| DIETARY | ||
| SERVICE CHARGE CODE | SERVICE DESCRIPTION | SERVICE CHARGE PRICE |
| 6000001 | EF-PULMOCARE 8 OZ | 1.87 |
| 6000002 | EF-PEDIASURE 8 OZ | 1.48 |
| 6000003 | EF-SUPP-VITAL POWDER 2.79 OZ | 3.87 |
| 6000004 | WATER STERILE 1 QUART | 6.02 |
| 6000005 | EF-JEVITY RTH 1000 CC | 9.60 |
| 6000007 | DIET CONSULTATION | 25.80 |
| 6000010 | EF-SUPP-PROMOD 6.6 GM SCOOP | 13.54 |
| 6000023 | DIETARY BREAKFAST | 5.91 |
| 6000027 | EF-NEPRO 8 OZ | 2.29 |
| 6000031 | DIETARY LUNCH | 7.31 |
| 6000040 | EF-ENSURE 8 OZ | 1.44 |
| 6000048 | DIETARY DINNER | 6.89 |
| 6000074 | SUSTAGEN BY DOSAGE | 1.34 |
| 6000086 | EF-SUPP-POLYCOSE PER HALF CUP | 0.69 |
| 6000110 | SUSTACAL PUDDINGS | 1.32 |
| 6000129 | SUSTACAL 8 OZ | 1.19 |
| 6000137 | SUSTACAL 12 OZ | 1.55 |
| 6000141 | CLEAR LIQUID DIET | 1.71 |
| 6000157 | FULL LIQUID DIET | 3.61 |
| 6000158 | EF-GLUCERNA 8 OZ | 2.64 |
| 6000222 | CLEAR LIQUID W/ ROSS SLD | 3.15 |