX 50 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501381 SENSI-TOUCH GLOVES 8.0 00249 MSG4080Z .2456 EA=1EA .00 1 00031110 12.00
SENSI-TOUCH G 12.28 BX=50EA/BX 50 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 644
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501201 SHAMPOO 00249 MSC095006 .28 EA=1EA .00 1 00000000 .00
SHAMPOO 26.69 CS=96EA/CS 96 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001336 SHAMPOO CAP 00249 MSC095230 .9678 EA=1EA .00 1 00000000 .00
SHAMPOO CAP 38.71 CS=30EA/CS 40 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001060 SHARP CONT. LAB 00249 KDL31143665 5.0033 EA=1EA .00 1 00000000 .00
SHARP CONT. L 30.02 CS=6EA/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000040 SHARP CONT.17 GAL 00249 KDL8991 13.582 EA=1EA .00 1 00000000 .00
SHARP CONT.17 00062 68-8980C 67.91 CS=5EA/CS 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=41115109 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000041 SHARP CONT.NEEDLE 00249 3.58331E+11 .94 EA=1EA .00 1 00000000 .00
SHARP CONT.NE 75.20 CS=80EA/CS 80 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001034 SHARP CONTAINER HK 00249 BEH175020 113.12 CS=1CS .00 1 00000000 .00
SHARP CONTAIN 113.12 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000645 SHARPIE-BLACK FINE POINT 00499 SAN30001 11.99 EA=1EA .00 1 00000000 .00
SHARPIE-BLACK 11.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000646 SHARPIE-XTRA FINE POINT BL 00499 125443 .8158 EA=1EA .00 1 00000000 .00
SHARPIE-XTRA 9.79 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 645
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501203 SHAVING CREAM 00249 MSC095014 .5314 EA=1EA .00 1 00000000 .00
SHAVING CREAM 76.52 CS=144EA/CS 144 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000582 SHEET PROTECTOR TOP 00499 UNV-21125 13.99 BX=1BX .00 1 00000000 .00
SHEET PROTECT 13.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000306 SHOECOVER 00249 CRI2002 4.82 BX=1BX .00 1 00000000 .00
SHOECOVER 14.46 CS=3BX/CS 3 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500434 SHOULDER BRACE MENS SM 00420 78301 7.32 BX=1BX .00 1 00000000 128.00
SHOULDER BRAC 7.32 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500437 SHOULDER BRACE MENS XL 00249 ORT16100XL 13.71 BX=1BX .00 1 00000000 128.00
SHOULDER BRAC 13.71 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500433 SHOULDER BRACE WOMEN XL 00420 78404 7.24 BX=1BX .00 1 00000000 128.00
SHOULDER BRAC 7.24 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500436 SHOULDER MENS LG 00249 ORT16100L 12.77 BX=1BX .00 1 00000000 128.00
SHOULDER MENS 12.77 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500435 SHOULDER MENS MD 00249 ORT16100M 17.49 BX=1BX .00 1 00000000 128.00
SHOULDER MENS 17.49 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 646
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500432 SHOULDER WOMEN LG 00249 ORT16100L 12.28 BX=1BX .00 1 00000000 128.00
SHOULDER WOME 12.28 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500431 SHOULDER WOMEN MD 00420 78402 9.28 BX=1BX .00 1 00000000 128.00
SHOULDER WOME 9.28 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500430 SHOULDER WOMEN SM 00249 ORT16100S 19.49 BX=1BX .00 1 00000000 128.00
SHOULDER WOME 19.49 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501466 SILVERSORB 1" 00249 MSC9310EP 2.5333 BX=1BX .00 1 00031110 51.00
SILVERSORB 1" 76.00 BX=30EA/BX 30 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1350030 SIMPLE PROCEDURE .00 EA= .00 1 00000000 184.00
SIMPLE PROCED .00 .00 2 00000000 .00
.......... EK(0761) INV.GL= EXP.GL= .00 .00 3 31300013 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2330511 SIMPLE PROCEDURE ER .00 EA= .00 1 00000000 230.00
SIMPLE PROCED .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501458 SINGLE BASIN SET 00249 DYNJ06610A 3.8517 EA=1EA .00 1 00000000 24.00
SINGLE BASIN 23.11 CS=6EA/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500197 SITZ BATH 00249 DYND801020 1.619 EA=1EA .00 1 00000000 90.00
SITZ BATH 16.19 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 647
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500862 SKIN MARKERS 00249 DYNJSM01 .369 EA=1EA .00 1 00000000 20.00
SKIN MARKERS 18.45 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000723 SMALL DISPOS VINYL NASAL M 01304 73312102EA 14.49 EA=1EA .00 1 00000000 44.00
SMALL DISPOS 14.49 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001392 SODIUM CHLORIDE INJECTION 00257 4131118881 312.75 CS=1CS .00 1 00000000 .00
SODIUM CHLORI 312.75 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001501 SODIUM CHLORIDE INJECTION 00257 723306544 .48 EA=1EA .00 1 00000000 .00
SODIUM CHLORI 231.31 CS=480EA/CS 480 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001387 SONY COLOR FILM ACCESS LAB 00085 UPT210BL 260.00 BX=1BX .00 1 00000000 .00
SONY COLOR FI 260.00 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001240 SONY COLOR PRINT 2010 00435 UPC-2010 85.00 BX=1BX .00 1 00000000 .00
SONY COLOR PR 85.00 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001241 SONY COLOR PRINT 5010 00435 UPC-501 140.00 BX=1BX .00 1 00000000 .00
SONY COLOR PR 140.00 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000285 SORBASAN 4X4 00257 202079409218 4.17 EA=1EA .00 1 00000000 25.00
SORBASAN 4X4 41.70 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 648
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000465 SPACELAB PAPER 00249 SHE307438001 1.816 RL=1RL .00 1 00000000 .00
SPACELAB PAPE 18.16 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500182 SPECIMEN CUP STERILE 00249 DYND30330 .113 EA=1EA .00 1 00031110 23.00
SPECIMEN CUP 00084 ST6 11.30 CS=100EA/CS 100 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000174 SPONGE DRAINAGE 4X4 6PLY 00249 NON256000H 2.51 BX=1BX .00 1 00000000 .00
SPONGE DRAINA 2.51 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000177 SPONGES 4X4 NS 00249 PRM21412C 2.823 PK=1PK .00 1 00000000 .00
SPONGES 4X4 N 28.23 CS=10PK/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000632 STAPLE REMOVER 00499 UNV00700 .23 EA=1EA .00 1 00000000 .00
STAPLE REMOVE .23 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500201 STAPLER REM.TRAY 00249 DYNJ04058Z .7683 EA=1EA .00 1 00000000 16.00
STAPLER REM.T 9.22 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000631 STAPLES 00118 UNV79000 1.29 BX=1BX .00 1 00000000 .00
STAPLES 1.29 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001428 STATLOCK PICC PLUS 00257 PIC0220 4.33 EA=1EA .00 1 00000000 .00
STATLOCK PICC 216.73 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 649
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500272 STERI-STRIP .25 00249 NON250114Z .4006 EA=1EA .00 1 00000000 41.00
STERI-STRIP . 20.03 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500273 STERI-STRIP .50 00249 MMMR1547Z .8362 EA=1EA .00 1 00000000 35.00
STERI-STRIP . 41.81 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501260 STERI-STRIPS W8514 (OR) 00249 NON250114Z 1.0708 EA=1EA .00 1 00000000 18.00
STERI-STRIPS 53.54 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500534 STERILE GUIDE 18GA NEEDLES 00249 BAR9001C0212 22.652 EA=1EA .00 1 00000000 144.00
STERILE GUIDE 00043 9001C0212 226.52 BX=10EA/BX 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001400 STERIS HAND SANITIZER 00249 DBU118187 5.3854 EA=1EA .00 1 00000000 .00
STERIS 64.625 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=41115109 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001220 STETHOSCOPE ISOLATION 00249 MDS9543 2.34 EA=1EA .00 1 00000000 .00
STETHOSCOPE I 2.34 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001433 STIFF GUIDE WIRE 00035 GS3508 69.30 EA=1EA .00 1 00000000 .00
STIFF GUIDE W 346.50 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000413 STOCKINETTE 3" 00249 MDT221203 5.49 BX=1BX .00 1 00000000 .00
STOCKINETTE 3 5.49 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 650
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000412 STOCKINETTE 4" 00249 MDT221204 7.18 BX=1BX .00 1 00000000 .00
STOCKINETTE 4 7.18 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001181 STOMADHESIVE POWDER 00257 1638025510 3.20 EA=1EA .00 1 00000000 .00
STOMADHESIVE 3.20 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001180 STOMEHESIVE PASTE 00249 SQU183910 2.07 EA=1EA .00 1 00000000 .00
STOMEHESIVE P 2.07 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000183 STOOL CUPS 00249 DYND30510 .894 PK=1PK .00 1 00000000 .00
STOOL CUPS 22.35 CS=25PK/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500309 STOPCOCK 3-WAY 00249 MDXMX412SL 1.4022 EA=1EA .00 1 00000000 25.00
STOPCOCK 3-WA 70.11 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000586 STRAIGHT CUT END TAB FOLDE 00361 24110 27.99 BX=1BX .00 1 00000000 .00
STRAIGHT CUT 00118 SMD24110 27.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501366 STRAIGHT TYPE BLOOD SET 2C 00793 M46443160 3.5437 EA=1EA .00 1 00000000 110.00
STRAIGHT TYPE 00249 BHL2C8750H 106.31 CS=30EA/CS 30 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000342 STRAWS 00249 NON02325 3.7724 BX=1BX .00 1 00000000 .00
STRAWS 00380 1234 94.31 CS=25BX/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 651
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001340 STYROFOAM CUP 8OZ. 00692 318 17.45 CS=1CS .00 1 00000000 .00
STYROFOAM CUP 17.45 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500084 SUCTION CANNISTER 1200 00249 BXT65651395 1.668 EA=1EA .00 1 00031110 54.00
SUCTION CANNI 50.04 CS=30EA/CS 30 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500077 SUCTION CATH 10FR 00249 DYND41900 .28 EA=1EA .00 1 00031110 18.00
SUCTION CATH 28.47 CS=100EA/CS 100 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500078 SUCTION CATH 12FR 00249 DYND41901H 1.40 EA=1EA .00 1 00031110 18.00
SUCTION CATH 1.40 EA=1EA/EA 1 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500079 SUCTION CATH 14FR 00249 DYND41902H 1.40 EA=1EA .00 1 00031110 18.00
SUCTION CATH 1.40 EA=1EA/EA 1 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500080 SUCTION CATH 16FR 00249 DYND41903 .2242 EA=1EA .00 1 00031110 41.00
SUCTION CATH 22.42 CS=100EA/CS 100 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500081 SUCTION CATH 18FR 00249 DYND40904 .32 EA=1EA .00 1 00031110 18.00
SUCTION CATH 31.90 CS=100EA/CS 100 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500075 SUCTION CATH 6FR 00249 413085370 .58 EA=1EA .00 1 00031110 18.00
SUCTION CATH 58.00 CS=100EA/CS 100 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 652
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500076 SUCTION CATH 8FR 00249 DYND41908H 1.40 EA=1EA .00 1 00031110 18.00
SUCTION CATH 1.40 EA=1EA 1 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500082 SUCTION CATH TRAY 14FR 00249 DYND41442 1.2486 EA=1EA .00 1 00031110 68.00
SUCTION CATH 44.95 CS=36EA/CS 36 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000311 SUR.GLOVES ALOETOUCH 6.0 00249 MDS206060Z .93 EA=1EA .00 1 00000000 .00
SUR.GLOVES AL 46.50 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501397 SURE SEAL 00249 2610085200 11.73 BX=1BX .00 1 00000000 7.00
SURE SEAL 11.73 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000217 SURG.BLADES 10 00257 0723-371110 12.32 BX=1BX .00 1 00000000 .00
SURG.BLADES 1 12.32 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000218 SURG.BLADES 11 00257 0723-371111 13.685 BX=1BX .00 1 00000000 .00
SURG.BLADES 1 13.685 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000220 SURG.BLADES 15 00249 B-D371153Z 15.74 BX=1BX .00 1 00000000 .00
SURG.BLADES 1 15.74 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500316 SURG.GLOVES 81/2 00249 407008327 .89 EA=1EA .00 1 00031110 12.00
SURG.GLOVES 8 44.33 BX=50EA/BX 50 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 653
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500312 SURG.GLOVES ALOE-TOUCH 61/ 00249 MSG1065Z 1.3736 EA=1EA .00 1 00031110 12.00
SURG.GLOVES A 34.34 BX=25EA/BX 25 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500313 SURG.GLOVES ALOETOUCH 7 00249 MSG1070Z 1.4016 EA=1EA .00 1 00031110 12.00
SURG.GLOVES A 35.04 BX=25EA/BX 25 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500314 SURG.GLOVES ALOETOUCH 7.5 00249 MSG1075Z 1.3736 EA=1EA .00 1 00031110 12.00
SURG.GLOVES A 34.34 BX=25EA/BX 25 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500315 SURG.GLOVES ALOETOUCH 8.0 00249 MSG1080Z 1.4016 EA=1EA .00 1 00031110 12.00
SURG.GLOVES A 35.04 BX=25EA/BX 25 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000301 SURG.MASK (BLUE) 00249 NON27376 7.9217 BX=1BX .00 1 00000000 .00
SURG.MASK (BL 47.53 CS=6BX/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000304 SURGEON CAPS 00249 NON28626 7.80 BX=1BX .00 1 00000000 .00
SURGEON CAPS 39.00 CS=5BX/CS 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001520 SURGEON GLOVES LF,PF 7.0 00257 407008514 76.63 BX=1BX .00 1 00000000 .00
SURGEON GLOVE 76.63 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001519 SURGEON GLOVES LF,PF 71/2 00257 407008515 76.63 BX=1BX .00 1 00000000 .00
SURGEON GLOVE 76.63 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 654
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000300 SURGICAL GOWN XL 00249 DYNJP2307P 3.3658 EA=1EA .00 1 00000000 .00
SURGICAL GOWN 80.78 CS=24EA/CS 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500474 SURGICEL 2X3 00249 ETH1953Z 51.2333 EA=1EA .00 1 00000000 79.00
SURGICEL 2X3 614.80 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500473 SURGICEL 4X8 00249 1952 52.14 EA=1EA .00 1 00000000 143.00
SURGICEL 4X8 625.71 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500237 SUSPENSORY LG 00249 IMP091103 4.86 EA=1EA .00 1 00000000 21.00
SUSPENSORY L 4.86 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500236 SUSPENSORY MD 00249 IMP091102 4.86 EA=1EA .00 1 00000000 21.00
SUSPENSORY MD 4.86 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500238 SUSPENSORY XL 00249 723202612 4.36 EA=1EA .00 1 00000000 21.00
SUSPENSORY XL 4.36 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500200 SUTURE REM.TRAY 00249 DYND70900 .8146 EA=1EA .00 1 00000000 36.00
SUTURE REM.TR 40.73 CS=50EA/CS 50 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000036 SYRINGE 10CC 00249 B-D309604 12.975 BX=1BX .00 1 00000000 .00
SYRINGE 10CC 25.95 CS=2BX/CS 2 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 655
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000057 SYRINGE 20CC 00249 SYR120010 35.07 BX=1BX .00 1 00000000 .00
SYRINGE 20CC 00062 68-9661 35.07 CS=4BX/CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000060 SYRINGE 3CC 00249 SYR103010 6.7325 BX=1BX .00 1 00000000 .00
SYRINGE 3CC 00062 68-1610 53.86 CS=8BX/CS 8 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000035 SYRINGE 5CC 00249 SYR105010 8.5575 BX=1BX .00 1 00000000 .00
SYRINGE 5CC 34.23 CS=4BX/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000065 SYRINGE 60CC CT 00249 B-D309620Z 11.89 BX=1BX .00 1 00000000 .00
SYRINGE 60CC 11.89 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000064 SYRINGE 60CC LL 00249 B-D309653Z 11.89 BX=1BX .00 1 00000000 .00
SYRINGE 60CC 11.89 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501068 SYRINGE EAR 2OZ 00249 DYND70280 .4136 EA=1EA .00 1 00000000 11.00
SYRINGE EAR 2 20.68 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001377 SYRINGE PREFILLED NS 3ML 00257 723306544 7.62 BX=1BX .00 1 00000000 .00
SYRINGE PREFI 228.61 CS=30BX/CS 30 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000629 TAPE DISPENSER 00052 MMMC38 4.99 EA=1EA .00 1 00000000 .00
TAPE DISPENSE 00361 649245 4.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 656
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000876 TAPE MICROPORE 00249 NON260001D .4669 EA=1EA .00 1 00000000 .00
TAPE MICROPOR 67.24 CS=144EA/CS 144 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000995 TB MASK 00249 MMM1860 10.485 BX=1BX .00 1 00000000 .00
TB MASK 62.91 CS=6BX/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001300 TB MASK SMALL 00249 MMM1860S 10.485 BX=1BX .00 1 00000000 .00
TB MASK SMALL 62.91 CS=6BX/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001105 TB SYRINGE 00249 B-D305945Z 29.85 BX=1BX .00 1 00000000 .00
TB SYRINGE 29.85 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500992 TEGERDERM IV 00249 MSC2302 .2391 EA=1EA .00 1 00000000 23.00
TEGERDERM IV 23.91 BX=100EA/BX 100 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000117 TELEMETRY POUCH 00249 35960MC500 .79 EA=1EA .00 1 00000000 .00
TELEMETRY POU 39.65 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500289 TELFA 4X8 ADH 00257 3583005111 .55 EA=1EA .00 1 00000000 14.00
TELFA 4X8 AD 27.29 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500288 TELFA 3X4 NON-ADH. 00249 NON25710 1.0762 EA=1EA .00 1 00000000 14.00
TELFA 3X4 NON 53.81 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 657
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500287 TELFA 3X8 NON-ADH 00249 NON25720Z .0912 EA=1EA .00 1 00000000 6.00
TELFA 3X8 NON 4.56 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500533 TEMP SHARP HOLDER 00249 DYNJNDLNEST .643 EA=1EA .00 1 00000000 .00
TEMP SHARP HO 32.15 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000341 TERRI-WIPES 00249 NON260506 2.15 BX=1BX .00 1 00000000 .00
TERRI-WIPES 00062 10-DW501 21.50 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2599999 TEST ITEM 00249 TEST123 8.8878 EA=1 EA .00 1 00000000 .00
TEST ITEM 159.98 CS=18EA/CS 18 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 8.8878 1 .00 3 00000000 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1496372 THERAPEUTIC PROPHYLACTIC INJECTION .00 EA= .00 1 00031110 50.00
THERAPEUTIC P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96372 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2500381 THIGH HIGH LG 00432 204029 8.04 EA=1EA .00 1 00000000 115.00
THIGH HIGH LG 00249 MDS160860 40.20 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500380 THIGH HIGH MED 00249 MDS160844 8.1417 EA=1EA .00 1 00000000 115.00
THIGH HIGH ME 48.85 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 658
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500379 THIGH HIGH SM 00249 MDS160824 9.2567 EA=1EA .00 1 00000000 115.00
THIGH HIGH SM 55.54 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500382 THIGH HIGH XL 00249 MDS160884 9.785 EA=1EA .00 1 00000000 259.00
THIGH HIGH XL 58.71 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2330521 THORACENTESIS FOR ASPIRATION .00 EA= .00 1 00000000 499.00
THORACENTESIS .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 32421 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330522 THORACENTESIS W/WATER SEAL .00 EA= .00 1 00000000 525.00
THORACENTESIS .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300023 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 32422 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2501425 TIP STOPS 00249 GMO114555H 2.48 EA=1EA .00 1 00000000 15.00
TIP STOPS 2.48 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000192 TONGUE BLADE NON 00257 5937W0D3002 3.25 BX=1BX .00 1 00000000 .00
TONGUE BLADE 3.25 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000193 TONGUE BLADE S 00249 MDS202075 1.673 BX=1BX .00 1 00000000 .00
TONGUE BLADE 16.73 CS=1BX/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 659
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501235 TOOTHBRUSHES 00249 MDS136000 .0344 EA=1EA .00 1 00000000 .00
TOOTHBRUSHES 4.95 BX=144BX/BX 144 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501195 TOOTHPASTE 00249 NONTP6IZ .1101 EA=1EA .00 1 00000000 .00
TOOTHPASTE 15.86 CS=144EA/CS 144 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001334 TOURNIQUET 00249 DYND75020 170.30 BX=1BX .00 1 00000000 .00
TOURNIQUET 00462 ML14325 170.30 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500083 TRACH CLEANING TRAY 00249 DYND40589 1.8935 EA=1EA .00 1 00031110 50.00
TRACH CLEANIN 37.87 CS=20EA/CS 20 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000090 TRACH TUBE HOLDER 00249 1821000240 2.77 EA=1EA .00 1 00000000 .00
TRACH TUBE HO 27.65 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000188 TRANSPORE TAPE 1" 00249 MMM15271 6.394 BX=1BX .00 1 00000000 .00
TRANSPORE TAP 63.94 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000189 TRANSPORE TAPE 2" 00249 MMM15272 6.591 BX=1BX .00 1 00000000 .00
TRANSPORE TAP 65.91 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000336 TRASH BAGS 24X33 00249 HTBD4832RC 23.107 CS=1CS .00 1 00000000 .00
TRASH BAGS 24 00380 5595806 23.107 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=41115109 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 660
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90000337 TRASHBAGS 43X48 00249 HTBX7658AK 26.8075 CS=1CS .00 1 00000000 .00
TRASHBAGS 43X 00380 1298845 26.8075 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=41115109 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500044 TRIPLE LUM CATH 20FR. 00035 CDC-45703-P1A 104.87 EA=1EA .00 1 00000000 822.00
TRIPLE LUM CA 00249 ARWDC42703P1A 524.35 CS=5EA/CS 5 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: C1751 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
80000295 TUBING NON-CONDUCTIVE 00249 BXTN7100RL 8.305 BX=1BX .00 1 00000000 .00
TUBING NON-CO 8.305 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501249 TWIN-CATH MULTIPLE -LUMEN 00249 ARWIV01100H 4.17 EA=1EA .00 1 00000000 44.00
TWIN-CATH MUL 4.17 EA=1EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001383 ULTRA SONIC GEL 00249 MDS092010 12.79 EA=1EA .00 1 00000000 .00
ULTRA SONIC G 51.16 CS=4EA/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500986 UNDERPADS 00249 MSC281226 .0967 EA=1EA .00 1 00000000 11.00
UNDERPADS 00074 KC7176 14.50 CS=150EA/CS 150 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501039 UNIVERSAL ARM SLING 00249 ORT11010D 9.4125 EA=1EA .00 1 00000000 65.00
ARM SLING UNI 00432 1796-12-10 37.65 CS=4EA/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 661
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501117 UNNA BOOT (WHITE BOX) 00249 GHFUNNA4H 11.12 BX=1BX .00 1 00000000 98.00
UNNA BOOT (WH 11.12 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500402 UNNA BOOT MEDICO PASTE 00249 4927001053 6.85 BX=1BX .00 1 00000000 98.00
UNNA BOOT MED 68.51 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500999 URETHRAL CATH TRAY 00249 BRD772415 1.2295 EA=1EA .00 1 00031110 110.00
URETHRAL CATH 00062 21-802214 24.59 CS=20EA/CS 20 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500185 URINALS 00249 DYND80235S .3194 EA=1EA .00 1 00000000 14.00
URINALS 00084 910 15.33 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500262 URINE FILTER 00249 2748010713 .08 EA=1EA .00 1 00000000 8.00
URINE FILTER 20.70 BX=250EA/BX 250 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000063 URINE JAR 24HR 00249 DYND80024 .985 EA=1EA .00 1 00000000 .00
URINE JAR 24H 19.70 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500244 URINE TOLET MEASURE 00249 DYND36600 .2354 EA=1EA .00 1 00000000 45.00
URINE TOLET M 23.54 CS=100EA/CS 100 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500291 UROMETER 00249 DYND17403 6.262 EA=1EA .00 1 00000000 212.00
UROMETER 62.62 CS=10EA/CS 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 662
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000023 VAC NEEDLE 21GA 00249 358381-216041 5.55 BX=1BX .00 1 00000000 .00
VAC NEEDLE 21 5.55 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1490471 VACCINE ADMINISTRATION FIRST SHOT .00 EA= .00 1 00000000 49.00
VACCINE ADMIN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90471 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2330506 VACCINE/TOXOID TETANUS .00 EA= .00 1 00000000 76.00
VACCINE/TOXOI .00 .00 2 00000000 .00
.......... EL(0771) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90471 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2501287 VAGINAL PACKING 00249 4684010026 5.05 EA=1EA .00 1 00000000 30.00
VAGINAL PACKI 121.24 CS=24EA/CS 24 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500276 VASELINE GAUZE 3X9 00249 CUR251390Z .3744 EA=1EA .00 1 00000000 12.00
VASELINE GAUZ 18.72 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001338 VASELINE LIP THERAPY 00257 123302831HP .92 EA=1EA .00 1 00000000 .00
VASELINE LIP 22.11 BX=24EA/BX 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000248 VASELINE TUBE 00249 MSC095034 1.8383 EA=1EA .00 1 00000000 .00
VASELINE TUBE 22.06 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 663
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90000744 VENTISURE DIS INFANT RESUS 01304 76750 81.75 EA=1EA .00 1 00000000 221.00
VENTISURE DIS 81.75 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000743 VENTISURE DISP PED RESUS B 01304 3015580EA 32.20 EA=1EA .00 1 00000000 221.00
VENTISURE DIS 32.20 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500153 VEST REST LG 00249 MDT828024 6.4783 EA=1EA .00 1 00031110 99.00
VEST REST LG 38.87 CS=6EA/CS 6 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500152 VEST REST MD 00249 MDT828022 6.4783 EA=1EA .00 1 00000000 99.00
VEST REST MD 38.87 CS=6EA/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500151 VEST REST SM 00249 MDT828020 6.115 EA=1EA .00 1 00031110 99.00
VEST REST SM 36.69 CS=6EA/CS 6 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501290 VEST RESTRAINT XL 00249 52557991628 8.49 EA=1EA .00 1 00000000 99.00
VEST RESTRAIN 84.88 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500253 WAFER 1.50 00249 SQU125258 .901 EA=1EA .00 1 00000000 39.00
WAFER 1.50 9.01 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500254 WAFER 1.75 00249 SQU125259 .901 EA=1EA .00 1 00000000 39.00
WAFER 1.75 9.01 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 664
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500255 WAFER 2.25 00249 1638125260 .908 EA=1EA .00 1 00000000 39.00
WAFER 2.25 00072 125260 9.08 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500256 WAFER 2.75 00249 SQU125261 .901 EA=1EA .00 1 00000000 39.00
WAFER 2.75 00072 125261 9.01 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500252 WAFER SURFIT 1.25 00249 SQU125257 .901 EA=1EA .00 1 00000000 39.00
WAFER SURFIT 9.01 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500890 WALKING BOOT PNEUMATIC LG. 00249 ORT28610L 85.12 BX=1BX .00 1 00000000 344.00
WALKING BOOT 00123 O1F-L 85.12 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500889 WALKING BOOT PNEUMATIC MED 00249 ORT28610M 85.12 BX=1BX .00 1 00000000 344.00
WALKING BOOT 00123 O1F-M 85.12 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500891 WALKING BOOT PNEUMATIC SM. 00249 ORT28610S 66.28 BX=1BX .00 1 00000000 344.00
WALKING BOOT 66.28 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500864 WARMING BLANKETS-ER/ICU 00093 243 7.049 EA=1EA .00 1 00000000 119.00
WARMING BLANK 00249 CSZ82243 70.49 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500863 WARMING BLANKETS-SURGERY 00093 443 9.719 EA=1EA .00 1 00000000 119.00
WARMING BLANK 00249 CSZ82443 97.19 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 665
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90002040 WASTE BAGS 00048 81904 30.69 EA=1EA .00 1 00000000 .00
WASTE BAGS 30.69 EA=1EA 1 .00 2 00000000 .00
.......... 55(0300) INV.GL=41115041 EXP.GL= .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000338 WATER SOLUBLE BG 00249 NON02800 7.405 PK=1PK .00 1 00000000 .00
WATER SOLUBLE 29.62 CS=4PK/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001027 WHITE-OUT 00052 PAP-56401 24.99 EA=1EA .00 1 00000000 .00
WHITE-OUT 00361 131383 24.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500557 WIRE GUIDE 145CM 00264 G09607 44.38 EA=1EA .00 1 00000000 128.00
WIRE GUIDE 14 44.38 EA=1EA/EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000318 WRAP 24 00249 GEM3124 45.00 PK=1PK .00 1 00000000 .00
WRAP 24 45.00 CS=1PK/CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000317 WRAP 36 00249 GEM3136 19.9933 PK=1PK .00 1 00000000 .00
WRAP 36 59.98 CS=3PK/CS 3 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000307 WRAP 54 00249 GEM4154 40.68 PK=1PK .00 1 00000000 .00
WRAP 54 40.68 CS=1PK/PK 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501037 WRIST SPLINT R 00432 1769-02 8.33 EA=1EA .00 1 00000000 92.00
WRIST SPLINT 00249 ORT18000R 8.33 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 666
TIME: 08:24 ITEM MASTER LIST DEPT# 013 OBSERVATION H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501036 WRIST SPLINT COCKUP L 00432 1769-03 8.33 EA=1EA .00 1 00000000 92.00
WRIST SPLINT 00249 ORT18000L 8.33 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500278 XEROFORM 4X4 00249 CUR253440Z .9864 EA=1EA .00 1 00000000 9.00
XEROFORM 4X4 24.66 BX=25EA/BX 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500277 XEROFORM 5X9 00249 CUR253590WZ .729 EA=1EA .00 1 00000000 16.00
XEROFORM 5X9 36.45 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500297 YANK.SUCTION W/TUBING 00249 16080034910 1.41 EA=1EA .00 1 00031110 171.00
YANK.SUCTION 28.11 CS=20EA/CS 20 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500296 YANKAUER SUCTION 00249 DYND50130 .258 EA=1EA .00 1 00031110 171.00
YANKAUER SUCT 12.90 CS=50EA/CS 50 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000359 YELLOW/WHITE CHARGE LABELS 00107 7228 127.60 BX=1BX .00 1 00000000 .00
YELLOW LABLES 127.60 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500391 ZIM-FLEX CAST TAPE 4" 00420 889704 7.78 EA=1EA .00 1 00000000 70.00
ZIM-FLEX CAST 77.77 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 667
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2800006 ADJACENT TISSUE TRANSFER OR REARRANG .00 EA= .00 1 00000000 1467.00
ADJACENT TISS .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 14000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800011 ADJACENT TISSUE TRANSFER OR REARRANG .00 EA= .00 1 00000000 1211.00
ADJACENT TISS .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 14000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410009 ADMIN PNEUMOCOCCAL VACCINE (MEDICARE .00 EA= .00 1 00000000 25.00
ADMIN PNEUMOC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0009 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1415734 ADVANCEMENT FLAPS TRUNK .00 EA= .00 1 00000000 6260.00
ADVANCEMENT F .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 15734 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1427613 ALBUTEROL INHALATION SOLUTION .00 EA= .00 1 00000000 12.00
ALBUTEROL INH .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J7613 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
90009171 ALERE AFINION A1C CTRLS 00146 23046643 63.34 EA=2 PACK .00 1 00000000 .00
A1C CONTROLS 63.34 2 PACK 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=41115014 EXP.GL=41115014 63.34 1 .00 3 00000000 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1495117 ALLERGY MULTIPLE- PROF SVS ALLERGY I .00 EA= .00 1 00000000 42.00
ALLERGY MULTI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 95117 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 668
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1495115 ALLERGY SINGLE- PROFESSIONAL SERVICE .00 EA= .00 1 00000000 28.00
ALLERGY SINGL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 95115 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410438 ANNUAL WELLNESS VISIT INITIAL VISIT .00 EA= .00 1 00000000 468.00
ANNUAL WELLNE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0438 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446600 ANOSCOPY DX W OR W/OUT SPECIMEN COLL .00 EA= .00 1 00000000 204.00
ANOSCOPY DX W .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 46600 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444950 APPENDECTOMY .00 EA= .00 1 00000000 2221.00
APPENDECTOMY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44950 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444960 APPENDECTOMY RUPTURED OPEN .00 EA= .00 1 00000000 2776.00
APPENDECTOMY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44960 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1429130 APPLICATION OF FINGER SPLINT STATIC .00 EA= .00 1 00000000 120.00
APPLICATION O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29130 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1429125 APPLICATION OF SHORT ARM SPLINT (FOR .00 EA= .00 1 00000000 180.00
APPLICATION O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29125 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 669
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1420600 ARTHROCENTESIS ASPIRATION AND/OR INJ .00 EA= .00 1 00000000 168.00
ARTHROCENTESI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20600 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420605 ARTHROCENTESIS ASPIRATION AND/OR INJ .00 EA= .00 1 00000000 174.00
ARTHROCENTESI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20605 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420610 ARTHROCENTESIS ASPIRATION OR INJECTI .00 EA= .00 1 00000000 206.00
ARTHROCENTESI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20610 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1427644 ATROVENT NONCOMPOUNDED UNIT DOSE FOR .00 EA= .00 1 00000000 12.00
ATROVENT NONC .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J7644 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1423420 B-12 INJECTION UP TO 1000 MCG .00 EA= .00 1 00000000 7.50
B-12 INJECTIO .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J3420 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411101 BIOPSY OF SKIN SUBQ (INCLUDING SIMPL .00 EA= .00 1 00000000 87.00
BIOPSY OF SKI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11101 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411100 BIOPSY OF SKIN SUBQ TISSUE (INCLUDIN .00 EA= .00 1 00000000 174.00
BIOPSY OF SKI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11100 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 670
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2800015 BIOPSY OR EXCISION OF LYMPH NODE OPE .00 EA= .00 1 00000000 617.00
BIO EXC LYMPH .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 38500 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499415 BIOPSY SOFT TISSUE OF NECK OR THORAX .00 EA= .00 1 00000000 382.00
BIOPSY SOFT T .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 21550 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800012 BIOPSY SOFT TISSUE OF THIGH OR KNEE .00 EA= .00 1 00000000 430.00
BIOPSY SOFT O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 27323 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1494664 BREATHING TREATMENT-DEMONSTRATION AN .00 EA= .00 1 00000000 69.00
BREATHING TRE .00 .00 2 00000000 .00
.......... 7D(0460) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 94664 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1436556 CENTRAL LINE > 5 YRS .00 EA= .00 1 00031110 659.00
CENTRAL LINE .00 .00 2 00031220 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 36556 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410101 CERVICAL OR VAGINAL CANCER SCRENING .00 EA= .00 1 00000000 119.00
CERVICAL OR V .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0101 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443760 CHANGE OF GASTOSTOMY TUBE PERCUTANIO .00 EA= .00 1 00000000 392.00
CHANGE OF GAS .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43760 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 671
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1417250 CHEMICAL CAUTERIZATION OF GRANULATIO .00 EA= .00 1 00000000 132.00
CHEMICAL CAUT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 17250 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
90009168 CHEMSTRIP 10MD 00146 22208840 27.56 EA= .00 1 00000000 .00
CHEMSTRIP 10M 27.65 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=41115014 EXP.GL=41115014 27.65 1 .00 3 00000000 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90009169 CHEMSTRIP CALIBRATION STRIPS 00146 23307378 39.81 EA= .00 1 00000000 .00
CHEMSTRIP CAL 39.81 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=41115014 EXP.GL=41115014 39.81 1 .00 3 00000000 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1447562 CHOLECYSTECTOMY LAPARASCOPIC .00 EA= .00 1 00000000 3123.00
CHOLECYSTECTO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 47562 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1447600 CHOLECYSTECTOMY OPEN .00 EA= .00 1 00000000 3123.00
CHOLECYSTECTO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 47600 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1447563 CHOLECYSTECTOMY W/ CHOLANGIOGRAM .00 EA= .00 1 00000000 3331.00
CHOLECYSTECTO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 47563 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1447605 CHOLECYSTECTOMY W/ CHOLANGIOGRAPHY .00 EA= .00 1 00000000 3331.00
CHOLECYSTECTO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 47605 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 672
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1444626 CLOSURE OF ENTEROSTOMY W/ RESECTION .00 EA= .00 1 00000000 3715.00
CLOSURE OF EN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 44626 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444140 COLECTOMY PARTIAL .00 EA= .00 1 00000000 4413.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44140 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444204 COLECTOMY PARTIAL W/ ANASTOMOSIS .00 EA= .00 1 00000000 4877.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44204 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444207 COLECTOMY PARTIAL W/ ANASTOMOSIS W/ .00 EA= .00 1 00000000 6037.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44207 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444208 COLECTOMY PARTIAL W/ ANASTOMOSIS W/ .00 EA= .00 1 00000000 6271.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44208 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444146 COLECTOMY PARTIAL W/ COLOPROCTOSTOMY .00 EA= .00 1 00000000 6921.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44146 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444143 COLECTOMY PARTIAL W/ END COLOSTOMY A .00 EA= .00 1 00000000 4503.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44143 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 673
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1444160 COLECTOMY PARTIAL W/ REMOVAL OF TERM .00 EA= .00 1 00000000 4181.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44160 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444205 COLECTOMY PARTIAL W/REMOVAL TERMINAL .00 EA= .00 1 00000000 4645.00
COLECTOMY PAR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44205 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444211 COLECTOMY TOTAL ABDOMINAL W/ PROCTEC .00 EA= .00 1 00000000 8129.00
COLECTOMY TOT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44211 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445378 COLONOSCOPY .00 EA= .00 1 00000000 1049.00
COLONOSCOPY .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
------------------------------------------------------------------------------------------------------------------------------------
1445383 COLONOSCOPY FLEXIBLE TO SPLENIC FLEX .00 EA= .00 1 00000000 1424.00
COLONOSCOPY F .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 45383 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445382 COLONOSCOPY FLEXIBLE W/ CONTROL OF B .00 EA= .00 1 00000000 1340.00
COLONOSCOPY F .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 45382 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444394 COLONOSCOPY THROUGH STOMA W/ REMOVAL .00 EA= .00 1 00000000 1693.00
COLONOSCOPY T .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 44394 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 674
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1413132 COLONOSCOPY W/ BIOPSY .00 EA= .00 1 00000000 1591.00
COLONOSCOPY W .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 13132 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445380 COLONOSCOPY W/ BIOPSY .00 EA= .00 1 00000000 1154.00
COLONOSCOPY W .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 45380 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445386 COLONOSCOPY W/ DILATION BY BALLOON 1 .00 EA= .00 1 00000000 1165.00
COLONOSCOPY W .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 45386 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445381 COLONOSCOPY W/ DIRECTED SUBMUCOSAL I .00 EA= .00 1 00000000 1300.00
COLONOSCOPY W .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 45381 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445384 COLONOSCOPY W/BIOPSY BY HOT BIOSPY F .00 EA= .00 1 00000000 1486.00
COLONOSCOPY W .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 45384 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445385 COLONOSCOPY W/BIOPSY SNARE .00 EA= .00 1 00000000 1486.00
COLONOSCOPY W .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 45385 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410122 COLORECTAL CANCER SCREENING COLONOSC .00 EA= .00 1 00000000 1105.00
COLORECTAL CA .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0121 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 675
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1410328 COLORECTAL SCREENING WELCOME TO MEDI .00 EA= .00 1 00000000 80.00
COLORECTAL SC .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0328 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499394 COMPREHENSIVE PHYSICAL 12-17 .00 EA= .00 1 00000000 175.00
COMPREHENSIVE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99394 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499395 COMPREHENSIVE PHYSICAL 18-39 .00 EA= .00 1 00000000 236.00
COMPREHENSIVE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99395 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499396 COMPREHENSIVE PHYSICAL 40-64 YRS .00 EA= .00 1 00000000 258.00
COMPREHENSIVE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99396 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499397 COMPREHENSIVE PHYSICAL >65 .00 EA= .00 1 00000000 292.00
COMPREHENSIVE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99397 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
80001705 COVIDIEN PROBE COVER 00249 KDL500500 .6408 BX=1B .00 1 00000000 .00
COVIDIEN PROB 16.02 BX=25/BX 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .6408 1 .00 3 00000000 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1499292 CRITICAL CARE EVAL/MGT EA ADDITIONAL .00 EA= .00 1 00031110 302.00
CRITICAL CARE .00 .00 2 00031220 .00
SERVICE .......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99292 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 676
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499291 CRITICAL CARE EVAL/MGT FIRST 30-74 M .00 EA= .00 1 00031110 604.00
CRITICAL CARE .00 .00 2 00031220 .00
SERVICE .......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99291 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1417340 CRYO SURGERY-ACNE .00 EA= .00 1 00000000 104.00
CRYO SURGERY- .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 17340 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
4187086 CULTURE BACTERIAL QUANTATIVE COLONY .00 EA= .00 1 00000000 66.00
CULTURE BACTE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 87086 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411044 DEBRIDEMENT BONE FIRS 20 SQ CM OR LE .00 EA= .00 1 00000000 828.00
DEBRIDEMENT B .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 11044 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411043 DEBRIDEMENT MUSCLE AND/OR FASCIA FIR .00 EA= .00 1 00000000 497.00
DEBRIDEMENT M .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 11043 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411000 DEBRIDEMENT OF EXTENSIVE EZCEMATOUS .00 EA= .00 1 00000000 200.00
DEBRIDEMENT O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 11000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411720 DEBRIDEMENT OF NAIL 1 TO 5 .00 EA= .00 1 00000000 92.00
DEBRIDEMENT O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11720 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 677
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1411721 DEBRIDEMENT OF NAILS BY ANY METHOD 6 .00 EA= .00 1 00000000 125.00
DEBRIDEMENT O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11721 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411040 DEBRIDEMENT SKIN-PARTIAL THICKNESS .00 EA= .00 1 00000000 150.00
DEBRIDEMENT S .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 11040 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411042 DEBRIDEMENT SUBCUTANEOUS TISSUE FIRS .00 EA= .00 1 00000000 232.00
DEBRIDEMENT S .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 11042 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1429590 DENIS-BROWNE SPLNT-LEG SPLINT .00 EA= .00 1 00000000 145.00
DENIS-BROWNE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29590 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446924 DESTR OF LES ANUS EXTENSIVE (EX LASE .00 EA= .00 1 00000000 2013.00
DESTR OF LES .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 46924 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1417280 DESTRUCTION MALIGNANT LESION .00 EA= .00 1 00000000 287.00
DESTRUCTION M .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 17280 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1417260 DESTRUCTION MALIGNANT LESION < .5 CM .00 EA= .00 1 00000000 211.00
DESTRUCTION M .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 17260 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 678
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1417263 DESTRUCTION MALIGNANT LESION TRUNK/A .00 EA= .00 1 00000000 313.00
DESTRUCTION M .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 17263 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446900 DESTRUCTION OF LESION ANUS SIMPLE CH .00 EA= .00 1 00000000 607.00
DESTRUCTION O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 46900 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446922 DESTRUCTION OF LESION ANUS SIMPLE SU .00 EA= .00 1 00000000 1087.00
DESTRUCTION O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 46922 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1417000 DESTRUCTION PRMLGNT LESION (ACTINIC .00 EA= .00 1 00000000 183.00
DESTRUCTION P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 17000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1417003 DESTRUCTION PRMLGNT LESION 2-14 EACH .00 EA= .00 1 00000000 41.00
DESTRUCTION P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 17003 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443450 DILATION OF ESOPHAGUS BY UNGUIDED SO .00 EA= .00 1 00000000 284.00
DILATION OF E .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43450 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490702 DIPHTERIA TETANUS TOXOIDS (DT) ADM T .00 EA= .00 1 00000000 45.00
DIPHTERIA TET .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90702 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 679
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1490700 DIPHTHERIA TETANUS TOXOIDS/PERTUSSIS .00 EA= .00 1 00000000 56.00
DIPHTHERIA TE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90700 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499419 DRAINAGE OF PERITIONEAL ABSCESS OR L .00 EA= .00 1 00000000 3897.00
DRAINAGE OF P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 49020 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800008 DRESSINGS AND OR DEBRIEDEMENT OR PAR .00 EA= .00 1 00000000 192.00
DRESSINGS AND .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 16020 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
4199000 DRUG SCREEN HANDLING FEE .00 EA= .00 1 00000000 21.00
DRUG SCREEN H .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1469210 EAR IRRIGATION (RMVL IMPACTED WAX) .00 EA= .00 1 00000000 127.00
EAR IRRIGATIO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 69210 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1493010 ECG ROUTINE INTERPRETATION AND REPOR .00 EA= .00 1 00000000 48.00
ECG ROUTINE I .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 93010 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499071 EDUCATIONAL SUPPLIES AND HANDOUTS .00 EA= .00 1 00000000 .00
EDUCATIONAL S .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99071 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 680
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1443235 EGD UPPER GASTROINESTINAL EDOSCOPY D .00 EA= .00 1 00000000 779.00
EGD UPPER GAS .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43235 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443244 EGD WITH BAND LIGATION OF ESOPHAGEAL .00 EA= .00 1 00000000 1156.00
EGD WITH BAND .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43244 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443239 EGD WITH BIOPSY UPPER GASTROINTESTIN .00 EA= .00 1 00000000 903.00
EGD WITH BIOP .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43239 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443255 EGD WITH CONTROL OF BLEEDING ANY MET .00 EA= .00 1 00000000 1190.00
EGD WITH CONT .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43255 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443246 EGD WITH PEG TUBE PLACEMENT .00 EA= .00 1 00000000 1558.00
EGD WITH PEG .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43246 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410405 EKG ROUNTINE INTERPRET/REPORT SCREEN .00 EA= .00 1 00000000 57.00
EKG ROUNTINE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0405 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410403 EKG WELCOME TO MEDICARE PHYSICAL .00 EA= .00 1 00000000 57.00
EKG WELCOME T .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0403 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 681
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1493005 EKG WITH 12 LEADS WITHOUT REPORT AND .00 EA= .00 1 00000000 47.00
EKG WITH 12 L .00 .00 2 00000000 .00
.......... CY(0000) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 93005 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1493000 EKG-ECG ROUTINE ECG W/AT LEAST 12 LD .00 EA= .00 1 00000000 101.00
EKG-ECG ROUTI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 93000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499285 EMERGENCY ROOM VISIT HIGH COMPLEXITY .00 EA= .00 1 00000000 702.00
EMERGENCY ROO .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99285 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499284 EMERGENCY ROOM VISIT MEDIUM COMPLEXI .00 EA= .00 1 00000000 470.00
EMERGENCY ROO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99284 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499283 EMERGENCY ROOM VISIT MINIMUM COMPLEX .00 EA= .00 1 00000000 315.00
EMERGENCY ROO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99283 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800003 ENTERECTOMY, RESECTION OR SMALL INTE .00 EA= .00 1 00000000 4204.00
ENTERECTOMY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 44120 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499409 ENTEROLYSIS FREEING OF INTESTINAL AD .00 EA= .00 1 00000000 2681.00
ENTEROLYSIS .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44005 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 682
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2800007 ESCHAROTOMY INITAL INCISION .00 EA= .00 1 00000000 494.00
ESCHOROTOMY I .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 16035 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499211 ESTABLISHED PT LEVEL 1 (5 MINS-NURSE .00 EA= .00 1 00000000 61.00
ESTABLISHED P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99211 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499212 ESTABLISHED PT LEVEL 2 (10 MINS) .00 EA= .00 1 00000000 86.00
ESTABLISHED P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99212 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499213 ESTABLISHED PT LEVEL 3 (15 MINS) .00 EA= .00 1 00031110 110.00
ESTABLISHED P .00 .00 2 00031220 .00
SERVICE .......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99213 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499214 ESTABLISHED PT LEVEL 4 (25 MINS) .00 EA= .00 1 00000000 160.00
ESTABLISHED P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99214 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499215 ESTABLISHED PT LEVEL 5 (40 MINS) .00 EA= .00 1 00000000 256.00
ESTABLISHED P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99215 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411740 EVACUATION OF SUBUNGUAL HEMATOMA .00 EA= .00 1 00000000 153.00
EVACUATION OF .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11740 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 683
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1411402 EXC B9 LES MRGN XCP SKT 1.1-2.0CM .00 EA= .00 1 00000000 364.00
EXC B9 LES MR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11402 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411403 EXC B9 LESIO MRGN 2.1-3.0 CM .00 EA= .00 1 00000000 467.00
EXC B9 LESIO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11403 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411400 EXC B9 LESION SCP SK TGS .5 CM< .00 EA= .00 1 00000000 239.00
EXC B9 LESION .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11400 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411422 EXC BENIGN LESION SCALP/NECK/HANDS/F .00 EA= .00 1 00000000 387.00
EXC BENIGN LE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11422 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411401 EXC BENIGN LESION TRUNK/ARMS/LESGS 0 .00 EA= .00 1 00000000 285.00
EXC BENIGN LE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11401 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411606 EXC MAL LES W/MRGN T/A/L > 4.0 CM .00 EA= .00 1 00000000 852.00
EXC MAL LES W .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11606 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411621 EXC MALIGNANT LESION .5/CM .00 EA= .00 1 00000000 426.00
EXC MALIGNANT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11621 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 684
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1411623 EXC MALIGNANT LESION 2.1 TO 3.0 CM S .00 EA= .00 1 00000000 639.00
EXC MALIGNANT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11623 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411600 EXC MALIGNANT LESION TRUNK/ARMS/LEGS .00 EA= .00 1 00000000 391.00
EXC MALIGNANT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11600 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411440 EXC OTHER BENIGN LESION INCL MARGINS .00 EA= .00 1 00000000 285.00
EXC OTHER BEN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11440 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499416 EXCISION BENIGN LESION INCLUDING MAR .00 EA= .00 1 00000000 266.00
EXCISION BENI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 11421 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800005 EXCISION MALIGNANT LESION INCLUDING .00 EA= .00 1 00000000 423.00
EXCISION MALI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11640 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1419125 EXCISION OF BREAST LESION .00 EA= .00 1 00000000 1550.00
EXCISION OF B .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 19125 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1419120 EXCISION OF CYST OF BREAST .00 EA= .00 1 00000000 1292.00
EXCISION OF C .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 19120 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 685
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1425111 EXCISION OF GANGLION CYST WRIST .00 EA= .00 1 00000000 1427.00
EXCISION OF G .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 25111 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499412 EXCISION OF LESION OF TENDON SHEATH .00 EA= .00 1 00000000 892.00
EXCISION OF L .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 27630 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411750 EXCISION OF NAIL AND NAIL MATRIX PAR .00 EA= .00 1 00000000 690.00
EXCISION OF N .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11750 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411772 EXCISION OF PILONIDAL CYST COMPLICAT .00 EA= .00 1 00000000 2023.00
EXCISION OF P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11772 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445171 EXCISION OF RECTAL TUMOR TRANSANAL A .00 EA= .00 1 00000000 2418.00
EXCISION OF R .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45171 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800010 EXCISION OF SKIN AND SUBCUTANEOUS TI .00 EA= .00 1 00000000 679.00
EXCISION OF S .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11470 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446320 EXCISION OF THROMBOSED HEMORRHOID EX .00 EA= .00 1 00000000 455.00
EXCISION OF T .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 46320 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 686
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499417 EXCISION OR DESTRUCTION OPEN INTRA A .00 EA= .00 1 00000000 2936.00
EXCISION OR D .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 49203 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1421930 EXCISION TUMOR SOFT TISSU OF BACK .00 EA= .00 1 00000000 1595.00
EXC TUM BACK .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 21930 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800014 EXCISION TUMOR SOFT TISSUE OF FACE S .00 EA= .00 1 00000000 1268.00
EXC TUM 2MM .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 21014 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499414 EXCISION TUMOR SOFT TISSUE OF PELVIS .00 EA= .00 1 00000000 1480.00
EXCISION TUMO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 27048 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800009 EXCISION TUMOR SOFT TISSUE OF SHOULD .00 EA= .00 1 00000000 1013.00
EXCISION TUMO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 23071 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1424075 EXCISION TUMOR SOFT TISSUE OF UPPER .00 EA= .00 1 00000000 1759.00
EXC TUM UP AR .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 24075 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
4180050 EXECUTIVE PROFILE .00 EA= .00 1 00000000 120.00
EXECUTIVE PRO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 80050 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 687
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2800004 EXPLORATORY LAPAROTOMY EXPLORATORY C .00 EA= .00 1 00000000 2640.00
EXPLORATORY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 49000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446200 FISSURECTOMY INCLUDING SPHINCTEROTOM .00 EA= .00 1 00000000 1275.00
FISSURECTOMY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 46200 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445331 FLEX SIGMOID WITH BIOPSY SINGLE OR M .00 EA= .00 1 00000000 480.00
FLEX SIGMOID .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45331 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
90009044 FMC GLUCOSE 201 HI/LO CONTROLS 00448 227033 41.45 BX=1 BX .00 1 00000000 .00
FMC GLU HI/LO 41.45 BX=2/BX 1 .00 2 00000000 .00
.......... 55(0300) INV.GL=41115014 EXP.GL= 41.45 1 .00 3 00000000 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90009040 FMC GLUCOSE 201 MICROCUVETTE 4/25 00249 HMQ110706 211.70 BX=1 BX .00 1 00000000 .00
FMC GLUCOSE 2 00146 22 601 004 211.70 BX=1 BX 4X25 1 .00 2 00000000 .00
.......... 55(0300) INV.GL=41115014 EXP.GL= 211.70 1 .00 3 00000000 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90009039 FMC PREG TEST HCG URINE 00448 101 72.40 BX=1 BX .00 1 00000000 .00
FMC PREG TEST 00249 OSOM101 72.40 BX=1 BX 1 .00 2 00000000 .00
.......... 55(0300) INV.GL=41115014 EXP.GL= 72.40 1 .00 3 00000000 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1490649 GARDASIL HPV VACCINE .00 EA= .00 1 00000000 282.00
GARDASIL HPV .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90649 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 688
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90002389 GEN CHEM LINEARITY SET 00693 22157101 259.25 EA=1EA .00 1 00000000 .00
GEN CHEM LINE 259.25 KT=1EA/KT 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1491110 GI TRACT IMAGING INTRALUMAL ESOPH TH .00 EA= .00 1 00000000 2107.00
GI TRACT IMAG .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 91110 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
4182948 GLUCOMETER STRIP .00 EA= .00 1 00000000 20.00
GLUCOMETER .00 .00 2 00000000 .00
....T....R 43(0270) INV.GL= EXP.GL= .00 .00 3 31300041 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY:N AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 82948 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490470 H1N1 VACCINATION .00 EA= .00 1 00000000 49.00
H1N1 VACCINAT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90470 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1419141 H1N1 VACCINATION ADMINISTRATION .00 EA= .00 1 00000000 25.00
H1N1 VACCINAT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G9141 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1492552 HEARING TEST-PURE TONE ADIOMETRY AIR .00 EA= .00 1 00000000 49.00
HEARING TEST- .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 92552 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
90002376 HEMOPOINT H2 NXT CUVET 00495 SB 3015-100 110.00 EA=1EA .00 1 00000000 .00
HEMOPOINT H2 110.00 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 689
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90002388 HEMOPOINT H2 NXT CUVET 00495 SB 3015-200 215.00 EA=1EA .00 1 00000000 .00
HEMOPOINT H2 215.00 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90002377 HEMOPOINT H2 OPTICS CLEANE 00495 SB 3050-003 34.00 EA=1EA .00 1 00000000 .00
HEMOPOINT H2 34.00 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1446221 HEMORRHOIDECTOMY INTERNAL BY RUBBER .00 EA= .00 1 00000000 546.00
HEMORRHOIDECT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 46221 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446947 HEMORRHOIDOPEXY BY STAPLING .00 EA= .00 1 00000000 1214.00
HEMORRHOIDOPE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 46947 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446260 HEMORROIDECTOMY COMPLEX .00 EA= .00 1 00000000 2276.00
HEMORROIDECTO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 46260 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1493233 HOLTER MONITOR .00 EA= .00 1 00000000 172.00
HOLTER MONITO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 93233 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499341 HOME VISIT INITIAL VISIT .00 EA= .00 1 00000000 197.00
HOME VISIT IN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99341 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 690
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499239 HOSPITAL DISCHARGE > 30 MINS .00 EA= .00 1 00000000 180.00
HOSPITAL DISC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300020 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99239 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499238 HOSPITAL DISCHARGE DAY MNGMT <30 MIN .00 EA= .00 1 00000000 144.00
HOSPITAL DISC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300020 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99238 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
90002390 HSCRP LIN SET 00693 22157105 259.25 EA=1EA .00 1 00000000 .00
HSCRP LIN SET 259.25 KT=1EA/KT 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1410180 I & D COMPLEX POST OP WOUND INFECTIO .00 EA= .00 1 00000000 592.00
I & D COMPLEX .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10180 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410140 I & D OF HEMATOMA SEROMA OR FLUID CO .00 EA= .00 1 00000000 335.00
I & D OF HEMA .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10140 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410081 I & D OF PILONIDAL CYST COMPLICATED .00 EA= .00 1 00000000 619.00
I & D OF PILO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10081 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410080 I & D OF PILONIDAL CYST SIMPLE .00 EA= .00 1 00000000 347.00
I & D OF PILO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10080 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 691
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1456405 I & D OF VULVA AND PERINEAL ABSCESS .00 EA= .00 1 00000000 424.00
I & D OF VULV .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 56405 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410061 I&D COMPLICATED OR MULTIPLE .00 EA= .00 1 00000000 523.00
I&D COMPLICAT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10061 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410060 I&D SIMPLE OR SINGLE .00 EA= .00 1 00000000 261.00
I&D SIMPLE OR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10060 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490460 IMMUNIZATION ADMINISTRATION THROUGH .00 EA= .00 1 00000000 49.00
IMMUNIZATION .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90460 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1449568 IMPLANTATION OF MESH/W INCISIONAL HE .00 EA= .00 1 00000000 876.00
IMPLANTATION .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 49568 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1449587 INCARCERATED UMBILICAL HERNIA .00 EA= .00 1 00000000 2103.00
INCARCERATED .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 49587 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800013 INCESION AND DRAINAGE SHOULDER AREA .00 EA= .00 1 00000000 865.00
INCESION AND .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 23030 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 692
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1446040 INCISION AND DRAINAGE OF ISCHIORECTA .00 EA= .00 1 00000000 2015.00
INCISION AND .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 46040 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800001 INCISION AND DRAINAGE OF SUBMUCOSAL .00 EA= .00 1 00000000 531.00
INC AND DRAIN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45005 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2800002 INCISION AND DRAINAGE SHOULDER AREA .00 EA= .00 1 00000000 865.00
INC AND DRAIN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 10121 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410121 INCISION AND REMOVAL OF FOREIGN BODY .00 EA= .00 1 00000000 712.00
INCISION AND .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10121 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410120 INCISION AND REMOVAL OF FOREIGN BODY .00 EA= .00 1 00000000 311.00
INCISION AND .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 10120 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446083 INCISION OF THROMBOSED HEMORRHOID EX .00 EA= .00 1 00000000 351.00
INCISION OF T .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 46083 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
4187804 INFECTIOUS AGENT ANTIGEN DETECTION I .00 EA= .00 1 00000000 59.00
INFECTIOUS AG .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 87804 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 693
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1410008 INFLUENZA ADMINISTRATION (MEDICARE O .00 EA= .00 1 00000000 25.00
INFLUENZA ADM .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0008 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1402038 INFLUENZA VACCINE 3 YEARS AND OLDER .00 EA= .00 1 00000000 34.00
INFLUENZA VAC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: Q2038 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490658 INFLUENZA VACCINE AGE 3 YRS + .00 EA= .00 1 00000000 34.00
INFLUENZA VAC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90658 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490656 INFLUENZA VACCINE PRESERVATIVE FREE .00 EA= .00 1 00000000 33.00
INFLUENZA VAC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90656 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490662 INFLUENZA VIRUS VACCINE SPLIT VIRUS .00 EA= .00 1 00000000 80.00
INFLUENZA VIR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90662 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499382 INITIAL COMPREH PHYSICAL AGE 1 TO 4 .00 EA= .00 1 00000000 183.00
INITIAL COMPR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99382 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499384 INITIAL COMPREHENSIVE PHYSICAL 12-17 .00 EA= .00 1 00000000 210.00
INITIAL COMPR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99384 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 694
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499386 INITIAL COMPREHENSIVE PHYSICAL 40-64 .00 EA= .00 1 00000000 310.00
INITIAL COMPR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99386 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499387 INITIAL COMPREHENSIVE PHYSICAL > 65 .00 EA= .00 1 00000000 349.00
INITIAL COMPR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99387 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499383 INITIAL COMPREHENSIVE PHYSICAL AGE 5 .00 EA= .00 1 00000000 196.00
INITIAL COMPR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99383 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499381 INITIAL COMPREHENSIVE PHYSICAL- UNDE .00 EA= .00 1 00000000 170.00
INITIAL COMPR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99381 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499385 INITIAL COMPREHENSIVE PREVENTIVE PHY .00 EA= .00 1 00000000 284.00
INITIAL COMPR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99385 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499222 INITIAL HOSPITAL CARE 50 MINS .00 EA= .00 1 00000000 252.00
INITIAL HOSPI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99222 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499223 INITIAL HOSPITAL CARE HIGH COMPLEXIT .00 EA= .00 1 00000000 380.00
INITIAL HOSPI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99223 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 695
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499221 INITIAL HOSPITAL CARE PER DAY 30 MIN .00 EA= .00 1 00000000 187.00
INITIAL HOSPI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99221 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499303 INITIAL NURSING FACILITY CARE 25 MIN .00 EA= .00 1 00000000 216.00
INITIAL NURSI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99304SW FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499304 INITIAL NURSING FACILITY CARE 25 MIN .00 EA= .00 1 00000000 216.00
INITIAL NURSI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99304 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499305 INITIAL NURSING FACILITY PER DAY 35 .00 EA= .00 1 00000000 303.00
INITIAL NURSI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99305 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499311 INITIAL NURSING FACILITY PER DAY 35 .00 EA= .00 1 00000000 303.00
INITIAL NURSI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99305SW FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499306 INITIAL NURSING FACILITY PER DAY 45 .00 EA= .00 1 00000000 368.00
INITIAL NURSI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300020 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99306 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499312 INITIAL NURSING FACILITY PER DAY 45 .00 EA= .00 1 00000000 368.00
INITIAL NURSI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99306SW FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 696
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499218 INITIAL OBSERVATION CARE LOW SEVERIT .00 EA= .00 1 00000000 168.00
INITIAL OBSER .00 .00 2 00000000 .00
.......... EJ(0762) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99218 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499219 INITIAL OBSERVATION CARE MODERATE SE .00 EA= .00 1 00000000 229.00
INITIAL OBSER .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99219 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499220 INITIAL OBSERVATION CARE PER DAY .00 EA= .00 1 00000000 287.00
INITIAL OBSER .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99220 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410402 INITIAL PREVENTATIVE PHYSICAL WELCOM .00 EA= .00 1 00000000 399.00
INITIAL PREVE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0402 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420550 INJ SINGLE TENDON SHEATH OR LIGAMENT .00 EA= .00 1 00000000 163.00
INJ SINGLE TE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20550 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420553 INJECT SINGLE/MULTIPLE TRIGGER POINT .00 EA= .00 1 00000000 198.00
INJECT SINGLE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20553 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420170 INJECTION ADRENALINE UP TO 1 ML AMPU .00 EA= .00 1 00000000 3.00
INJECTION ADR .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J0170 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 697
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1464413 INJECTION ANESTHETIC AGENT CERVICAL .00 EA= .00 1 00000000 649.00
INJECTION ANE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 64413 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1464412 INJECTION ANESTHETIC AGENT SPINAL AC .00 EA= .00 1 00000000 731.00
INJECTION ANE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 64412 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420702 INJECTION BETAMETHASONE SODIUM PHOSP .00 EA= .00 1 00000000 4.00
INJECTION BET .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J0702 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420704 INJECTION BETAMETHASONE SODIUM PHOSP .00 EA= .00 1 00000000 4.00
INJECTION BET .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J0704 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1421100 INJECTION DECADRON 1 MG .00 EA= .00 1 00000000 30.00
INJECTION DEC .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J1100 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1421000 INJECTION DEPO-ESTRADIOL UP TO 5MG .00 EA= .00 1 00000000 24.00
INJECTION DEP .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J1000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1421200 INJECTION DIPHENHYDRAMINE HCI UP TO .00 EA= .00 1 00000000 3.00
INJECTION DIP .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J1200 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 698
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1423410 INJECTION HYDROXYZINE HCL VISTARIL U .00 EA= .00 1 00000000 4.00
INJECTION HYD .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J3410 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1422001 INJECTION LIDOCAINE FOR INTRAVENOUS .00 EA= .00 1 00000000 50.00
INJECTION LID .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J2001 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1421055 INJECTION MEDROXYPROGESTERONE ACETAT .00 EA= .00 1 00000000 88.00
INJECTION MED .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J1055 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1422175 INJECTION MEPERIDINE PER 100 MG .00 EA= .00 1 00000000 7.00
INJECTION MEP .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J2175 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1421030 INJECTION METHYLPREDISOLONE ACETATE .00 EA= .00 1 00000000 12.00
INJECTION MET .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J1030 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1422300 INJECTION NALBUPHINE PER 10 MG .00 EA= .00 1 00000000 4.00
INJECTION NAL .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J2300 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1422550 INJECTION PHENERGEN PER 50 MG .00 EA= .00 1 00000000 6.00
INJECTION PHE .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J2550 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 699
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1421070 INJECTION TESTOSERONE CYPIONATE UP T .00 EA= .00 1 00000000 13.00
INJECTION TES .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J1070 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1421060 INJECTION TESTOSTERONE CYPIONATE AND .00 EA= .00 1 00000000 25.00
INJECTION TES .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J1060 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420526 INJECTION THERAPEUTIC CARPAL TUNNEL .00 EA= .00 1 00000000 219.00
INJECTION THE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20526 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420551 INJECTION(S) SINGLE TENDON ORIGIN/IN .00 EA= .00 1 00000000 168.00
INJECTION(S) .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20551 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499254 INPATIENT CONSULT COMPREHENSIVE .00 EA= .00 1 00000000 358.00
INPATIENT CON .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99254 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499253 INPATIENT CONSULT DETAILED .00 EA= .00 1 00000000 286.00
INPATIENT CON .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99253 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499252 INPATIENT CONSULT EXPANDED PROBLEM .00 EA= .00 1 00000000 232.00
INPATIENT CON .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99252 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 700
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499255 INPATIENT CONSULT HIGH COMPLEXITY .00 EA= .00 1 00000000 450.00
INPATIENT CON .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99255 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499251 INPATIENT CONSULT PROBLEM FOCUSED .00 EA= .00 1 00000000 153.00
INPATIENT CON .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99251 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
90002384 INRATIO PT TEST STRIPS 00448 100139 196.00 BX=1BX .00 1 00000000 .00
INRATIO PT TE 196.00 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1493503 INSERTION AND PLACEMENT OF FLOW DIRE .00 EA= .00 1 00000000 707.00
INSERTION AND .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 93503 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1436558 INSERTION GROSHON/HICKMAN CENTRAL LI .00 EA= .00 1 00000000 2268.00
INSERTION GRO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36558 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1436561 INSERTION TUNNELED CENTRAL LINE/PORT .00 EA= .00 1 00000000 2062.00
INSERTION TUN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36561 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1474360 INTRALUM DILAT STRICTURES AND/OR OBS .00 EA= .00 1 00000000 203.00
INTRALUM DILA .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 74360 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 701
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1431500 INTUBATION ENDOTRACHEAL ER PROCEDURE .00 EA= .00 1 00000000 513.00
INTUBATION EN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 31500 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1423301 KENALOG INJECTION .00 EA= .00 1 00000000 6.00
KENALOG INJEC .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J3301 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1478708 KIDNEY IMAGING SINGLE STUDY WITH PHA .00 EA= .00 1 00000000 1064.00
KIDNEY IMAGIN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 78708 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444970 LAPARASCOPIC APPENDECTOMY .00 EA= .00 1 00000000 2721.00
LAPARASCOPIC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44970 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499407 LAPAROSCOPY SURG WITH REMOVAL OF ADN .00 EA= .00 1 00000000 1612.00
LAPARO SURG W .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 58661 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444213 LAPAROSCOPY SURGICAL MOBILIZATION WI .00 EA= .00 1 00000000 696.00
LAPAROSCOPY S .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 44213 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1427614 LEVALBUTEROL INHAL SOL NONCOMPOUNDED .00 EA= .00 1 00000000 12.00
LEVALBUTEROL .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J7614 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 702
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1464445 LUMBAR INJECTION ANESTHETIC AGEN SCI .00 EA= .00 1 00000000 649.00
LUMBAR INJECT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 64445 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499411 LYSIS OF ADHESIONS SALPINGOLYSIS OVA .00 EA= .00 1 00000000 2181.00
LYSIS OF ADHE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 58740 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1419307 MASTECTOMY MODIFIED RADICAL .00 EA= .00 1 00000000 3620.00
MASTECTOMY MO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 19307 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1419301 MASTECTOMY PARTIAL LUMPECTOMY .00 EA= .00 1 00000000 1385.00
MASTECTOMY PA .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 19301 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1444139 MOBILIZATION OF SPLENIC FLEXURE .00 EA= .00 1 00000000 464.00
MOBILIZATION .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 44139 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411730 NAIL AVULSION PARTIAL OR COMPLETE .00 EA= .00 1 00000000 332.00
NAIL AVULSION .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11730 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1497605 NEG PRESS WOUND THER <= 50 SQ CM .00 EA= .00 1 00000000 204.00
WND THER <=50 .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 97605 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 703
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1497606 NEG PRESS WOUND THER >50 SQ CM .00 EA= .00 1 00000000 220.00
WND THER >50 .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 97606 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499201 NEW PATIENT LEVEL 1 (10 MINS) .00 EA= .00 1 00000000 124.00
NEW PATIENT L .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99201 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499202 NEW PATIENT LEVEL 2 (20 MINS) .00 EA= .00 1 00000000 155.00
NEW PATIENT L .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99202 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499203 NEW PATIENT LEVEL 3 (30 MINS) .00 EA= .00 1 00000000 202.00
NEW PATIENT L .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99203 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499204 NEW PATIENT LEVEL 4 (45 MINS) .00 EA= .00 1 00000000 288.00
NEW PATIENT L .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99204 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499205 NEW PATIENT LEVEL 5 (60 MINS) .00 EA= .00 1 00000000 389.00
NEW PATIENT L .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99205 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499315 NURSING FACILITY DISCHARGE 30 MINS .00 EA= .00 1 00000000 225.00
NURSING FACIL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300020 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99315 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 704
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499318 NURSING FACILITY DISCHARGE 30 MINS .00 EA= .00 1 00000000 225.00
NURSING FACIL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99315SW FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499316 NURSING FACILITY DISCHARGE > 30 MINS .00 EA= .00 1 00000000 281.00
NURSING FACIL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300020 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99316 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499319 NURSING FACILITY DISCHARGE > 30 MINS .00 EA= .00 1 00000000 281.00
NURSING FACIL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99316SW FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499217 OBSERVATION CARE DISCHARGE .00 EA= .00 1 00000000 135.00
OBSERVATION C .00 .00 2 00000000 .00
.......... EJ(0762) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99217 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499235 OBSERVATION OR INPATIENT HOSPITAL CA .00 EA= .00 1 00000000 340.00
OBSERVATION O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99235 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499236 OBSERVATION OR INPATIENT HOSPITAL CA .00 EA= .00 1 00000000 438.00
OBSERVATION O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99236 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499234 OBSERVATION OR IP STAY INCLUDING ADM .00 EA= .00 1 00000000 241.00
OBSERVATION O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99234 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 705
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499245 OFFICE CONSULT COMPREHENSIVE HIGH .00 EA= .00 1 00000000 485.00
OFFICE CONSUL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99245 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499244 OFFICE CONSULT COMPREHENSIVE-MODERAT .00 EA= .00 1 00000000 384.00
OFFICE CONSUL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99244 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499243 OFFICE CONSULT DETAILED .00 EA= .00 1 00000000 293.00
OFFICE CONSUL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99243 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499242 OFFICE CONSULT EXPANDED PROBLEM FOCU .00 EA= .00 1 00000000 230.00
OFFICE CONSUL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99242 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
90009166 OSOM HCG URINE PREG TEST STRIPS 00146 22071063 140.89 EA=OSMO PREG .00 1 00000000 .00
OSOM HCG URIN 140.89 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=41115014 EXP.GL=41115014 140.89 1 .00 3 00000000 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2800016 OVARIAN CYSTECTOMY UNILATERAL OR BIL .00 EA= .00 1 00000000 1846.00
OVAR CYST UB .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 58925 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1400091 PAP SMEAR OBTAINING PREPARING AND CO .00 EA= .00 1 00000000 137.00
PAP SMEAR OBT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: Q0091 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 706
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1488150 PAP SMEAR-CYTOPATHOLOGY SLIDES CERVI .00 EA= .00 1 00000000 80.00
PAP SMEAR-CYT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 88150 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411056 PARING/CUTTING B9 KERATOTIC LES 2-4 .00 EA= .00 1 00000000 126.00
PARING/CUTTIN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11056 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411055 PARING/CUTTING KERATOTIC LESION 1 .00 EA= .00 1 00000000 101.00
PARING/CUTTIN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11055 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1460220 PARTIAL REMOVAL OF THYROID .00 EA= .00 1 00000000 1741.00
PARTIAL REMOV .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 60220 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499392 PERIODIC COMPREHENSIVE PHYSICAL EARL .00 EA= .00 1 00000000 148.00
PERIODIC COMP .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99392 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499391 PERIODIC COMPREHENSIVE PHYSICAL INFA .00 EA= .00 1 00000000 140.00
PERIODIC COMP .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99391 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499393 PERIODIC COMPREHENSIVE PHYSICAL-LATE .00 EA= .00 1 00000000 162.00
PERIODIC COMP .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99393 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 707
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1410250 PHY REVIEW INTERPRET AND PT MGMT OF .00 EA= .00 1 00000000 55.00
PHY REVIEW IN .00 .00 2 00000000 .00
.......... CY(0000) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0250 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499374 PHYS SUPERVISION OF A PATIENT UNDER .00 EA= .00 1 00000000 164.00
PHYS SUPERVIS .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99374 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410181 PHYSICIAN CERTIFICATION FOR MEDICARE .00 EA= .00 1 00000000 152.00
PHYSICIAN CER .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0180 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410179 PHYSICIAN RECERTIFICATION FOR MEDICA .00 EA= .00 1 00000000 115.00
PHYSICIAN REC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0179 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499378 PHYSICIAN SUPER HOSPICE PT 30 MIN OR .00 EA= .00 1 00000000 346.00
PHYSICIAN SUP .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99378 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499379 PHYSICIAN SUPER NURSING FACILITY PT .00 EA= .00 1 00000000 173.00
PHYSICIAN SUP .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99379 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499375 PHYSICIAN SUPER PT UNDER CARE OF HOM .00 EA= .00 1 00000000 303.00
PHYSICIAN SUP .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99375 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 708
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499380 PHYSICIAN SUPERVISION OF A NURSING F .00 EA= .00 1 00000000 272.00
PHYSICIAN SUP .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99380 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490732 PNEUMOCOCCAL VACCINE AGE 2YRS+ .00 EA= .00 1 00000000 72.00
PNEUMOCOCCAL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90732 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499024 POST OP .00 EA= .00 1 00000000 .00
POST OP .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99024 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499210 PREOP COLON OFFICE VISIT .00 EA= .00 1 00000000 .00
PREOP COLON O .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99211N FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445300 PROCTOSIGMOIDOSCOPY FIGID DIAGNOSTIC .00 EA= .00 1 00000000 202.00
PROCTOSIGMOID .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45300 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445110 PROTECTOMY COMPLETE COMBINED ABDOMIN .00 EA= .00 1 00000000 6386.00
PROTECTOMY CO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45110 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1494760 PULSE OX-NONINVASIVE EAR OR PULSE OX .00 EA= .00 1 00000000 41.00
PULSE OX-NONI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 94760 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 709
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1410160 PUNCTURE ASPIRATION OF ABSCESS HEMAT .00 EA= .00 1 00000000 232.00
PUNCTURE ASPI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 10160 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1419000 PUNCTURE ASPIRATION OF CYST OF BREAS .00 EA= .00 1 00000000 226.00
PUNCTURE ASPI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 19000 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499377 PYSICIAN SUPER OF A HOSPICE PT 15-29 .00 EA= .00 1 00000000 195.00
PYSICIAN SUPE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99377 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1424200 REMOVAL FOREIGN BODY UPPER ARM .00 EA= .00 1 00000000 248.00
REMOVAL FOREI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 24200 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1465220 REMOVAL OF FOREIGN BODY EXTERNAL EYE .00 EA= .00 1 00000000 351.00
REMOVAL OF FO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 65220 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411200 REMOVAL OF SKIN TAGS UP TO 15 .00 EA= .00 1 00000000 161.00
REMOVAL OF SK .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11200 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499418 REOPENING OF RECENT LAPAROTOMY .00 EA= .00 1 00000000 2567.00
REOPENING OF .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 49002 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 710
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
280017 REPAIR INCARCERATED INGUINAL HERNIA .00 EA= .00 1 00000000 1424.00
REP INC ING 5 .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 49507 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499413 REPAIR INITAL INCISIONAL OR VENTRAL .00 EA= .00 1 00000000 2273.00
REPAIR INITAL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 49561 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1449560 REPAIR INITIAL INCISIONAL OF VENTRAL .00 EA= .00 1 00000000 2409.00
REPAIR INITIA .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 49560 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1449505 REPAIR INITIAL INGUINAL HERNIA AGE 5 .00 EA= .00 1 00000000 1817.00
REPAIR INITIA .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 49505 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1449565 REPAIR RECURRENT INCISIONAL OR VENTR .00 EA= .00 1 00000000 2629.00
REPAIR RECURR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 49565 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1449585 REPAIR UMBILICAL HERNIA AGE 5 YRS OR .00 EA= .00 1 00000000 1884.00
REPAIR UMBILI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 49585 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420696 ROCEPHIN ANTIBIOTIC INJECTION PER 25 .00 EA= .00 1 00000000 4.00
ROCEPHIN ANTI .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J0696 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 711
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80008030 ROLL PAPER TOWELS 00249 GPC27385 17.46 CS=1CS .00 1 00000000 .00
ROLL PAPER TO 17.46 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=41115014 EXP.GL=41115 17.46 1 .00 3 00000000 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1499410 SALPINGO-OOHORECTOMY COMPLETE OR PAR .00 EA= .00 1 00000000 1807.00
SALPINGO OOHO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 58720 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410105 SCREENING COLONOSCOPY/HIGH RISK .00 EA= .00 1 00000000 1206.00
SCREENING COL .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0105 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1410104 SCREENING FLEX SIGMOIDOSCOPY .00 EA= .00 1 00000000 380.00
SCREENING FLE .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0104 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
99012 SELF PAY DISCOUNT .00 EA= .00 1 51068000 .00
SELF PAY DISC .00 .00 2 00000000 .00
.......... SE(0000) INV.GL= EXP.GL= .00 .00 3 00000000 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1411301 SHAVING OF DERMAL LESION SINGLE TRUN .00 EA= .00 1 00000000 192.00
SHAVING OF DE .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11301 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1411300 SHAVING OF EPIDERMAL /DERMAL LESION .00 EA= .00 1 00000000 156.00
SHAVING OF EP .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11300 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 712
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1445338 SIGMOIDOSCOPY FLEX DX W/REMOVALTUMOR .00 EA= .00 1 00000000 1040.00
SIGMOIDOSCOPY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45338 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445531 SIGMOIDOSCOPY FLEX W/ BIOPSY SINGLE .00 EA= .00 1 00000000 480.00
SIGMOIDOSCOPY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45531 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1445330 SIGMOIDOSCOPY FLEXIBLE DIAGNOSTIC .00 EA= .00 1 00000000 392.00
SIGMOIDOSCOPY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 45330 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1412002 SIMPLE REPAIR OF SUPERFICIAL WOUND 7 .00 EA= .00 1 00000000 544.00
SIMPLE REPAIR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 12002 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1412001 SIMPLE REPAIR SUPERFICIAL WOUND .00 EA= .00 1 00000000 450.00
SIMPLE REPAIR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 12001 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1486580 SKN TEST-PPD .00 EA= .00 1 00000000 33.00
SKN TEST-PPD .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 86580 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499406 SMOKING AND TOBACCO CESSATION .00 EA= .00 1 00000000 44.00
SMOKING AND T .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99406 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 713
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1410436 SMOKING AND TOBACCO CESSATON .00 EA= .00 1 00000000 44.00
SMOKING AND T .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: G0436 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499080 SPECIAL REPORTS MEDICAL RECORDS INSU .00 EA= .00 1 00000000 .00
SPECIAL REPOR .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99080 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1494010 SPIROMETRY PLAIN .00 EA= .00 1 00000000 140.00
SPIROMETRY PL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 94010 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1438100 SPLENECTOMY TOTAL .00 EA= .00 1 00000000 6702.00
SPLENECTOMY T .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 38100 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499401 SPORTS PHYSICAL .00 EA= .00 1 00000000 25.00
SPORTS PHYSIC .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99401F FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
90002378 STREP A QUICKVUE WAIVED 00146 23043027 48.86 EA=1EA .00 1 00000000 .00
STREP A QUICK 48.86 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
1487430 STREP GROUP A .00 EA= .00 1 00000000 41.00
STREP GROUP A .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 87430 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 714
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499231 SUBSEQUENT HOSPITAL CARE 15 MINS .00 EA= .00 1 00000000 102.00
SUBSEQUENT HO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99231 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499232 SUBSEQUENT HOSPITAL CARE PER DAY 25 .00 EA= .00 1 00000000 139.00
SUBSEQUENT HO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300020 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99232 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499233 SUBSEQUENT HOSPITAL VISIT .00 EA= .00 1 00000000 259.00
SUBSEQUENT HO .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99233 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499308 SUBSEQUENT NURSING CARE 15 MINS .00 EA= .00 1 00000000 164.00
SUBSEQUENT NU .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99308 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499314 SUBSEQUENT NURSING CARE 15 MINS .00 EA= .00 1 00000000 164.00
SUBSEQUENT NU .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99308SW FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499309 SUBSEQUENT NURSING CARE 25 MINUTES .00 EA= .00 1 00000000 238.00
SUBSEQUENT NU .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300020 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99309 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499317 SUBSEQUENT NURSING CARE 25 MINUTES .00 EA= .00 1 00000000 238.00
SUBSEQUENT NU .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99309SW FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 715
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1499310 SUBSEQUENT NURSING FACILITY CARE 35 .00 EA= .00 1 00000000 324.00
SUBSEQUENT NU .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300020 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99310 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499307 SUBSEQUENT NURSING HOME CARE .00 EA= .00 1 00000000 121.00
SUBSEQUENT NU .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99307 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499313 SUBSEQUENT NURSING HOME CARE .00 EA= .00 1 00000000 121.00
SUBSEQUENT NU .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99307SW FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499224 SUBSEQUENT OBSERVATION CARE 15 MINS .00 EA= .00 1 00000000 66.00
SUBSEQUENT OB .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99224 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499225 SUBSEQUENT OBSERVATION CARE 25 MINS .00 EA= .00 1 00000000 132.00
SUBSEQUENT OB .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99225 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499226 SUBSEQUENT OBSERVATION CARE 35 MINS .00 EA= .00 1 00000000 184.00
SUBSEQUENT OB .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 99226 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1446270 SURGICAL TREATMENT OF ANAL FISTULA .00 EA= .00 1 00000000 1502.00
SURGICAL TREA .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 46270 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 716
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1420670 SUTURE REMOVAL .00 EA= .00 1 00000000 1031.00
SUTURE REMOVA .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20670 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490715 TDAP > 7YRS IM .00 EA= .00 1 00000000 36.00
TDAP > 7YRS I .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90715 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1421080 TESTOSTERONE INJECTION .00 EA= .00 1 00000000 18.00
TESTOSTERONE .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J1080 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490703 TETANUS SHOT .00 EA= .00 1 00000000 48.00
TETANUS SHOT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90703 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490718 TETANUS/DIPHTHERIA TOXOIDS (TD) ADM .00 EA= .00 1 00000000 44.00
TETANUS/DIPHT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90718 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1496372 THERAPEUTIC PROPHYLACTIC INJECTION .00 EA= .00 1 00031110 50.00
THERAPEUTIC P .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 96372 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499408 THYROIDECTOMY, REMOVAL OF ALL REMAIN .00 EA= .00 1 00000000 2696.00
THROIDECTOMY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 60260 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 717
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1421885 TORADOL KETOROLAC PER 15 MG .00 EA= .00 1 00000000 6.00
TORADOL KETOR .00 .00 2 00000000 .00
.......... AN(0636) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: J1885 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1431600 TRACHEOSTOMY PLANNED .00 EA= .00 1 00000000 1554.00
TRACHEOSTOMY .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 31600 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1420552 TRIGGER PT INJECTION .00 EA= .00 1 00000000 169.00
TRIGGER PT IN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 20552 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1432551 TUBE THORACOSTOMY INCLUDES WATER SEA .00 EA= .00 1 00000000 661.00
TUBE THORACOS .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 32551 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1429580 UNNA BOOT .00 EA= .00 1 00000000 116.00
UNNA BOOT .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 29580 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443248 UP GI ENDO W/ INSERT GUIDE WIRE THEN .00 EA= .00 1 00000000 901.00
UP GI ENDO W/ .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43248 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443245 UP GI ENDO W/DILAT GASTRIC OUT OBSTR .00 EA= .00 1 00000000 928.00
UP GI ENDO W/ .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43245 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 718
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1443251 UP GI ENDOSCOPY WITH REMOVAL OF TUMO .00 EA= .00 1 00000000 1122.00
UP GI ENDOSCO .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43251 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443247 UPPER GASTROINTESTINAL ENDOSCOPY WIT .00 EA= .00 1 00000000 928.00
UPPER GASTROI .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43247 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1443249 UPPER GI ENDOSCOPY WITH BALLOON DILA .00 EA= .00 1 00000000 986.00
UPPER GI ENDO .00 .00 2 00000000 .00
.......... 42(0360) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $99999.99 #:
CPT CODE: 43249 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
4181025 URINE PREGNANCY TEST BY VISUAL COLOR .00 EA= .00 1 00000000 45.00
URINE PREGNAN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 81025 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490472 VACCINE ADMINISTRATION EACH ADDITION .00 EA= .00 1 00000000 26.00
VACCINE ADMIN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90472 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490471 VACCINE ADMINISTRATION FIRST SHOT .00 EA= .00 1 00000000 49.00
VACCINE ADMIN .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90471 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1499172 VISUAL FUNCTION SCREENING .00 EA= .00 1 00000000 62.00
VISUAL FUNCTI .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 99172 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 719
TIME: 08:24 ITEM MASTER LIST DEPT# 014 RHC H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
1411765 WEDGE EXCOF SKIN NAIL FOLD (INGROWN .00 EA= .00 1 00000000 409.00
WEDGE EXCOF S .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 11765 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
1490736 ZOSTER SHINGLES VACCINE LIVE SUBCUTA .00 EA= .00 1 00000000 356.00
ZOSTER SHINGL .00 .00 2 00000000 .00
.......... 8B(0521) INV.GL= EXP.GL= .00 .00 3 31300014 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 90736 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 720
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501040 ARM SLING L 00432 1796-13-10 3.72 EA=1EA .00 1 00000000 65.00
ARM SLING L 37.16 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000615 1 X 2 5/8 WHITE LABLES 816 00499 UNV80201 9.99 PK=1PK .00 1 00000000 .00
1 X 2 5/8 WHI 9.99 PK=1PK/PK 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000614 1"X 2 5/8 CLEAR LABELS 866 00499 AVE8660 23.99 PK=1PK .00 1 00000000 .00
1"X 2 5/8 CLE 23.99 PK=1PK/PK 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000739 1.2 GAL CAP ROOM HUMIDIFIE 01304 4714100HF 31.91 EA=1EA .00 1 00000000 93.00
1.2 GAL CAP R 31.91 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000754 100FT ROLL-SEG 6"-COR TUB 01304 301150 11.70 EA=1EA .00 1 00000000 69.00
100FT ROLL-SE 11.70 RL=1EA/RL 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500512 2WAY CATH 12FR. FOLEY 5CC 00249 S512 4.3092 EA=1EA .00 1 00000000 44.00
2WAY CATH 12F 51.71 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500513 2WAY CATH 14FR 5CC BALLON 00249 DYND11501 4.3092 EA=1EA .00 1 00000000 44.00
2WAY CATH 14F 51.71 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500514 2WAY CATH 16FR 5CC BALLON 00249 DYND11502 4.3092 EA=1EA .00 1 00000000 44.00
2WAY CATH 16F 51.71 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 721
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500499 2WAY CATH 16FR FOLEY 30CC 00249 S186 4.91 EA=1EA .00 1 00000000 35.00
2WAY CATH 16F 58.89 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500515 2WAY CATH 18FR 5CC BALLON 00249 DYND11503 4.3092 EA=1EA .00 1 00000000 44.00
2WAY CATH 18F 51.71 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500500 2WAY CATH 18FR FOLEY 30CC 00249 S618 4.91 EA=1EA .00 1 00000000 35.00
2WAY CATH 18F 58.89 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500516 2WAY CATH 20FR 5CC BALLON 00249 S520 1.31 EA=1EA .00 1 00000000 44.00
2WAY CATH 20F 15.66 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500501 2WAY CATH 20FR FOLEY 30CC 00249 S620 4.91 EA=1EA .00 1 00000000 35.00
2WAY CATH 20F 58.89 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500517 2WAY CATH 22FR 5CC BALLON 00249 DYND11504 4.3092 EA=1EA .00 1 00000000 44.00
2WAY CATH 22F 51.71 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500502 2WAY CATH 22FR FOLEY 30CC 00249 S622 1.18 EA=1EA .00 1 00000000 35.00
2WAY CATH 22F 14.13 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500518 2WAY CATH 24FR 5CC BALLON 00249 S524 1.31 EA=1EA .00 1 00000000 44.00
2WAY CATH 24F 15.66 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 722
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500503 2WAY CATH 24FR FOLEY 30CC 00249 S624 1.18 EA=1EA .00 1 00000000 35.00
2WAY CATH 24F 14.13 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500519 2WAY CATH 26FR 5CC BALLON 00249 S526 1.31 EA=1EA .00 1 00000000 44.00
2WAY CATH 26F 15.66 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500520 2WAY CATH 28FR 5CC BALLON 00249 S528 .28 EA=1EA .00 1 00000000 44.00
2WAY CATH 28F 3.40 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500504 2WAY CATH 28FR FOLEY 30CC 00249 S628 .28 EA=1EA .00 1 00000000 35.00
2WAY CATH 28F 3.40 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500521 2WAY CATH 30FR 5CC BALLON 00249 265730 .28 EA=1EA .00 1 00000000 44.00
2WAY CATH 30F 3.40 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500505 2WAY CATH 30FR FOLEY 30CC 00249 S630 1.21 EA=1EA .00 1 00000000 35.00
2WAY CATH 30F 14.49 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001016 3-0 VICRYL J416H 00257 23000J416H 44.995 BX=1BX .00 1 00000000 .00
3-0 VICRYL J4 44.995 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000759 340 ML HUMIDIFIER W/ ADAPT 01304 36-003-40 1.01 EA=1EA .00 1 00000000 12.00
340 ML HUMIDI 20.12 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 723
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500506 3WAY CATH 16FR 30CC 00249 DYND11572 7.3233 EA=1EA .00 1 00000000 63.00
3WAY CATH 16F 87.88 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500507 3WAY CATH 18FR 30CC 00249 DYND11573 7.3233 EA=1EA .00 1 00000000 63.00
3WAY CATH 18F 87.88 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500508 3WAY CATH 20FR 00249 PS720 3.70 EA=1EA .00 1 00000000 63.00
3WAY CATH 20F 44.37 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500509 3WAY CATH 22FR 30CC 00249 DYND11575 7.3233 EA=1EA .00 1 00000000 63.00
3WAY CATH 22F 87.88 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500510 3WAY CATH 24FR 00249 06200167L24 8.82 EA=1EA .00 1 00000000 63.00
3WAY CATH 24F 105.78 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500511 3WAY CATH 26FR 00249 2D2655 2.85 EA=1EA .00 1 00000000 63.00
3WAY CATH 26F 34.20 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000764 760ML NEB W/ADAPTER (HUMI 01304 04-3D0808 3.29 EA=1EA .00 1 00000000 78.00
760ML NEB W/ 39.51 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500471 ABDOMIBAL BINDER 60-75 IN 00249 1821000818 22.06 EA=1EA .00 1 00000000 166.00
ABDOMIBAL BIN 22.06 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 724
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500468 ABDOMINAL BINDER 12" 00249 MDS169028 17.66 EA=1EA .00 1 00000000 166.00
ABDOMINAL BIN 17.66 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500470 ABDOMINAL BINDER 58-442 00249 58442 11.90 EA=1EA .00 1 00000000 166.00
ABDOMINAL BIN 11.90 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500467 ABDOMINAL BINDER 9" 00249 MDS169022 12.69 EA=1EA .00 1 00000000 166.00
ABDOMINAL BIN 12.69 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500469 ABDOMNIAL BINDER 9"58432 00249 58432 9.52 EA=1EA .00 1 00000000 166.00
ABDOMNIAL BIN 9.52 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501141 ABDUCTION PILLOW 00249 17.09 EA=1EA .00 1 00000000 185.00
ABDUCTION PIL 102.52 CS=6EA/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500985 ACUDYNE SWABSTICKS 00249 MDS093901ZZ .2044 EA=1EA .00 1 00000000 .00
ACUDYNE SWABS 10.22 BX=50/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501001 ADAPTIC 3X3 00249 CUR250330Z .2074 EA=1EA .00 1 00000000 8.00
ADAPTIC 3X3 10.37 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501002 ADAPTIC 3X8 00249 CUR250381Z .5342 EA=1EA .00 1 00000000 32.00
ADAPTIC 3X8 12.82 BX=24EA/BX 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:Y MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 725
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000326 ADHERENT DRAPE 92-0500 2.22 EA=1EA .00 1 00000000 .00
ADHERENT DRAP 55.51 BX=25EA/BX 25 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001228 ADHESIVE MEDICAL SPRAY 00257 3158007730 11.41 EA=1EA .00 1 00000000 .00
ADHESIVE MEDI 45.62 BX=4EA/BX 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001003 ADMISSION KIT 00249 DYKD2002A 2.4525 EA=1EA .00 1 00000000 .00
ADMISSION KIT 29.43 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000762 ADULT AEROSOL MASK 00396 301-170EA .4968 EA=1EA .00 1 00031110 49.00
ADULT AEROSOL 00249 HCS4630B 24.84 CS=50EA/CS 50 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000763 ADULT NASAL CANNULA 7’ 00396 301-100EA .4694 EA=1EA .00 1 00031110 35.00
ADULT NASAL C 00249 HCS4514 23.47 CS=50EA/CS 50 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000760 ADULT NON-REBREATHER 01304 301181 .7226 EA=1EA .00 1 00031110 69.00
ADULT NON-REB 36.13 CS=50EA/CS 50 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501339 ADULT SLIPPERS XXL 00249 MDT211218XXLI 1.0215 EA=1EA .00 1 00031110 7.50
ADULT SLIPPER 00304 6239LG 49.03 CS=48EA/CS 48 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500039 ADULT WIPES 00249 MSC263810 1.5171 EA=1EA .00 1 00031110 16.00
ADULT WIPES 00062 10-710 36.41 CS=24EA/CS 24 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 726
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001537 AERO CHAMBERS 01304 317-621-210 101.46 CS=1CS .00 1 00031110 150.00
AERO CHAMBERS 101.46 CS=1CS 1 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501021 AIRCAST LEFT 00123 02BLK 25.41 EA=1EA .00 1 00000000 425.00
AIRCAST LEFT 00249 ARC02BLK 25.41 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501022 AIRCAST RIGHT 00123 02BRK 31.46 EA=1EA .00 1 00000000 425.00
AIRCAST RIGHT 00249 ARC02BRK 31.46 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500142 AIRWAY 100MM 00249 DYND60425 .2267 EA=1EA .00 1 00031110 32.00
AIRWAY 100MM 2.72 BX=12EA/BX 12 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500143 AIRWAY 110MM 0249 5568122006 .3233 EA=1EA .00 1 00031110 14.00
AIRWAY 110MM 3.88 BX=12EA/BX 12 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500137 AIRWAY 40MM 00249 6697-002041 .18 EA=1EA .00 1 00031110 14.00
AIRWAY 40MM 2.21 BX=12EA/BX 12 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500138 AIRWAY 60MM 00249 DYND60410 .2267 EA=1EA .00 1 00031110 14.00
AIRWAY 60MM 2.72 BX=12EA/BX 12 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500139 AIRWAY 70MM 00249 6697412071 .21 EA=1EA .00 1 00031110 14.00
AIRWAY 70MM 2.52 BX=12EA/BX 12 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 727
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500140 AIRWAY 80MM 00249 DYND60415 .2267 EA=1EA .00 1 00031110 14.00
AIRWAY 80MM 2.72 BX=12EA/BX 12 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500141 AIRWAY 90MM 00249 6697412091 .21 EA=1EA .00 1 00031110 14.00
AIRWAY 90MM 2.52 BX=12EA/BX 12 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000209 ALCOHOL 00249 MDS098003Z .9875 EA=1EA .00 1 00000000 .00
ALCOHOL 11.85 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000001 ALCOHOL PREP 00249 KDL5750 1.0175 BX=1BX .00 1 00000000 .00
ALCOHOL PREP 00074 KC5033 20.35 CS=20BX/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001276 ALLEN WRIST SPLINT LG. 00123 79-71047 18.20 EA=1EA .00 1 00000000 41.00
ALLEN WRIST S 00249 ORT33600L 18.20 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001275 ALLEN WRIST SPLINT SM. 00249 SDJ7971043 9.74 EA=1EA .00 1 00000000 41.00
ALLEN WRIST S 9.74 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000367 ALLERGIC TO LABEL 00783 59704578 48.06 BX=1BX .00 1 00000000 .00
ALLERGIC TO L 48.06 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501526 ALOE VESTA BODY WASH &SHAM 00249 MSC095348 .3583 EA=1EA .00 1 00000000 .00
ALOE VESTA BO 00062 82-0994 17.20 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 728
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001432 AMPLATZ WIRE 00058 46-525 40.654 EA=1EA .00 1 00000000 102.00
AMPLATZ WIRE 203.27 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500374 ANKLE BRACE LG 00420 176705 15.18 EA=1EA .00 1 00000000 161.00
ANKLE BRACE L 15.18 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500373 ANKLE BRACE MED 00420 176704 15.66 EA=1EA .00 1 00000000 161.00
ANKLE BRACE M 15.66 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500372 ANKLE BRACE SM 00420 176703 13.50 EA=1EA .00 1 00000000 161.00
ANKLE BRACE S 13.50 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001185 AQUACEL AG 4X4 00257 1638177902 10.39 EA=1EA .00 1 00000000 14.00
AQUACEL AG 4X 103.86 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501038 ARM SLING CHILD 00249 ORT11400SD 5.86 BX=1BX .00 1 00000000 65.00
ARM SLING S 23.44 BX=4EA/BX 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500071 ARMBOARD 18" 00249 NON24291H 1.42 EA=1EA .00 1 00000000 20.00
ARMBOARD 18" 1.42 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500070 ARMBOARD 9" 00249 5189450010 .39 EA=1EA .00 1 00000000 20.00
ARMBOARD 9" 39.00 CS=100EA/CS 100 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 729
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500038 ART LINE ARM BD 00249 18686010 6.00 EA=1EA .00 1 00000000 45.00
ART LINE ARM 120.06 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000736 ASMAPLANT STAND PEAK FLOW 01304 26111300 10.00 EA=1EA .00 1 00000000 48.00
ASMAPLANT STA 100.00 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001028 ATRAC-TAIN CREAM 5OZ TUBE 00249 COL1814 5.1238 EA=1EA .00 1 00000000 25.00
ATRAC-TAIN CR 61.485 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500404 BANDAGE ACE 2" 00249 MDS046002 .2944 EA=1EA .00 1 00000000 5.00
BANDAGE ACE 2 14.72 BX=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500405 BANDAGE ACE 3" 00249 MDS046003 .3758 EA=1EA .00 1 00000000 7.00
BANDAGE ACE 3 18.79 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500406 BANDAGE ACE 4" 00249 MDS087004LF .4236 EA=1EA .00 1 00000000 9.00
BANDAGE ACE 4 21.18 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500407 BANDAGE ACE 6" 00249 MDS046006 .7446 EA=1EA .00 1 00000000 14.00
BANDAGE ACE 6 37.23 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001277 BANDAID 1" 00249 NON25600 1.10 BX=1BX .00 1 00000000 .00
BANDAID 1" 13.20 CS=12BX/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 730
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001678 BANDAID 2" 00249 NON25504 2.3242 BX=1BX .00 1 00000000 .00
BANDAID 2" 27.89 CS=12BX/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001176 BARALYME 00299 32-55-001-0006 94.75 CS=1CS .00 1 00000000 .00
BARALYME 94.75 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001179 BARRIER WIPES 00257 1638037439 5.79 BX=1BX .00 1 00000000 .00
BARRIER WIPES 5.79 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500150 BASIN 7QT 00249 DYND80347 .2964 EA=1EA .00 1 00000000 14.00
BASIN 7QT 00062 93-H36210 14.82 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001093 BATTERY 9V 00249 DRCPC1604Z .6988 EA=1EA .00 1 00000000 .00
BATTERY 9V 00361 810694 8.386 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001092 BATTERY AAA 00249 DRCPC2400Z .1982 EA=1EA .00 1 00000000 .00
BATTERY AAA 4.756 BX=24EA/BX 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001309 BATTERY C 00249 DRCPC1400Z .4588 EA=1EA .00 1 00000000 .00
BATTERY C 5.505 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001310 BATTERY D 00249 DRCPC1300Z .605 EA=1EA .00 1 00000000 .00
BATTERY D 7.26 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 731
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001020 BATTERY-AA 00249 DRCPC1500 .1963 EA=1EA .00 1 00000000 .00
BATTERY-AA 00052 EVEE91SBP36H 28.26 CS=144EA/CS 144 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
4111334 BB TRANSFUSE BLOOD PRODUCT .00 EA= 1.00 1 00000000 1063.00
TRANSFUSE BLD .00 .00 2 00000000 .00
....P..... 6B(0391) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT:N CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: 36430 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2500003 BEDPAN 00249 DYND80245 .4694 EA=1EA .00 1 00000000 36.00
BEDPAN 00062 541-5072-0000 23.47 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500004 BEDPAN FRACTURE 00249 DYNC8521 .5696 EA=1EA .00 1 00000000 39.00
BEDPAN FRACTU 13.67 CS=24EA/CS 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500556 BENSON WIRE 180CM 00104 G01431 11.50 EA=1EA .00 1 00000000 128.00
BENSON WIRE 1 00058 49-147 11.50 EA=1EA/EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000072 BIO-HAZ BAG 6X9 00249 DYND30261 4.715 PK=1PK .00 1 00000000 .00
BIO-HAZ BAG 6 00084 SB69BZ 47.15 CS=10PK/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500472 BIO-PATCH DRESSING 00249 J-J4150Z 7.50 EA=1EA .00 1 00000000 115.00
BIO-PATCH DRE 75.00 BX=10EA/BX 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 732
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90000339 BIOHAZARD BAG 17X17 00249 NON151717 56.12 CS=1CS .00 1 00000000 .00
BIOHAZARD BAG 56.12 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000340 BIOHAZARD BAG 40X46 00249 HTBA8046ZR 55.20 CS=1CS .00 1 00000000 .00
BIOHAZARD BAG 00146 14-828-89 55.20 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001332 BIOHAZARD BAGS 24X33 00249 NON122433 5.748 RL=1RL .00 1 00000000 .00
BIOHAZARD BAG 57.48 CS=10RL/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001345 BIOPSY SKIN PUNCH 2MM 00285 DD-2MM 25.00 BX=1BX .00 1 00000000 20.00
BIOPSY SKIN P 25.00 BX=1BX 1 .00 2 00000000 .00
.......... 44(0272) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001344 BIOPSY SKIN PUNCH 4MM 00285 DD-4MM 25.00 BX=1BX .00 1 00000000 20.00
BIOPSY SKIN P 25.00 BX=1BX 1 .00 2 00000000 .00
.......... 44(0272) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001404 BLOOD GAS CARTRIDGE 00316 945-713 807.84 EA=1EA .00 1 00000000 .00
BLOOD GAS CAR 807.84 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001459 BLUNT FILL NEEDLE 00249 B-D305180 6.601 BX=1BX .00 1 00000000 .00
BLUNT FILL NE 66.01 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001638 BLUNT FILTER NEEDLE 00249 B-D305211Z 19.90 BX=1BX .00 1 00000000 .00
BLUNT FILTER 19.90 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 733
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001503 BP CUFF ISOLATION 00328 39203 3.82 EA=1EA .00 1 00000000 .00
BP CUFF ISOLA 76.32 BX=20EA/BX 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500033 BUTTERFLY 19GA X7/8 00249 45900101 .54 EA=1EA .00 1 00000000 16.00
BUTTERFLY 19G 26.95 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500034 BUTTERFLY 25GA X1/2 00249 B-D367298Z .5814 EA=1EA .00 1 00000000 36.00
BUTTERFLY 25G 29.07 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501518 BUTTERFLY SETS 21GA. 00249 723367296 .59 EA=1EA .00 1 00000000 16.00
BUTTERFLY SET 29.67 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2146226 C-QUR/TACSHIELD MESH 4X6 00249 BAR9001C0212 .00 EA=1EA .00 1 00000000 2325.00
CQURTASMESH4X 00043 9001C0212 .00 BX=10EA/BX 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: C1781 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
80000653 CALCULATOR TAPE-2 1/4 00499 UNV35715 .9992 EA=1EA .00 1 00000000 .00
CALCULATOR TA 11.99 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500056 CARRA-KLENZ 00249 CRR102060 2.7892 EA=1EA .00 1 00000000 144.00
CARRA-KLENZ 33.47 CS=12EA/CS 12 .00 2 00000000 .00
.......... 78(0250) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 734
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500408 CAST PADDING 2" 00420 889002 .60 EA=1EA .00 1 00000000 9.00
CAST PADDING 12.00 BG=20EA/BG 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500409 CAST PADDING 3" 00249 MDS067003Z 1.5917 BG=1BG .00 1 00000000 12.00
CAST PADDING 19.10 BG=12/BG 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500410 CAST PADDING 4" 00249 MDS067004Z 1.8808 EA=1EA .00 1 00000000 20.00
CAST PADDING 22.57 BG=12EA/BG 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500411 CAST PADDING 5" 00420 889005 3.29 EA=1EA .00 1 00000000 24.00
CAST PADDING 65.79 BG=20EA/BG 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000974 CASTILE SOAP 00249 MDS001005H .76 EA=1EA. .00 1 00000000 .00
CASTILE SOAP .76 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501223 CATH 10FR PED 00249 DYND11710 3.65 EA=1EA .00 1 00031110 44.00
CATH 10FR PED 43.77 BX=12EA/BX 12 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500531 CATH 16FR 5CC COUDE 00249 DYND11216 4.2158 EA=1EA .00 1 00000000 49.00
CATH 16FR 5CC 50.59 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: C1758 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 735
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500529 CATH 22FR 30CC TELFON 3WA 00249 0167V22S 12.77 EA=1EA .00 1 00000000 44.00
CATH 22FR 30 153.20 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500532 CATH 22FR 5CC COUDE 00249 0168L22 1.22 EA=1EA .00 1 00000000 49.00
CATH 22FR 5CC 14.69 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: C1758 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2500530 CATH 24FR 30CC TEFLON 3WAY 00249 0167V24 12.77 EA=1EA .00 1 00000000 63.00
CATH 24FR 30C 153.20 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501222 CATH 8FR PED 00249 DYND11708 3.18 EA=1EA .00 1 00031110 44.00
CATH 8FR PED 38.14 BX=12EA/BX 12 .00 2 00031220 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501014 CATH FOLEY 2WAY 26 FR 00249 5626 1.21 EA=1EA .00 1 00000000 35.00
CATH FOLEY 2W 14.49 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500526 CATH FOLEY 2WAY 30FR 30CC 00249 0166SI30 10.65 EA=1EA .00 1 00000000 35.00
CATH FOLEY 2W 127.80 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500522 CATH FOLEY 30CC 16FR SILVE 00249 06200166S116 11.22 EA=1EA .00 1 00000000 35.00
CATH FOLEY 30 134.61 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 736
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500523 CATH FOLEY 30CC 18FR SILVE 00249 06200166S118 11.22 EA=1EA .00 1 00000000 35.00
CATH FOLEY 30 134.61 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500524 CATH FOLEY 30CC 20FR SILVE 00249 06200166S120 11.22 EA=1EA .00 1 00000000 35.00
CATH FOLEY 30 134.61 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500525 CATH FOLEY 30CC 22FR SILVE 00249 06200166S122 11.51 EA=1EA .00 1 00000000 35.00
CATH FOLEY 30 138.07 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500528 CATH FOLEY 30CC 30FR SILVE 00249 016SS128 10.65 EA=1EA .00 1 00000000 44.00
CATH FOLEY 30 127.80 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500527 CATH FOLEY 5CC 28FR SILVER 00249 01655I30 10.65 EA=1EA .00 1 00000000 44.00
CATH FOLEY 5C 127.80 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500095 CATH MALE LG TEXAS 00249 RCH33304 .816 EA=1EA .00 1 00000000 39.00
CATH MALE LG 24.48 BX=30EA/BX 30 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500094 CATH MALE MED TEXAS 00249 DYND12302 .6288 EA=1EA .00 1 00000000 39.00
CATH MALE MED 15.72 CS=25EA/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500976 CATH PLUG 00249 76 .32 EA=1EA .00 1 00000000 6.00
CATH PLUG 80.24 CS=250EA/CS 250 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 737
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000977 CATH STRIP 00249 DERCS50Z 1.4352 EA=1EA .00 1 00000000 .00
CATH STRIP 71.76 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500996 CATH TRAY ADD-A FOLEY 00249 DYND11020 8.696 EA=1EA .00 1 00000000 288.00
CATH TRAY ADD 86.96 CS=10EA/CS 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501114 CATH. PED. 6FR. 00249 DYND11706 3.18 EA=1EA .00 1 00000000 44.00
CATH. PED. 6F 38.14 BX=12EA/BX 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001523 CAVICIDE 00249 MAP131150 5.5956 EA=1EA .00 1 00000000 .00
CAVICIDE 67.1466 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500050 CENTRAL VENOUS SET 00310 CS04300 21.50 EA=1EA .00 1 00000000 232.00
CENTRAL VENOU 107.48 CS=5EA/CS 5 .00 2 00000000 .00
.......... 50(0278) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
CPT CODE: C1751 FC/CPT2 CODES:
------------------------------------------------------------------------------------------------------------------------------------
2501227 CERVICAL RIGID COLLAR PED. 00420 167601 11.88 EA=1EA .00 1 00000000 183.00
CERVICAL RIGI 11.88 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501225 CERVICAL RIGID COLLAR TALL 00432 167605 14.10 EA=1EA .00 1 00000000 183.00
CERVICAL RIGI 14.10 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 738
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501226 CERVICAL RIGID REGULAR 00432 1676-04-00 14.10 EA=1EA .00 1 00000000 412.00
CERVICAL RIGI 14.10 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000689 CHINSTRAP FOR BIPSP/CPSP 01304 73302175 18.90 EA=1EA .00 1 00000000 59.00
CHINSTRAP FOR 18.90 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501423 CHLORAPREP 26ML. 00249 MDF260815 5.6012 EA=1EA .00 1 00000000 122.00
CHLORAPREP 26 140.03 CS=25EA/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001493 CHLORASCRUB SWABS 00249 NPKB10800z 10.43 BX=1BX .00 1 00000000 .00
CHLORASCRUB S 10.43 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500426 CLAVICAL SPL. S 00420 73512 6.03 BX=1BX .00 1 00000000 49.00
CLAVICAL SPL. 6.03 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500428 CLAVICLE SPL.LG 00249 SDJ7985007 6.18 BX=1BX .00 1 00000000 49.00
CLAVICLE SPL. 6.18 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500427 CLAVICLE SPL.MD 00420 73513 6.60 BX=1BX .00 1 00000000 49.00
CLAVICLE SPL. 6.60 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500429 CLAVICLE SPL.XL 00420 73515 8.27 BX=1BX .00 1 00000000 49.00
CLAVICLE SPL. 8.27 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 739
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001603 CLIPPER CHARGER 00257 4509009662 32.70 EA=1EA .00 1 00000000 .00
CLIPPER CHARG 32.70 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001602 CLIPPER SURGICAL 00241 MMM9661 31.96 EA=1EA .00 1 00000000 .00
CLIPPER SURGI 31.96 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000767 COACH INCENTIVE SPIROMETER 00249 DHD221200 4.8017 EA=1EA .00 1 00000000 30.00
COACH INCENTI 57.62 CS=12EA/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL=41115017 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500393 COBAN 1" 00249 4509001581 .51 EA=1EA .00 1 00031110 12.00
COBAN 1" 3.04 CS=6EA/CS 6 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501420 COBAN 2 COMPRESSION SYSTEM 00249 4509002094 13.00 BX=1BX .00 1 00000000 40.00
COBAN 2 COMPR 104.02 CS=8BX/CS 8 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501585 COBAN 2" 00249 MDS089002 1.3964 EA=1EA .00 1 00000000 35.00
COBAN 2" 50.27 CS=36EA/CS 36 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:Y MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500395 COBAN 3" 00249 MDS089003 1.8392 EA=1EA .00 1 00031110 59.00
COBAN 3" 44.14 CS=24EA/CS 24 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:Y MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500396 COBAN 4" 00249 MDS089004 2.3061 EA=1EA .00 1 00031110 79.00
COBAN 4" 41.51 CS=18EA/CS 18 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:Y MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 740
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500886 COBAN STERILE 4" 00249 MMM1584S 1.6194 EA=1EA .00 1 00000000 35.00
COBAN STERILE 29.15 CS=18EA/CS 18 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500423 COLLAR LG 00249 ORT13100L 3.45 BX=1BX .00 1 00000000 99.00
COLLAR LG 3.45 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500422 COLLAR MD 00249 ORT13100M 2.58 BX=1BX .00 1 00000000 223.00
COLLAR MD 2.58 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500421 COLLAR SM 00249 ORT13100S 3.22 BX=1BX .00 1 00000000 99.00
COLLAR SM 3.22 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500424 COLLAR UNIVERSAL 00420 73705 3.50 BX=1BX .00 1 00000000 99.00
COLLAR UNIVER 3.50 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500425 COLLAR X-LONG 00420 73706 3.50 BX=1BX .00 1 00000000 99.00
COLLAR X-LONG 3.50 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001280 COLLES FOREARM L LG. 00249 ORT33300LL 7.05 EA=1EA .00 1 00000000 18.00
COLLES FOREAR 7.05 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001278 COLLES FOREARM L MD. 00249 ORT33300LM 6.81 EA=1EA .00 1 00000000 18.00
COLLES FOREAR 6.81 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 741
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001279 COLLES FOREARM R LG. 00249 ORT33300RL 7.20 EA=1EA .00 1 00000000 18.00
COLLES FOREAR 7.20 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001277 COLLES FOREARM RIGHT MD. 00249 ORT33300RM 6.81 EA=1EA .00 1 00000000 18.00
COLLES FOREAR 6.81 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001362 COLLES FOREARM SMALL LEFT 00249 ORT33300LS 6.06 EA=1EA .00 1 00000000 18.00
COLLES FOREAR 6.06 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500158 COMBINE DRESSING SURGIPAD 00249 NON21453 .083 EA=1EA .00 1 00000000 2.00
COMBINE DRESS 19.92 CS=240EA/CS 240 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2330513 COMPLEX PROCEDURE .00 EA= .00 1 00000000 985.00
COMPLEX PROCE .00 .00 2 00000000 .00
.......... 36(0450) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001521 COMPLY 3983MM 00249 3983MM 106.71 BX=1BX .00 1 00000000 .00
COMPLY 3983M 106.71 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000352 COPY PAPER 00118 4COPY 3.45 RM=1RM .00 1 00000000 .00
COPY PAPER 00361 135848 34.50 CS=10RM/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000569 COPY PAPER-14" 00499 HAM10329-01 12.99 RM=1RM .00 1 00000000 .00
COPY PAPER-14 12.99 RM=1RM/RM 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 742
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000573 COPY PAPER-BLUE 00052 UNV11202 12.99 RM=1RM .00 1 00000000 .00
COPY PAPER-BL 12.99 RM=1RM/RM 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000570 COPY PAPER-GOLDENROD 00499 UNV11205 5.44 RM=1RM .00 1 00000000 .00
COPY PAPER-GO 5.44 RM=1RM/RM 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000575 COPY PAPER-GREEN 00499 UNV11203 10.49 RM=1RM .00 1 00000000 .00
COPY PAPER-GR 10.49 RM=1RM/RM 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000576 COPY PAPER-PINK 00499 UNV11204 4.03 RM=1RM .00 1 00000000 .00
COPY PAPER-PI 4.03 RM=1RM/RM 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000572 COPY PAPER-YELLOW 00499 UNV11201 12.99 RM=1RM .00 1 00000000 .00
COPY PAPER-YE 12.99 RM=1RM/RM 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000571 COPY PAPRER-BUFF 00499 UNV11206 5.27 RM=1RM .00 1 00000000 .00
COPY PAPRER-B 5.27 RM=1RM/RM 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001076 CORRECTION TAPE 00118 BICWOETP21 3.145 EA=1EA .00 1 00000000 .00
CORRECTION TA 6.29 EA=2EA/EA 2 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000975 COTTON TIP 6" STERILE 00249 MDS202000 1.666 BX=1BX .00 1 00000000 .00
COTTON TIP 6" 16.66 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 743
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000007 COTTONBALLS 00249 MDS21461 1.0015 BG=1BG .00 1 00000000 .00
COTTONBALLS 00062 13-3170 20.03 CS=20BG/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500459 CRADLE BOOT 00249 5.95551E+11 17.89 EA=1EA .00 1 00000000 49.00
CRADLE BOOT 17.89 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001023 CRITIKON PAPER ER 00760 E9050JC 25.00 BX=1BX .00 1 00000000 .00
CRITIKON PAPE 25.00 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001140 CRITIKON PAPER OR 00760 E9050K 25.00 BX=1BX .00 1 00000000 .00
CRITIKON PAPE 25.00 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500480 CRUTCHES ADULT 5’10"-6’6" 00249 MDSV80534 12.5617 EA=1EA .00 1 00000000 75.00
CRUTCHES ADUL 75.37 CS=6EA/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500481 CRUTCHES ADULT 5’2"TO 5’10 00249 MDSV80535 9.4213 EA=1EA .00 1 00000000 169.00
CRUTCHES ADUL 75.37 CS=8EA/CS 8 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500479 CRUTCHES XLONG 6’6"-7 2" 00249 9.84 EA=1EA .00 1 00000000 75.00
CRUTCHES XLON 59.03 CS=6EA/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500482 CRUTCHES YOUTH 4’6"TO 5’2" 00249 MDSV80536 9.9063 EA=1EA .00 1 00000000 75.00
CRUTCHES YOUT 79.25 CS=8EA/CS 8 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 744
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001550 CUFF 1 TUBE L ADULT LG.972 00328 99872 5.21 EA=1EA .00 1 00000000 .00
CUFF 1 TUBE L 104.20 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001627 CUFF ADULT SINGLE MDS9723D 00249 MDS9723DM 5.01 EA=1EA .00 1 00000000 .00
CUFF ADULT SI 25.07 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001552 CUFF DUAL ADULT LONG 3929 00328 39294 3.75 EA=1EA .00 1 00000000 .00
CUFF DUAL ADU 75.00 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001621 CUFF DUAL ADULT MDS9713DM 00249 MDS9713DM 3.82 EA=1EA .00 1 00000000 .00
CUFF DUAL ADU 19.08 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001581 CUFF DUAL ADULT MDS9713HP 00328 99593 5.52 EA=1EA .00 1 00000000 .00
CUFF DUAL ADU 110.48 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001554 CUFF DUAL CHILD 39296 00328 39296 4.14 EA=1EA .00 1 00000000 .00
CUFF DUAL CHI 82.80 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001624 CUFF DUAL CHILD MDS9711CM 00249 MDS9711DM 3.75 EA=1EA .00 1 00000000 .00
CUFF DUAL CHI 18.76 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001553 CUFF DUAL L.ADULT MDS9714H 00328 39291 5.05 EA=1EA .00 1 00000000 .00
CUFF DUAL L.A 101.04 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 745
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001622 CUFF DUAL LG ADULT MDS9714 00249 MDS9714DM 4.11 EA=1EA .00 1 00000000 .00
CUFF DUAL LG 20.53 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001625 CUFF INFANT SINGLE MDS9720 00249 MDS9720DM 4.83 EA=1EA .00 1 00000000 .00
CUFF INFANT S 24.17 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001628 CUFF LG.ADULT SING.MDS9724 00249 MDS9724DM 5.53 EA=1EA .00 1 00000000 .00
CUFF LG.ADULT 27.65 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001551 CUFF S.ADULT LONG MDS9723H 00249 MDS9723HPL 5.108 EA=1EA .00 1 00000000 .00
CUFF S.ADULT 25.54 PK=5EA/PK 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001546 CUFF SINGLE ADULT MDS9913HP 00249 MDS9913HP 2.954 EA=1EA .00 1 00000000 .00
CUFF SINGLE A 14.77 PK=5EA/PK 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001549 CUFF SINGLE INFANT MDS9720 00249 MDS9720HP 3.23 EA=1EA .00 1 00000000 .00
CUFF SINGLE I 16.15 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001545 CUFF SINGLE L.ADULT MDS9914HP 00249 MDS9914HP 4.272 EA=1EA .00 1 00000000 .00
CUFF SINGLE L 21.36 BX=5EA/BX 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001547 CUFF SINGLE SM.ADULT MDS9912HP 00249 MDS9912HP 3.904 EA=1EA .00 1 00000000 .00
CUFF SINGLE S 19.52 CS=5EA/CS 5 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 746
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500002 CULTURE SWAB 00249 B-D220109 1.1872 EA=1EA .00 1 00031110 18.00
CULTURE SWAB 00146 220109 59.36 BG=50EA/BG 50 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001341 CUP 16OZ. 00692 2373 40.77 CS=1CS .00 1 00000000 .00
CUP 16OZ. 40.77 CS=1CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000343 CUP SOUFFLE 00249 NON024220 1.53 PK=1PK .00 1 00000000 .00
CUP SOUFFLE 30.60 CS=20PK/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000345 CUPS 5OZ 00249 NON03005 1.9224 PK=1PK .00 1 00000000 .00
CUPS 5OZ 00062 63-0351 48.06 CS=25PK/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000344 CUPS MED PLASTIC 00249 DYND80000 .523 PK=1PK .00 1 00000000 .00
CUPS MED PLAS 26.15 CS=50PK/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000187 CURAD CLOTH TAPE 2" 00249 1538-2 5.40 BX=1BX .00 1 00000000 .00
DURAPORE TAPE 64.79 CS=12BX/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001424 CUSTOM CD 00089 XX 1.05 BX=1BX .00 1 00000000 .00
CUSTOM CD 1.05 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001487 CUSTOM HOLTER KITS 00111 S0A2R5ABKW 4.35 EA=1EA .00 1 00000000 .00
CUSTOM HOLTER 4.35 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 747
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501403 CVP DRESSING TRAY 00249 DYND75223 2.7213 EA=1EA .00 1 00000000 169.00
CVP DRESSING 108.85 CS=40EA/CS 40 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 31300025 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000100 CYSTO BLADDER 00249 07062C4040 3.31 EA=1EA .00 1 00000000 .00
CYSTO BLADDER 159.05 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501575 CYTOLOGY BRUSH 00756 158R 11.50 EA=1EA .00 1 00000000 79.00
CYTOLOGY BRUS 230.00 BX=20BX/BX 20 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000101 DEFIB PAD 00249 4509-02346N 4.00 EA=1EA .00 1 00000000 .00
DEFIB PAD 39.95 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001261 DEFOAMER 00522 3238 13.99 BT=1BT .00 1 00000000 .00
DEFOAMER 13.99 BT=1BT 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000979 DENTIPS 00249 MDS096502 32.75 BX=1BX .00 1 00000000 .00
DENTIPS 65.50 CS=2BX/CS 2 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000181 DENTURE CUPS 00249 DYND70293 .9024 PK=1PK .00 1 00000000 .00
DENTURE CUPS 22.56 CS=25PK/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501202 DEODRANT 00249 MSC095010 .2293 EA=1EA .00 1 00000000 .00
DEODRANT 00062 D82-752 22.01 CS=96EA/CS 96 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 748
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500494 DERMABOND 00249 ETHDHVM12 15.6108 EA=1EA .00 1 00000000 103.00
DERMABOND 00202 DHVM12 187.33 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001096 DESK CALENDAR PD/WALL BK 00499 7.99 EA=1EA .00 1 00000000 .00
DESK CALENDAR 7.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000630 DESK STAPLER 00118 UNV43119 5.99 EA=1EA .00 1 00000000 .00
DESK STAPLER 5.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500009 DIAPER ADULT 00249 FITULTRALG 7.175 BG=1BG .00 1 00000000 70.00
DIAPER ADULT 00062 10-VB013 28.70 CS=4PK/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500010 DIAPER ADULTXL 00249 FITPLUSXLG 7.6875 PK=1PK .00 1 00000000 31.00
DIAPER ADULTX 30.75 CS=4PK/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501395 DIAPERS PULL-UP LG. 00249 MSC23505 6.2775 PK=1PK .00 1 00000000 31.00
DIAPERS PULL- 25.11 CS=4PK/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501394 DIAPERS PULL-UP MED 00249 MSC23005 6.2775 PK=1PK .00 1 00000000 31.00
DIAPERS PULL 25.11 CS=4PK/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501396 DIAPERS PULL-UP XL 00249 MSC23600 6.2775 PK=1PK .00 1 00000000 31.00
DIAPERS PULL- 25.11 CS=4PK/CS 4 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 749
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001405 DIGITAL THERMOMETER 00257 3596916814 4.72 EA=1EA .00 1 00000000 .00
DIGITAL THERM 113.28 CS=24EA/CS 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000461 DINAMAP PAPER 00257 8156 24.00 BX=1BX .00 1 00000000 .00
DINAMAP PAPER 24.00 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500250 DISP. VAGINAL SPECULUM 00249 W-A59001Z 1.4058 EA=1EA .00 1 00000000 81.00
DISP. VAGINAL 33.74 BX=24EA/BX 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000688 DISPOSABLE HEADSTRAP FOR B 01304 73312106 4.78 EA=1EA .00 1 00000000 59.00
DISPOSABLE HE 47.80 PK=10EA/PK 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500251 DONUT CUSHION 00249 2867-351819 1.34 EA=1EA .00 1 00000000 59.00
DONUT CUSHION 1.34 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500258 DRAIN BAG 1.50 00249 401933 1.16 EA=1EA .00 1 00000000 18.00
DRAIN BAG 1.5 11.62 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500260 DRAIN BAG 2.25 00249 SQU401935 .651 EA=1EA .00 1 00000000 18.00
DRAIN BAG 2.2 00072 401513 6.51 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500261 DRAIN BAG 2.75 00249 SQU401936 .651 EA=1EA .00 1 00000000 18.00
DRAIN BAG 2.7 00072 401936 6.51 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 750
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500098 DRAINAGE BAG 00249 DYND15205 2.3995 EA=1EA .00 1 00000000 30.00
DRAINAGE BAG 47.99 CS=20EA/CS 20 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500259 DRAINBAG 1.75 00249 SQU401512 .523 EA=1EA .00 1 00000000 18.00
DRAINBAG 1.7 5.23 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500257 DRAINBAG 1.25 00249 401510 1.65 EA=1EA .00 1 00000000 18.00
DRAINBAG 1.25 16.49 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501030 DRAPE LOWER EXTREMITY 00249 DYNJP8002 4.93 EA=1EA .00 1 00000000 46.00
DRAPE LOWER E 59.16 CS=12EA/CS 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500299 DRAPE SHEET 00249 DYNJP2419 1.96 EA=1EA .00 1 00000000 45.00
DRAPE SHEET 23.52 CS=12EA/CS 12 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501069 DRAPE UNDER BUTTOCK 00249 1259001229 .99 EA=1EA .00 1 00000000 110.00
DRAPE UNDER B 53.43 CS=54EA/CS 54 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001451 DUAL LUER LOCK M/FEM. 00249 BHL2C6250 .1788 EA=1EA .00 1 00000000 .00
DUAL LUER LOC 90.13 CS=504EA/CS 504 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500283 DUODERM 4X4 00249 SQU187660 1.912 EA=1EA .00 1 00000000 14.00
DUODERM 4X4 9.56 BX=5EA/BX 5 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 751
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500284 DUODERM 8X8 00249 1638187662 10.19 EA=1EA .00 1 00000000 49.00
DUODERM 8X8 50.93 BX=5EA/BX 5 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000186 DURAPORE TAPE 1" 00249 MMM15382 6.394 BX=1BX .00 1 00000000 .00
DURAPORE TAPE 63.94 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501059 DURAPREP 00249 4509008630 5.297 EA=1EA .00 1 00000000 30.00
DURAPREP 105.94 CS=20EA/CS 20 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501267 DYNA-HEX4 4OZ. 00249 MDS098710 1.7058 EA=1EA .00 1 00031110 25.00
DYNA-HEX4 4 81.88 CS=48EA/CS 48 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500124 E TRACH TUBE UNCUFFED 4.5 00277 4130-86226 1.04 EA=1EA .00 1 00031110 25.00
E TRACH TUBE 10.39 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500129 E,TRACH TUBE 6.0 00249 4130-086109 1.58 EA=1EA .00 1 00031110 25.00
E,TRACH TUBE 15.84 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001316 E-TRAP 00372 711099 11.00 EA=1EA .00 1 00000000 .00
E-TRAP 00414 711099 275.00 CS=25EA/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500134 E. TRACH TUBE 8.0 00249 4130086113 2.16 EA=1EA .00 1 00031110 25.00
E. TRACH TUBE 21.56 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 752
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500136 E. TRACH TUBE CUFF 10.0 00249 4130-086117 4.01 EA=1EA .00 1 00031110 35.00
E. TRACH TUBE 40.11 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500132 E. TRACH TUBE CUFF 7.5 00249 4130-086112 1.026 EA=1EA .00 1 00031110 25.00
E. TRACH TUBE 10.26 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500128 E.TRACH TUBE 5.5 00249 4130-086108 3.42 EA=1EA .00 1 00031110 35.00
E.TRACH TUBE 34.22 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500127 E.TRACH TUBE CUFF 5.0 00249 4130-86107 1.92 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 19.16 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500130 E.TRACH TUBE CUFF 6.5 00249 DYND43065 1.568 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 15.68 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500131 E.TRACH TUBE CUFF 7.0 00249 DYND43070 2.21 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 22.10 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500133 E.TRACH TUBE CUFF 8.5 00249 4130-086114 4.01 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 40.11 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500135 E.TRACH TUBE CUFF 9.0 00249 4130-086115 2.68 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 26.76 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 753
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500120 E.TRACH TUBE UNCUFF 2.5 00249 4130-086222 1.33 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 13.27 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500121 E.TRACH TUBE UNCUFFED 3.0 00249 4130-086223 1.04 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 10.39 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500122 E.TRACH TUBE UNCUFFED 3.5 00249 4130-86224 1.04 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 10.39 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500123 E.TRACH TUBE UNCUFFED 4.0 00249 4130-86225 1.04 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 10.39 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500126 E.TRACH TUBE UNCUFFED 5.5 00249 4130-86228 1.04 EA=1EA .00 1 00031110 25.00
E.TRACH TUBE 10.39 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001229 EAKIN SEAL COHESIVE 00257 1638839001 3.82 EA=1EA .00 1 00000000 .00
EAKIN SEAL CO 38.24 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001599 EAR CURETTES BLUE 00257 819004888 36.69 BX=1BX .00 1 00000000 .00
EAR CURETTES 36.69 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001600 EAR CURETTES GREEN 00257 819001222 36.69 BX=1BX .00 1 00000000 .00
EAR CURETTES 36.69 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 754
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001601 EAR CURETTES WHITE 00257 819009555 36.69 BX=1BX .00 1 00000000 .00
EAR CURETTES 36.69 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500988 EGG CRATE 00249 NON081962H 29.66 EA=1EA .00 1 00000000 200.00
EGG CRATE 29.66 EA=IEA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001133 EKG RECORDING PAPER 00929 9402-024 48.34 EA=1EA .00 1 00000000 .00
EKG RECORDING 48.34 CS=1EA/CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001134 EKG RECORDING TABS 00929 120 49.00 EA=1EA .00 1 00000000 .00
EKG RECORDING 49.00 CS=1EA/CS 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001120 ELASTIC NET 2" 00249 NONNET02 10.13 BX=1BX .00 1 00000000 .00
ELASTIC NET 2 10.13 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001121 ELASTIC NET 3" 00257 4304058440 6.15 BX=1BX .00 1 00000000 .00
ELASTIC NET 3 6.15 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001236 ELASTIC NET 4 00249 NONNET04 12.41 BX=1BX .00 1 00000000 .00
ELASTIC NET 4 12.41 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001237 ELASTIC NET 6 00249 NONNET06 17.09 BX=1BX .00 1 00000000 .00
ELASTIC NET 6 17.09 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 755
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000401 ELASTIC NET 7" 00249 NONNET07 19.78 BX=1BX .00 1 00000000 .00
ELASTIC NET 7 19.78 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000116 ELECTRODE ADULT 00249 MMM2560 5.785 PK=1PK .00 1 00000000 .00
ELECTRODE ADU 115.70 CS=20PK/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000115 ELECTRODE INFANT 00249 MDS611303AH 1.31 PK=1PK .00 1 00000000 .00
ELECTRODE INF 1.31 PK=1EA/PK 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500180 EMESIS BASIN 00249 DYND80321 .061 EA=1EA .00 1 00000000 5.00
EMESIS BASIN 15.24 CS=250EA/CS 250 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2504020 EMPI FLEECE PADS 00249 4509001581 .51 EA=1EA .00 1 00031110 214.00
EMPI FLEEC PA 3.04 CS=6EA/CS 6 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501137 ENDO POUCH 10MM 00249 ETHPOUCH 52.15 EA=1EA .00 1 00000000 .00
ENDO POUCH 10 00202 POUCH 312.90 BX=6EA/BX 6 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500005 ENEMA SET 00249 DYND-70100 .766 EA=1EA .00 1 00000000 68.00
ENEMA SET 36.77 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001157 ENVELOPES W/O WINDOWS CCH 00393 123 17.99 BX=1BX .00 1 00000000 .00
ENVELOPES W/ 17.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 756
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80001194 ENVELOPES WINDOW CCH 00393 1234 52.99 BX=1BX .00 1 00000000 .00
ENVELOPES WIN 52.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000679 ENVELOPES-#10 PAYROLL 00107 8003 49.00 BX=1BX .00 1 00000000 .00
ENVELOPES-#10 49.00 BX=1BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000581 ENVELOPES-BROWN CLASP 10X1 00052 UNV35267 23.99 BX=1BX .00 1 00000000 .00
ENVELOPES-BRO 23.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000580 ENVELOPES-BROWN CLASP 9X12 00052 UNV35264 19.99 BX=1BX .00 1 00000000 .00
ENVELOPES-BRO 00361 187021 19.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501333 EPISTAT NASAL CATH KIT 00251 15-27030 71.92 EA=1EA .00 1 00000000 503.00
EPISTAT NASAL 71.92 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500990 ER LACERATION TRAY 00249 DYNJ03000 3.5338 EA=1EA .00 1 00000000 133.00
ER LACERATION 00062 11-4523 56.54 CS=16EA/CS 16 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2504028 ERBE PAD 00854 20193-074 3.95 EA=1EA .00 1 00000000 732.00
ERBE PAD 197.50 BX=50EA/BX 50 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 3.95 1 .00 3 00000000 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT= 1
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500866 ESMARK BANDAGE 4X9 00249 5868055514 2.58 EA=1EA .00 1 00000000 35.00
ESMARK BANDAG 51.55 CS=20EA/CS 20 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 757
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
80000119 ESOPH. STETH 18FR 00249 DTXM1024215 4.4488 EA=1EA .00 1 00000000 .00
ESOPH. STETH 111.22 BX=25EA/BX 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500125 ETRACH TUBE UNCUFFED 5.0 00249 4130-86227 1.04 EA=1EA .00 1 00031110 25.00
ETRACH TUBE U 10.39 BX=10EA/BX 10 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000205 EXAM GLOVE NITRILE LG. 00249 T-X925030 3.254 BX=1BX .00 1 00000000 .00
EXAM GLOVE NI 00062 11-2523 32.54 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000204 EXAM GLOVE NITRILE MED. 00249 T-X925020 3.254 BX=1BX .00 1 00000000 .00
EXAM GLOVE NI 00062 11-2522 32.54 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000203 EXAM GLOVE NITRILE SM. 00249 T-X925010 3.254 BX=1BX .00 1 00000000 .00
EXAM GLOVE NI 00062 11-2521 32.54 CS=10BX/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000332 EXAM GLOVES LG S 00249 MDS194136Z .2234 EA=1EA .00 1 00000000 .00
EXAM GLOVES L 22.34 BX=100EA/BX 100 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001615 EXAM PAPER 00249 NON23322 1.8092 RL=1RL .00 1 00000000 .00
EXAM PAPER 21.71 CS=12RL/CS 12 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2504004 EXUDERM 2X2 00249 MSC5522 .765 EA=1EA .00 1 00000000 18.00
EXUDERM 2X2 7.65 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 758
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501139 EXUDERM 4X4 00249 MSC5544 1.504 EA=1EA .00 1 00000000 26.00
EXUDERM 4X4 15.04 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500173 EYE PAD SMALL 00249 NON21600Z .0632 EA=1EA .00 1 00000000 11.00
EYE PAD SMALL 3.16 BX=50EA/BX 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001595 EZ STABILIZER 00053 9066 4.00 EA=1EA .00 1 00000000 36.00
EZ STABILIZER 4.00 EA=1EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90000737 EZPAP THERAPY SYS PRESS PO 01304 26230747 15.00 EA=1EA .00 1 00031110 100.00
EZPAP THERAPY 150.00 CS=10EA/CS 10 .00 2 00031220 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500216 FACIAL TISSUE 00249 NON243275 .1347 BX=1BX .00 1 00031110 5.00
FACIAL TISSUE 00062 13-200 26.94 CS=200BX/CS 200 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501510 FALL RISK KIT LARGE 00249 6238Y 3.69 EA=1EA .00 1 00000000 146.00
FALL RISK KIT 00304 6237Y 3.69 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501509 FALL RISK KIT REGULAR 00249 6236Y 19.37 EA=1EA .00 1 00000000 146.00
FALL RISK KIT 19.37 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501511 FALL RISK SLIPPERS LARGE 00249 516306250L 5.08 EA=1EA .00 1 00000000 38.00
FALL RISK SLI 5.08 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 759
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501512 FALL RISK SLIPPERS MEDIUM 00249 516306250M 4.93 EA=1EA .00 1 00000000 86.00
FALL RISK SLI 4.93 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501514 FALL RISK SLIPPERS SMALL 00249 516306250S 5.17 EA=1EA .00 1 00000000 86.00
FALL RISK SLI 124.08 CS=24EA/CS 24 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501508 FALL RISK SOCKS STANDARD 00249 MDTPS4B03FPY .96 EA=1EA .00 1 00000000 .00
FALL RISK SOC 00304 6239Y 46.08 CS=48EA/CS 48 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501507 FALL RISK SOCKS LARGE 00249 MDTPS4B04FPY .9906 EA=1EA .00 1 00031110 10.00
FALL RISK SOC 00304 6239LY 47.55 CS=48EA/CS 48 .00 2 00031111 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000656 FASTENERS-2" 00499 UNV81002 2.69 EA=1EA .00 1 00000000 .00
FASTENERS-2" 2.69 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000666 FASTENERS-SELF ADHESIVE 00361 SMD68220 17.99 BX=1BX .00 1 00000000 .00
FASTENERS-SEL 00118 SMD68220 17.99 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001258 FAX CART.TN430 00052 IVRTN430 49.99 EA=1EA .00 1 00000000 .00
FAX CART.TN43 00361 IVRTN430 49.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000623 FAX CARTRIDGE TN420 00361 IVRTN420 47.99 EA=1EA .00 1 00000000 .00
BRTTN420 47.99 EA=1EA/EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 760
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500293 FECAL INCONT.COLLECTION 00249 9822 5.06 EA=1EA .00 1 00000000 30.00
FECAL INCONT. 50.62 BX=10EA/BX 10 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500105 FEEDING TUBE 8FR 00249 BRD0036410H .56 EA=1EA .00 1 00000000 16.00
FEEDING TUBE .56 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500146 FEEDING TUBE INFANT 5FR‘ 00249 BRD0036400H .57 EA=1EA .00 1 00000000 16.00
FEEDING TUBE .57 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501231 FEMALE CATH KIT 00249 DYND10805 1.5424 EA=1EA .00 1 00000000 23.00
FEMALE CATH K 38.56 CS=25EA/CS 25 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001382 FEMORAL LEG SPLINT 25" 00585 79-72295 36.39 EA=1EA .00 1 00000000 311.00
FEMORAL LEG S 36.39 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500333 FENESTRATED TOWEL 00249 DYA4409Z .2098 EA=1EA .00 1 00000000 5.00
FENESTRATED T 10.49 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000585 FILE FOLDER STANDARD 00052 UNV12113 8.29 BX=1BX .00 1 00000000 .00
FILE FOLDER S 00361 744100 8.29 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41214 .00 .00 3 00031300 .00
MULT QTY:N MULT ORD:N ASSOC CHGS: RAW PROC CNT=
0 CHG AMT:Y CHG @ ORD ENTRY:Y AUTO COMP ORD:Y VIEW UNVER ORD:N PRT ORD SLIP:N CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001635 FILTER NEEDLE 18GA.X11/2 00257 3.58381E+11 22.50 BX=1BX .00 1 00000000 .00
FILTER NEEDLE 22.50 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 761
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001204 FINGER SPLINT 00249 ZIM254801700 1.9183 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 23.02 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001205 FINGER SPLINT 00420 66-0025-002-00 2.41 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 28.93 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001206 FINGER SPLINT 00420 66-0017-001-00 1.17 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 13.98 BX=12EA/BX 12 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001207 FINGER SPLINT 00249 ZIM254801500 3.1617 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 18.97 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001208 FINGER SPLINT 00420 00-2548-016-00 .88 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 5.28 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001209 FINGER SPLINT 00420 00-2548-017-00 .94 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 5.63 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001210 FINGER SPLINT PLASTALUME 00420 00-2548-015-00 .97 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 5.82 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001211 FINGER SPLINT PLASTALUME 00420 00-2548-018-00 1.02 EA=1EA .00 1 00000000 18.00
FINGER SPLINT 6.09 BX=6EA/BX 6 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 762
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500292 FLATUS BAG 00249 3583145524 1.20 EA=1EA .00 1 00000000 23.00
FLATUS BAG 59.81 CS=50EA/CS 50 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500106 FLEXIFLO 8FR 00249 5520-000473 14.69 EA=1EA .00 1 00000000 158.00
FLEXIFLO 8FR 146.90 CS=10EA/CS 10 .00 2 00000000 .00
.......... 44(0272) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001230 FLEXISENSOR ADULT 00719 0998-00-0076-05 51.46 PK=1PK .00 1 00000000 .00
FLEXISENSOR A 154.38 PK=3PK/PK 3 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000067 FLEXISENSOR ADULT BANDAGE 00719 0683-00-0409-02 103.08 BX=1BX .00 1 00000000 .00
FLEXISENSOR A 103.08 BX=1BX/BX 1 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001112 FLOW SELECTOR,STANDARD 01304 715-PM1000 28.38 EA=1EA .00 1 00000000 .00
FLOW SELECTOR 28.38 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501303 FLOW TRON 00033 DVT10 17.29 EA=1EA .00 1 00031110 254.00
FLOW TRON 00249 MDS601MD 17.29 EA=1EA/EA 1 .00 2 00031220 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:Y
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000303 FOG FREE MASK GREEN 00249 NON27378A 7.8617 BX=1BX .00 1 00000000 .00
FOG FREE MASK 47.17 CS=6BX/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80000302 FOG FREE MASK W/ SHIELD OR 00249 NON27710 8.95 BX=1BX .00 1 00000000 .00
FOG FREE MASK 53.70 CS=6BX/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 763
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2500091 FOLEY TRAY 14FR 00249 DYND160414 21.036 EA=1EA .00 1 00000000 128.00
FOLEY TRAY 14 210.36 CS=10EA/CS 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500092 FOLEY TRAY 16FR 00249 BRD800361 6.725 CS=1EA .00 1 00000000 288.00
FOLEY TRAY 16 00062 27-802016 67.25 CS=10EA/CS 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500093 FOLEY TRAY 18FR 00249 BRD800362 6.725 EA=1EA .00 1 00000000 288.00
FOLEY TRAY 18 67.25 CS=10EA/CS 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501636 FOLEY TRAY URINE METER 16F 00249 0620303316A 18.94 EA=1EA .00 1 00000000 131.00
FOLEY TRAY UR 189.41 CS=10EA/CS 10 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2501637 FOLEY TRAY URINE METER 18F 00249 0620303318A 18.94 EA=1EA .00 1 00000000 .00
FOLEY TRAY UR 189.41 CS=10EA/CS 10 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
80001591 FOLEY TRICOT STAT LOK 00257 0620FOL0102 3.01 EA=1EA .00 1 00000000 .00
FOLEY TRICOT 75.31 CS=25EA/CS 25 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001292 FOREARM PADDED LT,LG. 00585 79-71977 4.26 EA=1EA .00 1 00000000 18.00
FOREARM PADDE 4.26 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001291 FOREARM PADDED RT,LG. 00585 79-71987 4.26 EA=1EA .00 1 00000000 18.00
FOREARM PADDE 4.26 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 764
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
90001317 FOREARM SPLINT LEFT 00585 79-71973 4.26 EA=1EA .00 1 00000000 .00
FOREARM SPLIN 4.26 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001398 FOREARM SPLINT LEFT 00585 79-71972 4.36 EA=1EA .00 1 00000000 .00
FOREARM SPLIN 4.36 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001302 FOREARM SPLINT LEFT MED. 00585 79-71975 4.32 EA=1EA .00 1 00000000 18.00
FOREARM SPLIN 4.32 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001281 FOREARM SPLINT R 00585 79-71985 4.32 EA=1EA .00 1 00000000 18.00
FOREARM SPLIN 4.32 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001490 FROG FINGER SPLINT 13/4" 00522 VC5407 22.00 EA=1EA .00 1 00000000 18.00
FROG FINGER S 22.00 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001488 FROG FINGER SPLINT 21/4 00522 VC5406 22.00 EA=1EA .00 1 00000000 18.00
FROG FINGER S 22.00 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
90001489 FROG FINGER SPLINT 3" 00522 VC5408 22.00 EA=1EA .00 1 00000000 18.00
FROG FINGER S 22.00 EA=1EA 1 .00 2 00000000 .00
.......... 43(0270) INV.GL= EXP.GL= .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500403 GAIT TRANSFER BELT 00249 MDT828203 3.5983 EA=1EA .00 1 00000000 35.00
GAIT TRANSFER 21.59 CS=6EA/CS 6 .00 2 00000000 .00
.......... 43(0270) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
RUN DATE: 01/02/19 CANDLER COUNTY HOSPITAL PAGE 765
TIME: 08:24 ITEM MASTER LIST DEPT# 015 SWING BED H5IVREP1

NUMBER DESCRIPTION ------SUPPLIERS----- ----------UNITS OF ISSUE---------- WORK ----REVENUE----

SHORT-DESC GENERIC VEND MANUFACTURER # COST PACKING DESC. CONV. VALUE G/L PRICE
------------------------------------------------------------------------------------------------------------------------------------
2501390 GASTROSTOMY TUBE 00058 51364 23.37 EA=1EA .00 1 00000000 163.00
GASTROSTOMY T 00249 DYND70320 23.37 EA=1EA/EA 1 .00 2 00000000 .00
.......... 44(0272) INV.GL=11111025 EXP.GL=41115 .00 .00 3 00031300 .00
MULT QTY: MULT ORD: ASSOC CHGS: RAW PROC CNT=
0 CHG AMT: CHG @ ORD ENTRY: AUTO COMP ORD: VIEW UNVER ORD: PRT ORD SLIP: CUMM DET SEQ: FREQ CODE: PAT CHG’ABLE:N
PHYSICIAN’S CHARGE: $.00 #:
------------------------------------------------------------------------------------------------------------------------------------
2500172 GAUZE 2X2 8PLY S 00249 PRM21224H 1.94 EA=1EA .00 1 00031110 2.00
GAUZE 2X2 8PL