09/15/2025
M	0001U	RBC DNA HEA 35 AG 11 BLD GRP            	   576.00	  $576.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0003U	ONC OVAR 5 PRTN SER ALG SCOR            	   760.00	  $760.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0007U	RX TEST PRSMV UR W/DEF CONF             	    91.54	   $91.54	      ---	       --	009	0	0	0.00	    $0.00	N	
J	00100	ANESTH SALIVARY GLAND                   	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00102	ANESTH REPAIR OF CLEFT LIP              	     5.42	   $75.93	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00103	ANESTH BLEPHAROPLASTY                   	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00104	ANESTH ELECTROSHOCK                     	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00120	ANESTH EAR SURGERY                      	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00124	ANESTH EAR EXAM                         	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00126	ANESTH TYMPANOTOMY                      	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00140	ANESTH PROCEDURES ON EYE                	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00142	ANESTH LENS SURGERY                     	     5.42	   $75.93	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00144	ANESTH CORNEAL TRANSPLANT               	     5.42	   $75.93	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00145	ANESTH VITREORETINAL SURG               	     5.42	   $75.93	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00147	ANESTH IRIDECTOMY                       	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00148	ANESTH EYE EXAM                         	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00160	ANESTH NOSE/SINUS SURGERY               	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00162	ANESTH NOSE/SINUS SURGERY               	     6.32	   $88.54	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00164	ANESTH BIOPSY OF NOSE                   	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0016U	ONC HMTLMF NEO RNA BCR/ABL1             	   131.17	  $131.17	      ---	       --	009	0	0	0.00	    $0.00	N	
J	00170	ANESTH PROCEDURE ON MOUTH               	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00172	ANESTH CLEFT PALATE REPAIR              	     5.42	   $75.93	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00174	ANESTH PHARYNGEAL SURGERY               	     5.42	   $75.93	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00176	ANESTH PHARYNGEAL SURGERY               	     6.32	   $88.54	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0017M	ONC DLBCL MRNA 20 GENES ALG             	  2510.21	 $2510.21	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0017U	ONC HMTLMF NEO JAK2 MUT DNA             	    73.33	   $73.33	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0018U	ONC THYR 10 MICRORNA SEQ ALG            	  2401.67	 $2401.67	      ---	       --	009	0	0	0.00	    $0.00	N	
J	00190	ANESTH FACE/SKULL BONE SURG             	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00192	ANESTH FACIAL BONE SURGERY              	     6.32	   $88.54	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00210	ANESTH CRANIAL SURG NOS                 	     9.93	  $139.12	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00211	ANESTH CRAN SURG HEMOTOMA               	     0.00	    $0.00	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00212	ANESTH SKULL DRAINAGE                   	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00214	ANESTH SKULL DRAINAGE                   	     8.13	  $113.90	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00215	ANESTH SKULL REPAIR/FRACT               	     8.13	  $113.90	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00216	ANESTH HEAD VESSEL SURGERY              	    13.55	  $189.84	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00218	ANESTH SPECIAL HEAD SURGERY             	    11.74	  $164.48	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00220	ANESTH INTRCRN NERVE                    	     9.03	  $126.51	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00222	ANESTH HEAD NERVE SURGERY               	     5.42	   $75.93	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0022U	TGSAP NSM LUNG NEO DNA&RNA23            	  1560.00	 $1560.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0023U	ONC AML DNA DETCJ/NONDETCJ              	   198.81	  $198.81	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0026U	ONC THYR DNA&MRNA 112 GENES             	  2880.00	 $2880.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0027U	JAK2 GENE TRGT SEQ ALYS                 	    97.53	   $97.53	      ---	       --	009	0	0	0.00	    $0.00	N	
J	00300	ANESTH HEAD/NECK/PTRUNK                 	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00320	ANESTH NECK ORGAN 1YR/>                 	     5.42	   $75.93	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00322	ANESTH BIOPSY OF THYROID                	     2.71	   $37.97	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00326	ANESTH LARYNX/TRACH < 1 YR              	     7.22	  $101.15	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0034U	TPMT NUDT15 GENES                       	   372.94	  $372.94	      ---	       --	009	0	0	0.00	    $0.00	N	
J	00350	ANESTH NECK VESSEL SURGERY              	     9.03	  $126.51	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00352	ANESTH NECK VESSEL SURGERY              	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0035U	NEURO CSF PRION PRTN QUAL               	   432.79	  $432.79	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0037U	TRGT GEN SEQ DNA 324 GENES              	  2800.00	 $2800.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0038U	VITAMIN D SRM MICROSAMP QUAN            	    23.68	   $23.68	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0039U	DNA ANTB 2STRAND HI AVIDITY             	    10.99	   $10.99	      ---	       --	009	0	0	0.00	    $0.00	N	
J	00400	ANESTH SKIN EXT/PER/ATRUNK              	     2.71	   $37.97	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00402	ANESTH SURGERY OF BREAST                	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00404	ANESTH SURGERY OF BREAST                	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00406	ANESTH SURGERY OF BREAST                	    11.74	  $164.48	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0040U	BCR/ABL1 GENE MAJOR BP QUAN             	   327.92	  $327.92	      ---	       --	009	0	0	0.00	    $0.00	N	
J	00410	ANESTH CORRECT HEART RHYTHM             	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0041U	B BRGDRFERI ANTB 5 PRTN IGM             	    13.77	   $13.77	      ---	       --	009	0	0	0.00	    $0.00	N	
L	0042T	CT PERFUSION W/CONTRAST CBF             	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
M	0042U	B BRGDRFERI ANTB 12 PRTN IGG            	    13.77	   $13.77	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0043U	TBRF B GRP ANTB 4 PRTN IGM              	    11.89	   $11.89	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0044U	TBRF B GRP ANTB 4 PRTN IGG              	    11.89	   $11.89	      ---	       --	009	0	0	0.00	    $0.00	N	
J	00450	ANESTH SURGERY OF SHOULDER              	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00454	ANESTH COLLAR BONE BIOPSY               	     2.71	   $37.97	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0046U	FLT3 GENE ITD VARIANTS QUAN             	   325.94	  $325.94	      ---	       --	009	0	0	0.00	    $0.00	N	
J	00470	ANESTH REMOVAL OF RIB                   	     5.42	   $75.93	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00472	ANESTH CHEST WALL REPAIR                	     9.03	  $126.51	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00474	ANESTH SURGERY OF RIB                   	    11.74	  $164.48	      ---	       --	002	0	0	0.00	    $0.00	N	
M	0047U	ONC PRST8 MRNA 17 GENE ALG              	  3098.40	 $3098.40	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0049U	NPM1 GENE ANALYSIS QUAN                 	   325.94	  $325.94	      ---	       --	009	0	0	0.00	    $0.00	N	
J	00500	ANESTH ESOPHAGEAL SURGERY               	    13.55	  $189.84	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0050U	TRGT GEN SEQ DNA 194 GENES              	  2333.28	 $2333.28	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0051U	RX MNTR LC-MS/MS UR/BLD 31              	   154.97	  $154.97	      ---	       --	009	0	0	0.00	    $0.00	N	
J	00520	ANESTH CHEST PROCEDURE                  	     5.42	   $75.93	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00522	ANESTH CHEST LINING BIOPSY              	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00524	ANESTH CHEST DRAINAGE                   	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00528	ANES MEDIASCPY & DX THORSCPY            	     7.22	  $101.15	      ---	       --	002	0	0	0.00	    $0.00	N	
J	00529	ANES MEDSCPY&THORSCPY 1 LUNG            	     9.93	  $139.12	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0052U	LPOPRTN BLD W/5 MAJ CLASSES             	    27.09	   $27.09	      ---	       --	009	0	0	0.00	    $0.00	N	
J	00530	ANESTH PACEMAKER INSERTION              	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00532	ANESTH VASCULAR ACCESS                  	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00534	ANESTH CARDIOVERTER/DEFIB               	     6.32	   $88.54	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00537	ANESTH CARDIAC ELECTROPHYS              	     6.32	   $88.54	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00539	ANESTH TRACH-BRONCH RECONST             	    16.25	  $227.66	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00540	ANESTH CHEST SURGERY                    	    11.74	  $164.48	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00541	ANESTH ONE LUNG VENTILATION             	    13.55	  $189.84	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00542	ANESTHESIA REMOVAL PLEURA               	    13.55	  $189.84	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00546	ANESTH LUNG CHEST WALL SURG             	    13.55	  $189.84	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00548	ANESTH TRACHEA BRONCHI SURG             	    13.55	  $189.84	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0054U	RX MNTR 14+ DRUGS & SBSTS               	   119.17	  $119.17	      ---	       --	009	0	0	0.00	    $0.00	N	
J	00550	ANESTH STERNAL DEBRIDEMENT              	     9.03	  $126.51	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00560	ANESTH HEART SURG W/O PUMP              	    13.55	  $189.84	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00561	ANESTH HEART SURG <1 YR                 	    22.58	  $316.35	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00562	ANESTH HRT SURG W/PMP AGE 1+            	    18.06	  $253.02	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00563	ANESTH HEART SURG W/ARREST              	    22.58	  $316.35	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00566	ANESTH CABG W/O PUMP                    	    22.58	  $316.35	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00567	ANESTH CABG W/PUMP                      	     0.00	    $0.00	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00580	ANESTH HEART/LUNG TRANSPLNT             	    18.06	  $253.02	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0058U	ONC MERKEL CLL CARC SRM QUAN            	   258.37	  $258.37	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0059U	ONC MERKEL CLL CARC SRM +/-             	   258.37	  $258.37	      ---	       --	009	0	0	0.00	    $0.00	N	
J	00600	ANESTH SPINE CORD SURGERY               	     9.03	  $126.51	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00604	ANESTH SITTING PROCEDURE                	    11.74	  $164.48	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00620	ANESTH SPINE CORD SURGERY               	     9.03	  $126.51	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00625	ANES SPINE TRANTHOR W/O VENT            	    11.74	  $164.48	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00626	ANES SPINE TRANSTHOR W/VENT             	    13.55	  $189.84	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00630	ANESTH SPINE CORD SURGERY               	     7.22	  $101.15	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00632	ANESTH REMOVAL OF NERVES                	     6.32	   $88.54	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00635	ANESTH LUMBAR PUNCTURE                  	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00640	ANESTH SPINE MANIPULATION               	     2.71	   $37.97	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0064U	ANTB TP TOTAL&RPR IA QUAL               	    25.06	   $25.06	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0065U	SYFLS TST NONTREPONEMAL ANTB            	    14.47	   $14.47	      ---	       --	009	0	0	0.00	    $0.00	N	
J	00670	ANESTH SPINE CORD SURGERY               	    11.74	  $164.48	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0068U	CANDIDA SPECIES PNL AMP PRB             	   114.10	  $114.10	      ---	       --	009	0	0	0.00	    $0.00	N	
J	00700	ANESTH ABDOMINAL WALL SURG              	     2.71	   $37.97	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00702	ANESTH FOR LIVER BIOPSY                 	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00730	ANESTH ABDOMINAL WALL SURG              	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00731	ANES UPR GI NDSC PX NOS                 	     5.00	   $70.05	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00732	ANES UPR GI NDSC PX ERCP                	     6.00	   $84.06	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00750	ANES HRNA RPR UPR ABD NOS               	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00752	ANES HRNA RPR LMBR&VNT&/DEHS            	     5.42	   $75.93	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00754	ANES HRNA RPR OMPHALOCELE               	     6.32	   $88.54	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00756	ANES HRNA RPR DIPHRG HRNA               	     6.32	   $88.54	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00770	ANES PX MAJ ABD BLOOD VESSEL            	    13.55	  $189.84	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0077U	IG PARAPROTEIN QUAL BLD/UR              	    34.74	   $34.74	      ---	       --	009	0	0	0.00	    $0.00	N	
J	00790	ANES IPER UPR ABD NOS                   	     6.32	   $88.54	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00792	ANES IPER UPR ABD PRTL HPTC             	    11.74	  $164.48	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00794	ANES IPER UPR ABD PNCRTECT              	     7.22	  $101.15	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00796	ANES IPER UPR ABD LVR TRNSPL            	    27.09	  $379.53	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00797	ANES IPER UPR ABD GSTR PX MO            	     7.22	  $101.15	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00800	ANESTH ABDOMINAL WALL SURG              	     2.71	   $37.97	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00802	ANESTH FAT LAYER REMOVAL                	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00811	ANES LWR INTST NDSC NOS                 	     4.00	   $56.04	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00812	ANES LWR INTST SCR COLSC                	     3.00	   $42.03	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00813	ANES UPR LWR GI NDSC PX                 	     5.00	   $70.05	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00820	ANESTH ABDOMINAL WALL SURG              	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0082U	RX TEST DEF 90+ RX/SBSTS UR             	   197.54	  $197.54	      ---	       --	009	0	0	0.00	    $0.00	N	
J	00830	ANESTH REPAIR OF HERNIA                 	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00832	ANESTH REPAIR OF HERNIA                 	     5.42	   $75.93	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00834	ANESTH HERNIA REPAIR < 1 YR             	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00836	ANESTH HERNIA REPAIR PREEMIE            	     5.42	   $75.93	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00840	ANESTH SURG LOWER ABDOMEN               	     5.42	   $75.93	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00842	ANESTH AMNIOCENTESIS                    	     3.61	   $61.59	      ---	       --	037	0	0	0.00	    $0.00	Y	
J	00844	ANESTH PELVIS SURGERY                   	     6.32	   $88.54	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00846	ANESTH HYSTERECTOMY                     	     7.22	  $101.15	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00848	ANESTH PELVIC ORGAN SURG                	     7.22	  $101.15	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0084U	RBC DNA GNOTYP 10 BLD GROUPS            	   576.00	  $576.00	      ---	       --	009	0	0	0.00	    $0.00	N	
J	00851	ANESTH TUBAL LIGATION                   	     5.42	   $75.93	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00860	ANESTH SURGERY OF ABDOMEN               	     5.42	   $75.93	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00862	ANESTH KIDNEY/URETER SURG               	     6.32	   $88.54	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00864	ANESTH REMOVAL OF BLADDER               	     7.22	  $101.15	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00865	ANESTH REMOVAL OF PROSTATE              	     6.32	   $88.54	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00866	ANESTH REMOVAL OF ADRENAL               	     9.03	  $126.51	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00868	ANESTH KIDNEY TRANSPLANT                	     9.03	  $126.51	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00870	ANESTH BLADDER STONE SURG               	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00872	ANESTH KIDNEY STONE DESTRUCT            	     6.32	   $88.54	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00873	ANESTH KIDNEY STONE DESTRUCT            	     6.32	   $88.54	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0087U	CRD HRT TRNSPL MRNA 1283 GEN            	  2527.54	 $2527.54	      ---	       --	009	0	0	0.00	    $0.00	N	
J	00880	ANESTH ABDOMEN VESSEL SURG              	    13.55	  $189.84	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00882	ANESTH MAJOR VEIN LIGATION              	     9.03	  $126.51	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0088U	TRNSPLJ KDN ALGRFT REJ 1494             	  2527.54	 $2527.54	      ---	       --	009	0	0	0.00	    $0.00	N	
J	00902	ANESTH ANORECTAL SURGERY                	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00904	ANESTH PERINEAL SURGERY                 	     6.32	   $88.54	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00906	ANES VULVECTOMY                         	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00908	ANESTH REMOVAL OF PROSTATE              	     5.42	   $75.93	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00910	ANESTH BLADDER SURGERY                  	     2.71	   $37.97	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00912	ANESTH BLADDER TUMOR SURG               	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00914	ANESTH REMOVAL OF PROSTATE              	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00916	ANESTH BLEEDING CONTROL                 	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00918	ANESTH STONE REMOVAL                    	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00920	ANESTH GENITALIA SURGERY                	     2.71	   $37.97	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00921	ANESTH VASECTOMY                        	     2.71	   $37.97	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00922	ANESTH SPERM DUCT SURGERY               	     5.42	   $75.93	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00924	ANESTH TESTIS EXPLORATION               	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00926	ANESTH REMOVAL OF TESTIS                	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00928	ANESTH REMOVAL OF TESTIS                	     5.42	   $75.93	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00930	ANESTH TESTIS SUSPENSION                	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00932	ANESTH AMPUTATION OF PENIS              	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00934	ANESTH PENIS NODES REMOVAL              	     5.42	   $75.93	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00936	ANESTH PENIS NODES REMOVAL              	     7.22	  $101.15	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00938	ANESTH INSERT PENIS DEVICE              	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00940	ANESTH VAGINAL PROCEDURES               	     2.71	   $37.97	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00942	ANESTH SURG ON VAG/URETHRAL             	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00944	ANESTH VAGINAL HYSTERECTOMY             	     5.42	   $75.93	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00948	ANESTH REPAIR OF CERVIX                 	     3.61	   $61.59	      ---	       --	037	0	0	0.00	    $0.00	Y	
J	00950	ANESTH VAGINAL ENDOSCOPY                	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	00952	ANESTH HYSTEROSCOPE/GRAPH               	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0107U	C DIFF TOX AG DETCJ IA STOOL            	    12.80	   $12.80	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0109U	ID ASPERGILLUS DNA 4 SPECIES            	   114.10	  $114.10	      ---	       --	009	0	0	0.00	    $0.00	N	
J	01112	ANESTH BONE ASPIRATE/BX                 	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01120	ANESTH PELVIS SURGERY                   	     5.42	   $75.93	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01130	ANESTH BODY CAST PROCEDURE              	     2.71	   $37.97	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01140	ANESTH AMPUTATION AT PELVIS             	    13.55	  $189.84	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01150	ANESTH PELVIC TUMOR SURGERY             	     7.22	  $101.15	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01160	ANESTH PELVIS PROCEDURE                 	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01170	ANESTH PELVIS SURGERY                   	     7.22	  $101.15	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01173	ANESTH FX REPAIR PELVIS                 	    10.84	  $151.87	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0118U	TRNSPLJ DON-DRV CLL-FR DNA              	  2753.25	 $2753.25	      ---	       --	009	0	0	0.00	    $0.00	N	
J	01200	ANESTH HIP JOINT PROCEDURE              	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01202	ANESTH ARTHROSCOPY OF HIP               	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0120U	ONC B CLL LYMPHM MRNA 58 GEN            	  2008.17	 $2008.17	      ---	       --	009	0	0	0.00	    $0.00	N	
J	01210	ANESTH HIP JOINT SURGERY                	     5.42	   $75.93	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01212	ANESTH HIP DISARTICULATION              	     9.03	  $126.51	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01214	ANESTH HIP ARTHROPLASTY                 	     9.03	  $126.51	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01215	ANESTH REVISE HIP REPAIR                	     9.03	  $126.51	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01220	ANESTH PROCEDURE ON FEMUR               	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01230	ANESTH SURGERY OF FEMUR                 	     5.42	   $75.93	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01232	ANESTH AMPUTATION OF FEMUR              	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01234	ANESTH RADICAL FEMUR SURG               	     7.22	  $101.15	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01250	ANESTH UPPER LEG SURGERY                	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01260	ANESTH UPPER LEG VEINS SURG             	     2.71	   $37.97	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01270	ANESTH THIGH ARTERIES SURG              	     7.22	  $101.15	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01272	ANESTH FEMORAL ARTERY SURG              	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01274	ANESTH FEMORAL EMBOLECTOMY              	     5.42	   $75.93	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01320	ANESTH KNEE AREA SURGERY                	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01340	ANESTH KNEE AREA PROCEDURE              	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01360	ANESTH KNEE AREA SURGERY                	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01380	ANESTH KNEE JOINT PROCEDURE             	     2.71	   $37.97	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01382	ANESTH DX KNEE ARTHROSCOPY              	     2.71	   $37.97	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01390	ANESTH KNEE AREA PROCEDURE              	     2.71	   $37.97	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01392	ANESTH KNEE AREA SURGERY                	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01400	ANESTH KNEE JOINT SURGERY               	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01402	ANESTH KNEE ARTHROPLASTY                	     6.32	   $88.54	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01404	ANESTH AMPUTATION AT KNEE               	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0140U	NFCT DS FUNGI DNA 15 TRGT               	   156.75	  $156.75	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0141U	NFCT DS BACT&FNG GRAM POS               	   156.75	  $156.75	      ---	       --	009	0	0	0.00	    $0.00	N	
J	01420	ANESTH KNEE JOINT CASTING               	     2.71	   $37.97	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0142U	NFCT DS BACT&FNG GRAM NEG               	   156.75	  $156.75	      ---	       --	009	0	0	0.00	    $0.00	N	
J	01430	ANESTH KNEE VEINS SURGERY               	     2.71	   $37.97	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01432	ANESTH KNEE VESSEL SURG                 	     5.42	   $75.93	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01440	ANESTH KNEE ARTERIES SURG               	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01442	ANESTH KNEE ARTERY SURG                 	     7.22	  $101.15	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01444	ANESTH KNEE ARTERY REPAIR               	     7.22	  $101.15	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01462	ANESTH LOWER LEG PROCEDURE              	     2.71	   $37.97	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01464	ANESTH ANKLE/FT ARTHROSCOPY             	     2.71	   $37.97	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01470	ANESTH LOWER LEG SURGERY                	     2.71	   $37.97	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01472	ANESTH ACHILLES TENDON SURG             	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01474	ANESTH LOWER LEG SURGERY                	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01480	ANESTH LOWER LEG BONE SURG              	     2.71	   $37.97	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01482	ANESTH RADICAL LEG SURGERY              	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01484	ANESTH LOWER LEG REVISION               	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01486	ANESTH ANKLE REPLACEMENT                	     6.32	   $88.54	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01490	ANESTH LOWER LEG CASTING                	     2.71	   $37.97	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01500	ANESTH LEG ARTERIES SURG                	     7.22	  $101.15	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01502	ANESTH LWR LEG EMBOLECTOMY              	     5.42	   $75.93	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01520	ANESTH LOWER LEG VEIN SURG              	     2.71	   $37.97	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01522	ANESTH LOWER LEG VEIN SURG              	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0154U	ONC URTHL CA RNA FGFR3 GENE             	   385.71	  $385.71	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0155U	ONC BRST CA DNA PIK3CA GENE             	   219.86	  $219.86	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0157U	APC MRNA SEQ ALYS                       	   282.88	  $282.88	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0158U	MLH1 MRNA SEQ ALYS                      	   282.88	  $282.88	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0159U	MSH2 MRNA SEQ ALYS                      	   282.88	  $282.88	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0160U	MSH6 MRNA SEQ ALYS                      	   282.88	  $282.88	      ---	       --	009	0	0	0.00	    $0.00	N	
J	01610	ANESTH SURGERY OF SHOULDER              	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0161U	PMS2 MRNA SEQ ALYS                      	   282.88	  $282.88	      ---	       --	009	0	0	0.00	    $0.00	N	
J	01620	ANESTH SHOULDER PROCEDURE               	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01622	ANES DX SHOULDER ARTHROSCOPY            	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0162U	HERED COLON CA TRGT MRNA PNL            	   486.54	  $486.54	      ---	       --	009	0	0	0.00	    $0.00	N	
J	01630	ANESTH SURGERY OF SHOULDER              	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01634	ANESTH SHOULDER JOINT AMPUT             	     8.13	  $113.90	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01636	ANESTH FOREQUARTER AMPUT                	    13.55	  $189.84	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01638	ANESTH SHOULDER REPLACEMENT             	     9.03	  $126.51	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01650	ANESTH SHOULDER ARTERY SURG             	     5.42	   $75.93	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01652	ANESTH SHOULDER VESSEL SURG             	     9.03	  $126.51	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01654	ANESTH SHOULDER VESSEL SURG             	     7.22	  $101.15	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01656	ANESTH ARM-LEG VESSEL SURG              	     9.03	  $126.51	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0165U	PEANUT ALLG ASMT EPI                    	   463.76	  $463.76	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0166U	LIVER DS 10 BIOCHEM ASY SRM             	   402.72	  $402.72	      ---	       --	009	0	0	0.00	    $0.00	N	
J	01670	ANESTH SHOULDER VEIN SURG               	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01680	ANESTH SHOULDER CASTING                 	     2.71	   $37.97	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0169U	NUDT15&TPMT GENE COM VRNT               	   372.94	  $372.94	      ---	       --	009	0	0	0.00	    $0.00	N	
J	01710	ANESTH ELBOW AREA SURGERY               	     2.71	   $37.97	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01712	ANESTH UPPR ARM TENDON SURG             	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01714	ANESTH UPPR ARM TENDON SURG             	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01716	ANESTH BICEPS TENDON REPAIR             	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0171U	TRGT GEN SEQ ALYS PNL DNA 23            	  1519.06	 $1519.06	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0172U	ONC SLD TUM ALYS BRCA1 BRCA2            	  2424.00	 $2424.00	      ---	       --	009	0	0	0.00	    $0.00	N	
J	01730	ANESTH UPPR ARM PROCEDURE               	     2.71	   $37.97	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01732	ANESTH DX ELBOW ARTHROSCOPY             	     2.71	   $37.97	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01740	ANESTH UPPER ARM SURGERY                	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01742	ANESTH HUMERUS SURGERY                  	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01744	ANESTH HUMERUS REPAIR                   	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
L	0174T	CAD CXR WITH INTERP                     	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
J	01756	ANESTH RADICAL HUMERUS SURG             	     5.42	   $75.93	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01758	ANESTH HUMERAL LESION SURG              	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
L	0175T	CAD CXR REMOTE                          	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
J	01760	ANESTH ELBOW REPLACEMENT                	     6.32	   $88.54	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01770	ANESTH UPPR ARM ARTERY SURG             	     5.42	   $75.93	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01772	ANESTH UPPR ARM EMBOLECTOMY             	     5.42	   $75.93	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0177U	ONC BRST CA DNA PIK3CA 11               	   219.86	  $219.86	      ---	       --	009	0	0	0.00	    $0.00	N	
J	01780	ANESTH UPPER ARM VEIN SURG              	     2.71	   $37.97	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01782	ANESTH UPPR ARM VEIN REPAIR             	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0178U	PEANUT ALLG ASMT EPI CLIN RX            	   459.86	  $459.86	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0180U	ABO GNOTYP ABO 7 EXONS                  	   274.83	  $274.83	      ---	       --	009	0	0	0.00	    $0.00	N	
J	01810	ANESTH LOWER ARM SURGERY                	     2.71	   $37.97	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0181U	CO GNOTYP AQP1 EXON 1                   	   148.16	  $148.16	      ---	       --	009	0	0	0.00	    $0.00	N	
J	01820	ANESTH LOWER ARM PROCEDURE              	     2.71	   $37.97	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01829	ANESTH DX WRIST ARTHROSCOPY             	     2.71	   $37.97	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0182U	CROM GNOTYP CD55 EXONS 1-10             	   241.08	  $241.08	      ---	       --	009	0	0	0.00	    $0.00	N	
J	01830	ANESTH LOWER ARM SURGERY                	     2.71	   $37.97	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01832	ANESTH WRIST REPLACEMENT                	     5.42	   $75.93	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0183U	DI GNOTYP SLC4A1 EXON 19                	   148.16	  $148.16	      ---	       --	009	0	0	0.00	    $0.00	N	
J	01840	ANESTH LWR ARM ARTERY SURG              	     5.42	   $75.93	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01842	ANESTH LWR ARM EMBOLECTOMY              	     5.42	   $75.93	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01844	ANESTH VASCULAR SHUNT SURG              	     5.42	   $75.93	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0184U	DO GNOTYP ART4 EXON 2                   	   148.16	  $148.16	      ---	       --	009	0	0	0.00	    $0.00	N	
J	01850	ANESTH LOWER ARM VEIN SURG              	     2.71	   $37.97	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01852	ANESTH LWR ARM VEIN REPAIR              	     3.61	   $50.58	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0185U	FUT1 GNOTYP FUT1 EXON 4                 	   148.16	  $148.16	      ---	       --	009	0	0	0.00	    $0.00	N	
J	01860	ANESTH LOWER ARM CASTING                	     2.71	   $37.97	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0186U	FUT2 GNOTYP FUT2 EXON 2                 	   148.16	  $148.16	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0187U	FY GNOTYP ACKR1 EXONS 1-2               	   219.86	  $219.86	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0188U	GE GNOTYP GYPC EXONS 1-4                	   219.86	  $219.86	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0189U	GYPA GNOTYP NTRNS 1 5 EXON 2            	   219.86	  $219.86	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0190U	GYPB GNOTYP NTRNS 1 5 SEUX 3            	   219.86	  $219.86	      ---	       --	009	0	0	0.00	    $0.00	N	
J	01916	ANESTH DX ARTERIOGRAPHY                 	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0191U	IN GNOTYP CD44 EXONS 2 3 6              	   219.86	  $219.86	      ---	       --	009	0	0	0.00	    $0.00	N	
J	01920	ANESTH CATHETERIZE HEART                	     6.32	   $88.54	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01922	ANESTH CAT OR MRI SCAN                  	     6.32	   $88.54	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01924	ANES THER INTERVEN RAD ARTRL            	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01925	ANES THER INTERVEN RAD CARD             	     6.32	   $88.54	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01926	ANES TX INTERV RAD HRT/CRAN             	     7.22	  $101.15	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0192U	JK GNOTYP SLC14A1 EXON 9                	   219.86	  $219.86	      ---	       --	009	0	0	0.00	    $0.00	N	
J	01930	ANES THER INTERVEN RAD VEIN             	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01931	ANES THER INTERVEN RAD TIPS             	     6.32	   $88.54	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01932	ANES TX INTERV RAD TH VEIN              	     5.42	   $75.93	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01933	ANES TX INTERV RAD CRAN VEIN            	     6.32	   $88.54	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01937	ANES DRG/ASPIR CRV/THRC                 	     0.00	    $0.00	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01938	ANES DRG/ASPIR LMBR/SAC                 	     0.00	    $0.00	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01939	ANES NULYT AGT CRV/THRC                 	     0.00	    $0.00	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0193U	JR GNOTYP ABCG2 EXONS 2-26              	   226.30	  $226.30	      ---	       --	009	0	0	0.00	    $0.00	N	
J	01940	ANES NULYT AGT LMBR/SAC                 	     0.00	    $0.00	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01941	ANES NEUROMD/NTRVRT CRV/THRC            	     0.00	    $0.00	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01942	ANES NEUROMD/NTRVRT LMBR/SAC            	     0.00	    $0.00	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0194U	KEL GNOTYP KEL EXON 8                   	   148.16	  $148.16	      ---	       --	009	0	0	0.00	    $0.00	N	
J	01951	ANES 2&3 BURN LESS 4% TBSA              	     2.71	   $37.97	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01952	ANES 2&3 BURN 4-9% TBSA                 	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01953	ANES 2&3 BURN EA ADD 9% TBSA            	     0.90	   $12.61	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01958	ANES XTRNL CEPHALIC VERSION             	     4.52	   $77.11	      ---	       --	037	0	0	0.00	    $0.00	Y	
M	0195U	KLF1 TARGETED SEQUENCING                	   300.20	  $300.20	      ---	       --	009	0	0	0.00	    $0.00	N	
J	01960	ANES VAGINAL DELIVERY ONLY              	     4.52	   $77.11	      ---	       --	037	0	0	0.00	    $0.00	Y	
J	01961	ANES CESAREAN DELIVERY ONLY             	     6.32	  $107.82	      ---	       --	037	0	0	0.00	    $0.00	Y	
J	01962	ANES URGENT HYSTERECTOMY                	     5.93	  $101.17	      ---	       --	037	0	0	0.00	    $0.00	Y	
J	01963	ANES CESAREAN HYSTERECTOMY              	     5.93	  $101.17	      ---	       --	037	0	0	0.00	    $0.00	Y	
J	01965	ANES INCOMPL/MISSED AB PX               	     3.61	   $61.59	      ---	       --	037	0	0	0.00	    $0.00	Y	
J	01966	ANES INDUCED ABORTION PX                	     3.61	   $61.59	      ---	       --	037	0	0	0.00	    $0.00	Y	
J	01967	NEURAXL LBR ANES VAG DLVR               	     4.52	   $77.11	      ---	       --	037	0	0	0.00	    $0.00	Y	
J	01968	ANES/ANALG CS DLVR NEURAXIAL            	     1.81	   $30.88	      ---	       --	037	0	0	0.00	    $0.00	Y	
J	01969	ANES C HYST FLWG NEURAXIAL              	     4.52	   $77.11	      ---	       --	037	0	0	0.00	    $0.00	Y	
M	0196U	LU GNOTYP BCAM EXON 3                   	   148.16	  $148.16	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0197U	LW GNOTYP ICAM4 EXON 1                  	   148.16	  $148.16	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0198U	RHD&RHCE GNTYP RHD1-10&RHCE5            	   226.30	  $226.30	      ---	       --	009	0	0	0.00	    $0.00	N	
J	01990	SUPPORT FOR ORGAN DONOR                 	     6.32	   $88.54	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01991	ANESTH NERVE BLOCK/INJ                  	     2.71	   $37.97	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01992	ANESTH N BLOCK/INJ PRONE                	     4.52	   $63.33	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01996	HOSP MANAGE CONT DRUG ADMIN             	     2.71	   $37.97	      ---	       --	002	0	0	0.00	    $0.00	Y	
J	01999	UNLISTED ANES PROCEDURE                 	     0.00	    $0.00	      ---	       --	002	0	0	0.00	    $0.00	Y	
M	0199U	SC GNOTYP ERMAP EXONS 4 12              	   219.86	  $219.86	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0200U	XK GNOTYP XK EXONS 1-3                  	   219.86	  $219.86	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0202U	NFCT DS 22 TRGT SARS-COV-2              	   333.42	  $333.42	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0210U	SYPHILIS TST ANTB IA QUAN               	    14.90	   $14.90	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0216U	NEURO INH ATAXIA DNA 12 COM             	  1537.02	 $1537.02	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0217U	NEURO INH ATAXIA DNA 51 GENE            	  2198.35	 $2198.35	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0218U	NEURO MUSC DYS DMD SEQ ALYS             	  1823.20	 $1823.20	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0219U	NFCT AGT HIV GNRJ SEQ ALYS              	   725.00	  $725.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0221U	ABO GNOTYP NEXT GNRJ SEQ ABO            	   274.83	  $274.83	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0222U	RHD&RHCE GNTYP NEXT GNRJ SEQ            	   282.88	  $282.88	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0223U	NFCT DS 22 TRGT SARS-COV-2              	   238.88	  $238.88	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0224U	ANTIBODY SARS-COV-2 TITER(S)            	    33.70	   $33.70	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0225U	NFCT DS DNA&RNA 21 SARSCOV2             	   416.78	  $416.78	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0226U	SVNT SARSCOV2 ELISA PLSM SRM            	    42.28	   $42.28	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0227U	RX ASY PRSMV 30+RX/METABLT              	    62.14	   $62.14	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0230U	AR FULL SEQUENCE ANALYSIS               	   301.35	  $301.35	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0231U	CACNA1A FULL GENE ANALYSIS              	   846.27	  $846.27	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0232U	CSTB FULL GENE ANALYSIS                 	   274.83	  $274.83	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0233U	FXN GENE ANALYSIS                       	   274.83	  $274.83	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0234U	MECP2 FULL GENE ANALYSIS                	   527.87	  $527.87	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0235U	PTEN FULL GENE ANALYSIS                 	   600.00	  $600.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0236U	SMN1&SMN2 FULL GENE ANALYSIS            	   602.70	  $602.70	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0237U	CAR ION CHNLPTHY GEN SEQ PNL            	   584.90	  $584.90	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0238U	ONC LNCH SYN GEN DNA SEQ ALY            	   584.90	  $584.90	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0239U	TRGT GEN SEQ ALYS PNL 311+              	  3500.00	 $3500.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0242U	TRGT GEN SEQ ALYS PNL 55-74             	  5000.00	 $5000.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0244U	ONC SOLID ORGN DNA 257 GENES            	  3500.00	 $3500.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0245U	ONC THYR MUT ALYS 10 GEN&37             	  1266.07	 $1266.07	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0246U	RBC DNA GNOTYP 16 BLD GROUPS            	   720.00	  $720.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0268U	HEM AHUS GEN SEQ ALYS 15 GEN            	   608.17	  $608.17	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0269U	HEM AUT DM CGEN TRMBCTPNA 22            	   608.17	  $608.17	      ---	       --	009	0	0	0.00	    $0.00	N	
R	0270 	REV MEDICAL-SURGICAL SUPPLIES           	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0271U	HEM CGEN NEUTROPENIA 24 GEN             	   608.17	  $608.17	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0275U	HEM HEPRN NDUC TRMBCTPNA SRM            	    18.37	   $18.37	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0276U	HEM INH THROMBOCYTOPENIA 42             	  2448.56	 $2448.56	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0279U	HEM VW FACTOR&CLGN III BNDG             	    11.53	   $11.53	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0280U	HEM VW FACTOR&CLGN IV BNDG              	    17.27	   $17.27	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0281U	HEM VWD PROPEPTIDE AG LVL               	    17.27	   $17.27	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0282U	RBC DNA GNTYP 12 BLD GRP GEN            	   720.00	  $720.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0283U	VW FACTOR TYPE 2B EVAL PLSM             	    18.40	   $18.40	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0284U	VW FACTOR TYPE 2N EVAL PLSM             	    17.27	   $17.27	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0286U	CEP72 NUDT15&TPMT GENE ALYS             	   134.13	  $134.13	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0287U	ONC THYR DNA&MRNA 112 GENES             	  3600.00	 $3600.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0301U	IADNA BARTONELLA DDPCR                  	   262.72	  $262.72	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0302U	IADNA BRTNLA DDPCR FLWG LIQ             	   361.37	  $361.37	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0311U	NFCT DS BCT QUAN ANTMCRB SC             	     8.08	    $8.08	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0312U	AI DS SLE ALYS 8 IGG AUTOANT            	   840.65	  $840.65	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0314U	ONC CUTAN MLNMA MRNA 35 GENE            	  1950.00	 $1950.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0321U	IADNA GU PTHGN 20BCT&FNG ORG            	   634.84	  $634.84	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0323U	IADNA CNS PTHGN NEXT GEN SEQ            	  2126.20	 $2126.20	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0326U	TRGT GEN SEQ ALYS PNL 83+               	  5000.00	 $5000.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0327U	FTL ANEUPLOIDY TRSMY DNA SEQ            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0328U	DRUG ASSAY 120+ RX&METABLT              	   114.43	  $114.43	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0329U	ONC NEO XOME&TRNS SEQ ALYS              	  3437.98	 $3437.98	      ---	       --	009	0	0	0.00	    $0.00	N	
L	0330T	TEAR FILM IMG UNI/BI W/I&R              	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0331T	HEART SYMP IMAGE PLNR                   	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0332T	HEART SYMP IMAGE PLNR SPECT             	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
M	0333U	ONC LVR SURVEILANC HCC CFDNA            	   662.32	  $662.32	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0334U	ONC SLD ORGN TGSA DNA 84/+              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0339U	ONC PRST8 MRNA HOXC6 & DLX1             	   760.00	  $760.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0341U	FTL ANEUP DNA SEQ CMPR ALYS             	  1900.20	 $1900.20	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0345U	PSYC GENOM ALYS PNL 15 GEN              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
L	0348T	RSA SPINE EXAM                          	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0349T	RSA UPPER EXTR EXAM                     	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0350T	RSA LOWER EXTR EXAM                     	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
N	0352T	OCT BRST/NODE I&R PER SPEC              	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	0354T	OCT BREAST SURG CAVITY I&R              	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	0358T	BIA WHOLE BODY                          	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
M	0359U	ONC PRST8 CA ALYS ALL PSA               	   760.00	  $760.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0364U	ONC HL NEO GEN SEQ ALYS ALG             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0371U	IADNA GU PTHGN SEMIQ DNA16&1            	   416.78	  $416.78	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0372U	NFCT DS GU PTHGN ARG DETCJ              	   416.78	  $416.78	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0378U	RFC1 REPEAT XPNSJ VRNT ALYS             	   137.00	  $137.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0379U	TGSAP SL OR NEO DNA523&RNA55            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0381U	MAPLE SYRUP UR DS MNTR QUAN             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0382U	HYPRPHENYLALNINMIA MNTR QUAN            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0383U	TYROSINEMIA TYP I MNTR QUAN             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0388U	ONC NONSM CLL LNG CA 37 GEN             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0391U	ONC SLD TUM DNA&RNA 437 GEN             	  3600.00	 $3600.00	      ---	       --	009	0	0	0.00	    $0.00	N	
L	0394T	HDR ELCTRNC SKN SURF BRCHYTX            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0395T	HDR ELCTR NTRST/NTRCV BRCHTX            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
K	0402T	COLGN CRS-LINK CRN&PACHYMTRY            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	0402T	COLGN CRS-LINK CRN&PACHYMTRY            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
M	0408U	IAAD BLK AC WV BSNSR SARSCV2            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0409U	ONC SLD TUM DNA 80 & RNA 36             	  2919.60	 $2919.60	      ---	       --	009	0	0	0.00	    $0.00	N	
R	0420 	REV - PHYSICAL THERAPY                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
R	0421 	REV PHYSICAL THERAPY, VISIT             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
L	0422T	TACTILE BREAST IMG UNI/BI               	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
R	0430 	REV - OCCUPATIONAL THERAPY              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
R	0431 	REV OCCUPATIONAL THERAPY, VISIT         	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
L	0439T	MYOCRD CONTRAST PRFUJ ECHO              	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
R	0440 	REV - SPEECH THERAPY                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
R	0441 	REV MEDICAL SPEECH THERAPY VISIT        	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
R	0470 	REV - AUDIOLOGY                         	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0471U	ONC CLRC CA 35 VRN KRAS&NRAS            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0473U	ONC SLD TUM BLD/SLV 648 GENE            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0475U	HERED PRST8 CA GSAP 23 GENES            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0488U	OB FETAL AG NIPT CFDNA ALYS             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0493U	TRNSPL MED QUAN DD-CFDNA NGS            	  2753.25	 $2753.25	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0494U	RBC AG FTL RHD GENE ALYS NGS            	   759.05	  $759.05	      ---	       --	009	0	0	0.00	    $0.00	N	
L	0507T	NEAR IFR 2IMG MIBMN GLND I&R            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
R	0510 	REV - IHS-MOA CLINIC VISIT              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
R	0520 	REV - FREESTAND CLINIC                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
R	0521 	REV - FS-RURAL/CLINIC                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
R	0522 	REV - FS-RURAL/HOME                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
L	0523T	NTRAPX C FFR W/3D FUNCJL MAP            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
M	0523U	ONC SOLTUM DNA NGS SNV 22GEN            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
R	0524 	REV - FR/STD FAMILY CLINIC              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
R	0525 	REV - RHC/FQHC/SNF/NONCOVERED           	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
R	0527 	REV - RHC/FQHC/HOME/VIS NURSE           	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
R	0528 	REV - RHC/FQHC/OTHER SITE               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0528U	LRT IAD 18BCT/8VIR&7ARG RNA             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
R	0529 	REV - OTHER FS-CLINIC                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0540U	TRNSPLJ MED QUAN DD-CFDNA               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
L	0541T	MYOCARDIAL IMAGING MCG                  	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0542T	MYOCARDIAL IMAGING MCG I&R              	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
M	0543U	ONC SOL TUM NGS DNA 517 GENS            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
R	0551 	REV SKILLED NURSING, VISIT CHARGE       	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
R	0552 	REV HOSPICE SRV - RHC SIA               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
L	0554T	B1 STR & FX RSK ANALYSIS                	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0555T	B1 STR&FX RSK TRANSMIS DATA             	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0556T	B1 STR & FX RSK ASSESSMENT              	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0557T	B1 STR & FX RSK I&R                     	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0558T	CT SCAN F/BIOMCHN CT ALYS               	     0.00	    $0.00	      ---	       --	005	0	0	0.44	    $0.00	Y	
L	0559T	ANTMC MDL 3D PRINT 1ST CMPNT            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0560T	ANTMC MDL 3D PRINT EA ADDL              	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
R	0561 	REV - HH/MED SOC SVCS VISIT             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
L	0561T	ANTMC GUIDE 3D PRINT 1ST GD             	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0562T	ANTMC GUIDE 3D PRINT EA ADDL            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
M	0563U	NFCT DS PTHGN-SNA 11VIR&4BCT            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	0564U	NFCT DS PTHGN-SNA 10VIR&4BCT            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
R	0571 	REV HOME HEALTH AIDE VISIT CHARGE       	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
R	0572 	REV-HOME HEALTH AIDE,HOURLY CHARGE      	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
R	0580 	REV HOME HEALTH VISIT                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
R	0583 	REV HOME HEALTH OTHER VISITS ASSESS     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
R	0589 	REV HOME HEALTH OTHER VISITS; OTHER     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
N	0602T	TRANSDERMAL GFR MEASUREMENTS            	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	0603T	TRANSDERMAL GFR MONITORING              	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
L	0609T	MRS DISC PAIN ACQUISJ DATA              	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0610T	MRS DISC PAIN TRANSMIS DATA             	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0611T	MRS DISC PAIN ALG ALYS DATA             	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0612T	MRS DISCOGENIC PAIN I&R                 	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0623T	AUTO QUANTIFICATION C PLAQUE            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0624T	AUTO QUAN C PLAQ DATA PREP              	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0625T	AUTO QUAN C PLAQ CPTR ALYS              	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0626T	AUTO QUAN C PLAQ I&R                    	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0633T	CT BREAST W/3D UNI C-                   	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0634T	CT BREAST W/3D UNI C+                   	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0635T	CT BREAST W/3D UNI C-/C+                	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0636T	CT BREAST W/3D BI C-                    	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0637T	CT BREAST W/3D BI C+                    	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0638T	CT BREAST W/3D BI C-/C+                 	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0639T	WRLS SKN SNR ANISOTROPY MEAS            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0640T	NCNTC IFR SPCTRSC O/T PAD 1             	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0648T	QUAN MR TIS WO MRI 1ORGN                	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0649T	QUAN MR TISS W/MRI 1ORGN                	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
R	0650 	REV HOSPICE SRV - RHC HIGH              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
R	0651 	REV HOSPICE SRV - ROUTINE HOME CARE     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
R	0652 	REV HOSPICE SRV-CONTINUOUS HOME CARE    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
R	0655 	REV HOSPICE SRV-INPATIENT RESPITE CARE  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
R	0656 	REV HOSPICE SRV-GENERAL INPATIENT CARE  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
R	0657 	REV HOSPICE SRV-PHYSICIANS SERVICES     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
R	0658 	REV ROOM AND BOARD                      	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
L	0658T	ELEC IMPD SPECTRSC 1+SKN LES            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
R	0659 	REV HOSPICE SRV - RHC LOW               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
L	0689T	QUAN US TIS CHARAC W/O DX US            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0690T	QUAN US TIS CHARAC W/DX US              	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0691T	AUTO ALYS XST CT STD VRT FX             	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0693T	COMPRE FUL BDY 3D MTN ALYS              	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0694T	3D VOL IMG&RCNSTJ BRST/AX               	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0697T	QUAN MR TIS WO MRI MLT ORGN             	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0698T	QUAN MR TISS W/MRI MLT ORGN             	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
N	0700T	MOLEC FLUOR IMG SUS NEV 1ST             	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	0701T	MOLEC FLUOR IMG SUS NEV EA              	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
L	0710T	N-INVAS ARTL PLAQ ALYS                  	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0711T	N-NVS ARTL PLAQ ALYS DAT PRP            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0712T	N-NVS ARTL PLAQ ALYS QUAN               	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0713T	N-NVS ARTL PLAQ ALYS RVW I&R            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0721T	QUAN CT TISS CHARAC W/O CT              	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	N	
L	0722T	QUAN CT TISS CHARAC W/CT                	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	N	
L	0723T	QMRCP W/O DX MRI SM ANAT SES            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	N	
L	0724T	QMRCP W/DX MRI SAME ANATOMY             	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	N	
L	0742T	AQMBF SPECT XERS/STRS & REST            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	N	
L	0743T	B1 STR & FX RSK VRT FX ASSMT            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	N	
L	0749T	B1 STR&FX RSK ASSMT DXR-BMD             	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	N	
L	0750T	B1 STR&FX RSK ASMT DXRBMD1VW            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	N	
L	0815T	US REMS B1 DNS HIPS PLVS/SPI            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0857T	OPTO-ACOUSTIC IMG BREAST UNI            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0877T	AUGMNT ALYS CH CT ILD W/O CT            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0878T	AUGMNT ALYS CH CT ILD W/CT              	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0879T	AUGMNT ALYS CH CT ILD PREP              	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0880T	AUGMNT ALYS CH CT ILD I&R               	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0888T	HISTOTRIPSY MAL RENAL TISSUE            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0889T	PRSNLZ TRGT DVL ARHFCMRIGTBS            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0890T	ARHFCMRIGTBS 1ST TX DAY                 	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0891T	ARHFCMRIGTBS SBSQ TX DAY                	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0892T	ARHFCMRIGTBS SBSQ PER TX DAY            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0898T	N-INVAS PRST8 CANCER EST MAP            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0899T	N-INVAS DETER AQMBF AUG CMR             	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
R	0900 	REV - BH/TREATMENTS                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
L	0900T	N-INVAS EST AQMBF ASSTV CMR             	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
N	0906T	COMS THER 1ST APPL<=50 SQ CM            	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	0907T	COMS THER EA ADDL<=50 SQ CM             	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
R	0940 	REV - OTHER RX SVCS                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
L	0944T	3D CNTR SIMULA TRGT LVR LES             	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0945T	INTRAOP ASSMT ABNL TUM TISS             	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0946T	ORTHO IMPL MVMT ALYS PAIR CT            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0947T	MRGFUS STRTCTC BL-BR DISRPJ             	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0950T	ABLTJ B9 PRST8 TISSUE HIFU              	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
K	0951T	TOT IMPL AMEI 1ST PLMT                  	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	N	
O	0951T	TOT IMPL AMEI 1ST PLMT                  	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	0952T	TOT IMPL AMEI REV/RPLC MSTDC            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	0952T	TOT IMPL AMEI REV/RPLC MSTDC            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	N	
K	0953T	TOT IMPL AMEI REV/RPLC W/O              	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	N	
O	0953T	TOT IMPL AMEI REV/RPLC W/O              	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	0954T	TOT IMPL AMEI RPLC SND PROC             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	0954T	TOT IMPL AMEI RPLC SND PROC             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	N	
K	0955T	TOT IMPL AMEI REMOVAL                   	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	N	
O	0955T	TOT IMPL AMEI REMOVAL                   	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
L	0961T	SHORTWAVE IFR RADIATION IMG             	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
R	0969 	REV - PRO FEE/OTHER                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
L	0970T	ABLT B9 BRST TUM PERQ LSR EA            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0971T	ABLT MAL BRST TUM PQ LSR UNI            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0972T	ASSTV ALG CLSFCTN BURN HLG              	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
K	0978T	SUBMUCOSAL CRYOLYSIS THERAPY            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	N	
K	0979T	SBMCSL CRYLYS THER SFT PALT             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	N	
K	0980T	SBMCSL CRYLYS THER TNG&TNSL             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	N	
L	0984T	IV IMG XTRC CERE VSL OCT 1ST            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0985T	IV IMG XTRC CERE VSL OCT EA             	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0986T	IV IMG ICR CERE VSL OCT 1ST             	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	0987T	IV IMG ICR CERE VSL OCT EA              	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
K	10004	FNA BX W/O IMG GDN EA ADDL              	     1.21	   $45.05	      ---	       --	004	0	0	0.00	    $0.00	Y	
P	10004	FNA BX W/O IMG GDN EA ADDL              	     1.21	   $45.05	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	10005	FNA BX W/US GDN 1ST LES                 	     3.00	  $111.69	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	10005	FNA BX W/US GDN 1ST LES                 	     3.00	  $111.69	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	10006	FNA BX W/US GDN EA ADDL                 	     1.39	   $51.75	      ---	       --	004	0	0	0.00	    $0.00	Y	
P	10006	FNA BX W/US GDN EA ADDL                 	     1.39	   $51.75	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	10007	FNA BX W/FLUOR GDN 1ST LES              	     6.97	  $259.49	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	10007	FNA BX W/FLUOR GDN 1ST LES              	     6.97	  $259.49	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	10008	FNA BX W/FLUOR GDN EA ADDL              	     3.91	  $145.57	      ---	       --	004	0	0	0.00	    $0.00	Y	
P	10008	FNA BX W/FLUOR GDN EA ADDL              	     3.91	  $145.57	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	10009	FNA BX W/CT GDN 1ST LES                 	    11.51	  $428.52	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	10009	FNA BX W/CT GDN 1ST LES                 	    11.51	  $428.52	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	10010	FNA BX W/CT GDN EA ADDL                 	     6.90	  $256.89	      ---	       --	004	0	0	0.00	    $0.00	Y	
P	10010	FNA BX W/CT GDN EA ADDL                 	     6.90	  $256.89	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	10011	FNA BX W/MR GDN 1ST LES                 	     0.00	    $0.00	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	10011	FNA BX W/MR GDN 1ST LES                 	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	10012	FNA BX W/MR GDN EA ADDL                 	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
P	10012	FNA BX W/MR GDN EA ADDL                 	     0.00	    $0.00	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	10021	FNA BX W/O IMG GDN 1ST LES              	     0.00	    $0.00	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	10021	FNA BX W/O IMG GDN 1ST LES              	     1.97	   $73.34	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	10030	IMG GID FLU COLL DRG SFT TIS            	     3.58	  $133.28	      ---	  $168.08	004	1	0	0.00	    $0.00	Y	
P	10030	IMG GID FLU COLL DRG SFT TIS            	     3.58	  $133.28	      ---	  $168.08	004	1	0	0.00	    $0.00	Y	
K	10035	PLMT SFT TISS LOCLZJ DEV 1ST            	    13.23	  $492.55	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	10036	PLMT SFT TISS LOCLZJ DEV EA             	    11.57	  $430.75	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	10040	ACNE SURGERY                            	     1.29	   $48.03	      ---	   $60.57	004	1	1	0.00	    $0.00	Y	
X	10040	ACNE SURGERY                            	   108.61	  $108.61	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	10060	I&D ABSCESS SIMPLE/SINGLE               	   109.05	  $109.05	      ---	       --	009	1	1	0.00	    $0.00	Y	
P	10060	I&D ABSCESS SIMPLE/SINGLE               	     1.14	   $42.44	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	10060	I&D ABSCESS SIMPLE/SINGLE               	     1.14	   $42.44	      ---	   $53.52	004	1	1	0.00	    $0.00	Y	
K	10061	I&D ABSCESS COMP/MULTIPLE               	    75.76	   $75.76	      ---	       --	042	0	0	0.00	    $0.00	Y	
P	10061	I&D ABSCESS COMP/MULTIPLE               	     0.00	    $0.00	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	10061	I&D ABSCESS COMP/MULTIPLE               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
X	10061	I&D ABSCESS COMP/MULTIPLE               	   195.14	  $195.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	10080	I&D PILONIDAL CYST SIMPLE               	   237.60	  $237.60	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	10080	I&D PILONIDAL CYST SIMPLE               	     1.48	   $55.10	      ---	   $69.49	004	1	1	0.00	    $0.00	Y	
K	10081	I&D PILONIDAL CYST COMP                 	   115.53	  $115.53	      ---	       --	042	0	0	0.00	    $0.00	Y	
X	10081	I&D PILONIDAL CYST COMP                 	   320.31	  $320.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	10081	I&D PILONIDAL CYST COMP                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
P	10120	INC&RMVL FB SUBQ TISS SMPL              	     1.39	   $51.75	      ---	       --	015	0	1	0.00	    $0.00	Y	
X	10120	INC&RMVL FB SUBQ TISS SMPL              	   140.63	  $140.63	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	10120	INC&RMVL FB SUBQ TISS SMPL              	     1.39	   $51.75	      ---	   $65.26	004	1	1	0.00	    $0.00	Y	
K	10121	INC&RMVL FB SUBQ TISS COMP              	    93.91	   $93.91	      ---	       --	042	0	0	0.00	    $0.00	Y	
X	10121	INC&RMVL FB SUBQ TISS COMP              	   243.36	  $243.36	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	10121	INC&RMVL FB SUBQ TISS COMP              	     0.00	    $0.00	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	10121	INC&RMVL FB SUBQ TISS COMP              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
P	10140	I&D HMTMA SEROMA/FLUID COLLJ            	     1.34	   $49.89	      ---	       --	015	0	1	0.00	    $0.00	Y	
X	10140	I&D HMTMA SEROMA/FLUID COLLJ            	   156.53	  $156.53	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	10140	I&D HMTMA SEROMA/FLUID COLLJ            	     1.34	   $49.89	      ---	   $62.91	004	1	1	0.00	    $0.00	Y	
K	10160	PNXR ASPIR ABSC HMTMA BULLA             	     1.26	   $46.91	      ---	   $59.16	004	1	1	0.00	    $0.00	Y	
X	10160	PNXR ASPIR ABSC HMTMA BULLA             	   120.11	  $120.11	      ---	       --	009	1	1	0.00	    $0.00	Y	
P	10160	PNXR ASPIR ABSC HMTMA BULLA             	     1.26	   $46.91	      ---	       --	015	0	1	0.00	    $0.00	Y	
P	10180	I&D COMPLEX PO WOUND INFCTJ             	     3.16	  $117.65	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	10180	I&D COMPLEX PO WOUND INFCTJ             	     0.63	   $23.45	      ---	   $29.58	004	1	0	0.00	    $0.00	Y	
X	10180	I&D COMPLEX PO WOUND INFCTJ             	   241.55	  $241.55	      ---	       --	009	1	0	0.00	    $0.00	Y	
K	10180	I&D COMPLEX PO WOUND INFCTJ             	     3.16	  $117.65	      ---	  $148.36	004	1	0	0.00	    $0.00	Y	
K	11000	DBRDMT ECZ/INFECTED SKIN<10%            	     0.53	   $19.73	      ---	   $24.88	004	1	1	0.00	    $0.00	Y	
X	11000	DBRDMT ECZ/INFECTED SKIN<10%            	    53.72	   $53.72	      ---	       --	009	1	1	0.00	    $0.00	Y	
P	11000	DBRDMT ECZ/INFECTED SKIN<10%            	     0.52	   $19.36	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	11001	DBRDMT ECZ/INFCT SKN EA ADDL            	     0.28	   $10.42	      ---	   $13.15	004	1	1	0.00	    $0.00	Y	
K	11004	DBRDMT SKIN XTRNL GENT&PER              	     9.11	  $339.17	      ---	  $427.71	004	1	0	0.00	    $0.00	Y	
O	11004	DBRDMT SKIN XTRNL GENT&PER              	     1.82	   $67.76	      ---	   $85.45	004	1	0	0.00	    $0.00	Y	
O	11005	DBRDMT SKIN ABDOMINAL WALL              	     2.44	   $90.84	      ---	  $114.56	004	1	0	0.00	    $0.00	Y	
K	11005	DBRDMT SKIN ABDOMINAL WALL              	    12.19	  $453.83	      ---	  $572.32	004	1	0	0.00	    $0.00	Y	
K	11006	DBRDMT SKIN XTRNL GENT PER              	    11.45	  $426.28	      ---	  $537.58	004	1	0	0.00	    $0.00	Y	
O	11006	DBRDMT SKIN XTRNL GENT PER              	     2.29	   $85.26	      ---	  $107.52	004	1	0	0.00	    $0.00	Y	
O	11008	RMV PRSTC MTRL/MESH ABD WALL            	     0.92	   $34.25	      ---	   $43.19	004	1	0	0.00	    $0.00	Y	
K	11008	RMV PRSTC MTRL/MESH ABD WALL            	     4.61	  $171.63	      ---	  $216.44	004	1	0	0.00	    $0.00	Y	
K	11010	DEBRIDE SKIN AT FX SITE                 	     6.05	  $225.24	      ---	  $284.05	004	1	0	0.00	    $0.00	Y	
O	11010	DEBRIDE SKIN AT FX SITE                 	     1.21	   $45.05	      ---	   $56.81	004	1	0	0.00	    $0.00	Y	
P	11010	DEBRIDE SKIN AT FX SITE                 	     6.05	  $225.24	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	11011	DEBRIDE SKIN MUSC AT FX SITE            	     7.58	  $282.20	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	11011	DEBRIDE SKIN MUSC AT FX SITE            	     1.52	   $56.59	      ---	   $71.36	004	1	0	0.00	    $0.00	Y	
K	11011	DEBRIDE SKIN MUSC AT FX SITE            	     7.59	  $282.58	      ---	  $356.35	004	1	0	0.00	    $0.00	Y	
K	11012	DEB SKIN BONE AT FX SITE                	    10.34	  $384.96	      ---	  $485.46	004	1	0	0.00	    $0.00	Y	
O	11012	DEB SKIN BONE AT FX SITE                	     2.06	   $76.69	      ---	   $96.72	004	1	0	0.00	    $0.00	Y	
P	11012	DEB SKIN BONE AT FX SITE                	    10.34	  $384.96	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	11042	DBRDMT SUBQ TIS 1ST 20SQCM/<            	     2.79	  $103.87	      ---	       --	015	1	1	0.00	    $0.00	Y	
X	11042	DBRDMT SUBQ TIS 1ST 20SQCM/<            	   119.98	  $119.98	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	11042	DBRDMT SUBQ TIS 1ST 20SQCM/<            	     2.79	  $103.87	      ---	  $130.99	004	1	1	0.00	    $0.00	Y	
K	11043	DBRDMT MUSC&/FSCA 1ST 20/<              	     4.21	  $156.74	      ---	  $197.66	004	1	0	0.00	    $0.00	Y	
X	11043	DBRDMT MUSC&/FSCA 1ST 20/<              	   211.14	  $211.14	      ---	       --	009	1	0	0.00	    $0.00	Y	
P	11043	DBRDMT MUSC&/FSCA 1ST 20/<              	     4.22	  $157.11	      ---	       --	015	1	0	0.00	    $0.00	Y	
P	11044	DBRDMT BONE 1ST 20 SQ CM/<              	     5.44	  $202.53	      ---	       --	015	0	0	0.00	    $0.00	Y	
X	11044	DBRDMT BONE 1ST 20 SQ CM/<              	   279.57	  $279.57	      ---	       --	009	1	0	0.00	    $0.00	Y	
K	11044	DBRDMT BONE 1ST 20 SQ CM/<              	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
K	11045	DBRDMT SUBQ TISS EACH ADDL              	     0.39	   $14.52	      ---	   $18.31	004	1	0	0.00	    $0.00	Y	
X	11045	DBRDMT SUBQ TISS EACH ADDL              	    36.03	   $36.03	      ---	       --	009	1	0	0.00	    $0.00	Y	
P	11045	DBRDMT SUBQ TISS EACH ADDL              	     0.39	   $14.52	      ---	       --	015	1	0	0.00	    $0.00	Y	
P	11046	DBRDMT MUSC&/FSCA EA ADDL               	     0.84	   $31.27	      ---	       --	015	1	0	0.00	    $0.00	Y	
X	11046	DBRDMT MUSC&/FSCA EA ADDL               	    64.84	   $64.84	      ---	       --	009	1	0	0.00	    $0.00	Y	
K	11046	DBRDMT MUSC&/FSCA EA ADDL               	     0.84	   $31.27	      ---	   $39.44	004	1	0	0.00	    $0.00	Y	
K	11047	DBRDMT BONE EACH ADDL                   	     1.46	   $54.36	      ---	   $68.55	004	1	0	0.00	    $0.00	Y	
P	11047	DBRDMT BONE EACH ADDL                   	     1.46	   $54.36	      ---	       --	015	1	0	0.00	    $0.00	Y	
P	11055	PARING/CUTG B9 HYPRKER LES 1            	     0.45	   $16.75	      ---	       --	015	0	0	0.00	    $0.00	Y	
X	11055	PARING/CUTG B9 HYPRKER LES 1            	    67.59	   $67.59	      ---	       --	009	1	0	0.00	    $0.00	Y	
K	11055	PARING/CUTG B9 HYPRKER LES 1            	     0.45	   $16.75	      ---	   $21.13	004	1	0	0.00	    $0.00	Y	
K	11056	PARNG/CUTG B9 HYPRKR LES 2-4            	     0.68	   $25.32	      ---	   $31.93	004	1	0	0.00	    $0.00	Y	
X	11056	PARNG/CUTG B9 HYPRKR LES 2-4            	    77.57	   $77.57	      ---	       --	009	1	0	0.00	    $0.00	Y	
P	11056	PARNG/CUTG B9 HYPRKR LES 2-4            	     0.68	   $25.32	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	11057	PARNG/CUTG B9 HYPRKR LES >4             	     0.72	   $26.81	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	11057	PARNG/CUTG B9 HYPRKR LES >4             	     0.72	   $26.81	      ---	   $33.80	004	1	0	0.00	    $0.00	Y	
K	11102	TANGNTL BX SKIN SINGLE LES              	     2.40	   $89.35	      ---	       --	004	0	1	0.00	    $0.00	Y	
P	11102	TANGNTL BX SKIN SINGLE LES              	     2.40	   $89.35	      ---	       --	015	0	1	0.00	    $0.00	Y	
X	11102	TANGNTL BX SKIN SINGLE LES              	    95.41	   $95.41	      ---	       --	009	0	1	0.00	    $0.00	Y	
X	11103	TANGNTL BX SKIN EA SEP/ADDL             	    48.03	   $48.03	      ---	       --	009	0	1	0.00	    $0.00	Y	
P	11103	TANGNTL BX SKIN EA SEP/ADDL             	     1.29	   $48.03	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	11103	TANGNTL BX SKIN EA SEP/ADDL             	     1.29	   $48.03	      ---	       --	004	0	1	0.00	    $0.00	Y	
K	11104	PUNCH BX SKIN SINGLE LESION             	     3.01	  $112.06	      ---	       --	004	0	1	0.00	    $0.00	Y	
P	11104	PUNCH BX SKIN SINGLE LESION             	     3.01	  $112.06	      ---	       --	015	0	1	0.00	    $0.00	Y	
X	11104	PUNCH BX SKIN SINGLE LESION             	   118.03	  $118.03	      ---	       --	009	0	1	0.00	    $0.00	Y	
X	11105	PUNCH BX SKIN EA SEP/ADDL               	    55.29	   $55.29	      ---	       --	009	0	1	0.00	    $0.00	Y	
P	11105	PUNCH BX SKIN EA SEP/ADDL               	     1.47	   $54.73	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	11105	PUNCH BX SKIN EA SEP/ADDL               	     1.47	   $54.73	      ---	       --	004	0	1	0.00	    $0.00	Y	
K	11106	INCAL BX SKN SINGLE LES                 	     3.65	  $135.89	      ---	       --	004	0	1	0.00	    $0.00	Y	
P	11106	INCAL BX SKN SINGLE LES                 	     3.65	  $135.89	      ---	       --	015	0	1	0.00	    $0.00	Y	
X	11106	INCAL BX SKN SINGLE LES                 	   146.21	  $146.21	      ---	       --	009	0	1	0.00	    $0.00	Y	
X	11107	INCAL BX SKN EA SEP/ADDL                	    66.82	   $66.82	      ---	       --	009	0	1	0.00	    $0.00	Y	
P	11107	INCAL BX SKN EA SEP/ADDL                	     1.74	   $64.78	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	11107	INCAL BX SKN EA SEP/ADDL                	     1.74	   $64.78	      ---	       --	004	0	1	0.00	    $0.00	Y	
K	11200	RMVL SKIN TAGS UP TO&INC 15             	     0.85	   $31.65	      ---	   $39.91	004	1	1	0.00	    $0.00	Y	
P	11200	RMVL SKIN TAGS UP TO&INC 15             	     0.85	   $31.65	      ---	       --	015	0	1	0.00	    $0.00	Y	
X	11200	RMVL SKIN TAGS UP TO&INC 15             	    84.77	   $84.77	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	11201	RMVL SKIN TAGS EA ADDL 10               	    16.50	   $16.50	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	11201	RMVL SKIN TAGS EA ADDL 10               	     0.34	   $12.66	      ---	   $15.96	004	1	1	0.00	    $0.00	Y	
K	11300	SHAVE SKIN LESION 0.5 CM/<              	     0.71	   $26.43	      ---	   $33.33	004	1	1	0.00	    $0.00	Y	
X	11300	SHAVE SKIN LESION 0.5 CM/<              	    95.51	   $95.51	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	11301	SHAVE SKIN LESION 0.6-1.0 CM            	   114.39	  $114.39	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	11301	SHAVE SKIN LESION 0.6-1.0 CM            	     0.91	   $33.88	      ---	   $42.72	004	1	1	0.00	    $0.00	Y	
K	11302	SHAVE SKIN LESION 1.1-2.0 CM            	     1.05	   $39.09	      ---	   $49.30	004	1	1	0.00	    $0.00	Y	
X	11302	SHAVE SKIN LESION 1.1-2.0 CM            	   128.70	  $128.70	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	11303	SHAVE SKIN LESION >2.0 CM               	   142.31	  $142.31	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	11303	SHAVE SKIN LESION >2.0 CM               	     1.26	   $46.91	      ---	   $59.16	004	1	1	0.00	    $0.00	Y	
K	11305	SHAVE SKIN LESION 0.5 CM/<              	     0.69	   $25.69	      ---	   $32.40	004	1	1	0.00	    $0.00	Y	
X	11305	SHAVE SKIN LESION 0.5 CM/<              	    99.33	   $99.33	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	11306	SHAVE SKIN LESION 0.6-1.0 CM            	   115.24	  $115.24	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	11306	SHAVE SKIN LESION 0.6-1.0 CM            	     0.95	   $35.37	      ---	   $44.60	004	1	1	0.00	    $0.00	Y	
K	11307	SHAVE SKIN LESION 1.1-2.0 CM            	     1.07	   $39.84	      ---	   $50.24	004	1	1	0.00	    $0.00	Y	
X	11307	SHAVE SKIN LESION 1.1-2.0 CM            	   130.21	  $130.21	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	11308	SHAVE SKIN LESION >2.0 CM               	   136.80	  $136.80	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	11308	SHAVE SKIN LESION >2.0 CM               	     1.36	   $50.63	      ---	   $63.85	004	1	1	0.00	    $0.00	Y	
K	11310	SHAVE SKIN LESION 0.5 CM/<              	     0.86	   $32.02	      ---	   $40.38	004	1	1	0.00	    $0.00	Y	
X	11310	SHAVE SKIN LESION 0.5 CM/<              	   109.44	  $109.44	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	11311	SHAVE SKIN LESION 0.6-1.0 CM            	   128.14	  $128.14	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	11311	SHAVE SKIN LESION 0.6-1.0 CM            	     1.06	   $39.46	      ---	   $49.77	004	1	1	0.00	    $0.00	Y	
K	11312	SHAVE SKIN LESION 1.1-2.0 CM            	     1.16	   $43.19	      ---	   $54.46	004	1	1	0.00	    $0.00	Y	
X	11312	SHAVE SKIN LESION 1.1-2.0 CM            	   145.93	  $145.93	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	11313	SHAVE SKIN LESION >2.0 CM               	   168.66	  $168.66	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	11313	SHAVE SKIN LESION >2.0 CM               	     1.47	   $54.73	      ---	   $69.02	004	1	1	0.00	    $0.00	Y	
K	11400	EXC TR-EXT B9+MARG 0.5 CM<              	     1.56	   $58.08	      ---	   $73.24	004	1	1	0.00	    $0.00	Y	
X	11400	EXC TR-EXT B9+MARG 0.5 CM<              	   119.85	  $119.85	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	11401	EXC TR-EXT B9+MARG 0.6-1 CM             	   145.50	  $145.50	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	11401	EXC TR-EXT B9+MARG 0.6-1 CM             	     1.76	   $65.52	      ---	   $82.63	004	1	1	0.00	    $0.00	Y	
K	11402	EXC TR-EXT B9+MARG 1.1-2 CM             	     1.93	   $71.85	      ---	   $90.61	004	1	1	0.00	    $0.00	Y	
X	11402	EXC TR-EXT B9+MARG 1.1-2 CM             	   159.78	  $159.78	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	11403	EXC TR-EXT B9+MARG 2.1-3CM              	   182.88	  $182.88	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	11403	EXC TR-EXT B9+MARG 2.1-3CM              	     2.18	   $81.16	      ---	  $102.35	004	1	1	0.00	    $0.00	Y	
K	11404	EXC TR-EXT B9+MARG 3.1-4 CM             	     2.38	   $88.61	      ---	  $111.74	004	1	1	0.00	    $0.00	Y	
X	11404	EXC TR-EXT B9+MARG 3.1-4 CM             	   206.82	  $206.82	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	11406	EXC TR-EXT B9+MARG >4.0 CM              	   289.85	  $289.85	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	11406	EXC TR-EXT B9+MARG >4.0 CM              	     5.19	  $193.22	      ---	  $243.67	004	1	1	0.00	    $0.00	Y	
K	11420	EXC H-F-NK-SP B9+MARG 0.5/<             	     1.43	   $53.24	      ---	   $67.14	004	1	1	0.00	    $0.00	Y	
X	11420	EXC H-F-NK-SP B9+MARG 0.5/<             	   119.13	  $119.13	      ---	       --	009	1	1	0.00	    $0.00	Y	
P	11420	EXC H-F-NK-SP B9+MARG 0.5/<             	     1.43	   $53.24	      ---	       --	015	0	1	0.00	    $0.00	Y	
P	11421	EXC H-F-NK-SP B9+MARG 0.6-1             	     1.80	   $67.01	      ---	       --	015	0	1	0.00	    $0.00	Y	
X	11421	EXC H-F-NK-SP B9+MARG 0.6-1             	   148.69	  $148.69	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	11421	EXC H-F-NK-SP B9+MARG 0.6-1             	     1.80	   $67.01	      ---	   $84.51	004	1	1	0.00	    $0.00	Y	
K	11422	EXC H-F-NK-SP B9+MARG 1.1-2             	     1.99	   $74.09	      ---	   $93.43	004	1	1	0.00	    $0.00	Y	
X	11422	EXC H-F-NK-SP B9+MARG 1.1-2             	   166.30	  $166.30	      ---	       --	009	1	1	0.00	    $0.00	Y	
P	11422	EXC H-F-NK-SP B9+MARG 1.1-2             	     1.99	   $74.09	      ---	       --	015	0	1	0.00	    $0.00	Y	
P	11423	EXC H-F-NK-SP B9+MARG 2.1-3             	     2.33	   $86.75	      ---	       --	015	0	1	0.00	    $0.00	Y	
X	11423	EXC H-F-NK-SP B9+MARG 2.1-3             	   188.90	  $188.90	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	11423	EXC H-F-NK-SP B9+MARG 2.1-3             	     2.33	   $86.75	      ---	  $109.39	004	1	1	0.00	    $0.00	Y	
K	11424	EXC H-F-NK-SP B9+MARG 3.1-4             	     2.72	  $101.27	      ---	  $127.70	004	1	1	0.00	    $0.00	Y	
X	11424	EXC H-F-NK-SP B9+MARG 3.1-4             	   216.74	  $216.74	      ---	       --	009	1	1	0.00	    $0.00	Y	
P	11424	EXC H-F-NK-SP B9+MARG 3.1-4             	     2.71	  $100.89	      ---	       --	015	0	1	0.00	    $0.00	Y	
P	11426	EXC H-F-NK-SP B9+MARG >4 CM             	     6.45	  $240.13	      ---	       --	015	0	1	0.00	    $0.00	Y	
X	11426	EXC H-F-NK-SP B9+MARG >4 CM             	   300.07	  $300.07	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	11426	EXC H-F-NK-SP B9+MARG >4 CM             	     6.45	  $240.13	      ---	  $302.83	004	1	1	0.00	    $0.00	Y	
K	11440	EXC FACE-MM B9+MARG 0.5 CM/<            	     1.73	   $64.41	      ---	   $81.22	004	1	1	0.00	    $0.00	Y	
X	11440	EXC FACE-MM B9+MARG 0.5 CM/<            	   134.46	  $134.46	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	11441	EXC FACE-MM B9+MARG 0.6-1 CM            	   161.88	  $161.88	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	11441	EXC FACE-MM B9+MARG 0.6-1 CM            	     2.00	   $74.46	      ---	   $93.90	004	1	1	0.00	    $0.00	Y	
K	11442	EXC FACE-MM B9+MARG 1.1-2 CM            	     2.15	   $80.04	      ---	  $100.94	004	1	1	0.00	    $0.00	Y	
X	11442	EXC FACE-MM B9+MARG 1.1-2 CM            	   179.43	  $179.43	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	11443	EXC FACE-MM B9+MARG 2.1-3 CM            	   210.54	  $210.54	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	11443	EXC FACE-MM B9+MARG 2.1-3 CM            	     2.66	   $99.03	      ---	  $124.89	004	1	1	0.00	    $0.00	Y	
K	11444	EXC FACE-MM B9+MARG 3.1-4 CM            	     3.30	  $122.86	      ---	  $154.94	004	1	1	0.00	    $0.00	Y	
X	11444	EXC FACE-MM B9+MARG 3.1-4 CM            	   259.62	  $259.62	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	11446	EXC FACE-MM B9+MARG >4 CM               	   348.76	  $348.76	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	11446	EXC FACE-MM B9+MARG >4 CM               	     7.48	  $278.48	      ---	  $351.19	004	1	1	0.00	    $0.00	Y	
K	11450	EXC SKN HDRDNT AX SMPL/NTRM             	     3.16	  $117.65	      ---	  $148.36	004	1	1	0.00	    $0.00	Y	
K	11451	EXC SKN HDRDNT AX COMPLEX               	     4.18	  $155.62	      ---	  $196.25	004	1	1	0.00	    $0.00	Y	
K	11462	EXC SKN HDRDNT ING SMPL/NTRM            	     3.04	  $113.18	      ---	  $142.73	004	1	1	0.00	    $0.00	Y	
K	11463	EXC SKN HDRDNT ING COMPLEX              	     4.35	  $161.95	      ---	  $204.23	004	1	1	0.00	    $0.00	Y	
K	11470	EXC SKN H/P/P/U SMPL/NTRM               	     3.64	  $135.52	      ---	  $170.90	004	1	1	0.00	    $0.00	Y	
K	11471	EXC SKN H/P/P/U COMPLEX                 	     4.68	  $174.24	      ---	  $219.73	004	1	0	0.00	    $0.00	Y	
K	11600	EXC TR-EXT MAL+MARG 0.5 CM/<            	     1.86	   $69.25	      ---	   $87.33	004	1	1	0.00	    $0.00	N	
K	11601	EXC TR-EXT MAL+MARG 0.6-1 CM            	     2.13	   $79.30	      ---	  $100.00	004	1	1	0.00	    $0.00	N	
K	11602	EXC TR-EXT MAL+MARG 1.1-2 CM            	     2.27	   $84.51	      ---	  $106.58	004	1	1	0.00	    $0.00	N	
K	11603	EXC TR-EXT MAL+MARG 2.1-3 CM            	     4.52	  $168.28	      ---	  $212.21	004	1	0	0.00	    $0.00	N	
K	11604	EXC TR-EXT MAL+MARG 3.1-4 CM            	     4.88	  $181.68	      ---	  $229.12	004	1	0	0.00	    $0.00	N	
K	11606	EXC TR-EXT MAL+MARG >4 CM               	     6.10	  $227.10	      ---	  $286.40	004	1	0	0.00	    $0.00	N	
K	11620	EXC H-F-NK-SP MAL+MARG 0.5/<            	     2.27	   $84.51	      ---	  $106.58	004	1	1	0.00	    $0.00	Y	
P	11620	EXC H-F-NK-SP MAL+MARG 0.5/<            	     2.26	   $84.14	      ---	       --	015	0	1	0.00	    $0.00	Y	
P	11621	EXC S/N/H/F/G MAL+MRG 0.6-1             	     3.39	  $126.21	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	11621	EXC S/N/H/F/G MAL+MRG 0.6-1             	     3.40	  $126.58	      ---	  $159.63	004	1	1	0.00	    $0.00	Y	
K	11622	EXC S/N/H/F/G MAL+MRG 1.1-2             	     4.48	  $166.79	      ---	  $210.34	004	1	1	0.00	    $0.00	Y	
P	11622	EXC S/N/H/F/G MAL+MRG 1.1-2             	     4.48	  $166.79	      ---	       --	015	0	1	0.00	    $0.00	Y	
P	11623	EXC S/N/H/F/G MAL+MRG 2.1-3             	     4.92	  $183.17	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	11623	EXC S/N/H/F/G MAL+MRG 2.1-3             	     4.93	  $183.54	      ---	  $231.46	004	1	0	0.00	    $0.00	Y	
K	11624	EXC S/N/H/F/G MAL+MRG 3.1-4             	     5.63	  $209.60	      ---	  $264.33	004	1	0	0.00	    $0.00	Y	
P	11624	EXC S/N/H/F/G MAL+MRG 3.1-4             	     5.63	  $209.60	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	11626	EXC S/N/H/F/G MAL+MRG >4 CM             	     7.24	  $269.55	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	11626	EXC S/N/H/F/G MAL+MRG >4 CM             	     7.24	  $269.55	      ---	  $339.92	004	1	0	0.00	    $0.00	Y	
K	11640	EXC F/E/E/N/L MAL+MRG 0.5CM<            	     3.40	  $126.58	      ---	  $159.63	004	1	1	0.00	    $0.00	N	
K	11641	EXC F/E/E/N/L MAL+MRG 0.6-1             	     4.53	  $168.65	      ---	  $212.68	004	1	1	0.00	    $0.00	N	
K	11642	EXC F/E/E/N/L MAL+MRG 1.1-2             	     5.00	  $186.15	      ---	  $234.75	004	1	1	0.00	    $0.00	N	
K	11643	EXC F/E/E/N/L MAL+MRG 2.1-3             	     6.20	  $230.83	      ---	  $291.09	004	1	0	0.00	    $0.00	N	
K	11644	EXC F/E/E/N/L MAL+MRG 3.1-4             	     7.50	  $279.23	      ---	  $352.13	004	1	0	0.00	    $0.00	N	
K	11646	EXC F/E/E/N/L MAL+MRG >4 CM             	     9.52	  $354.43	      ---	  $446.96	004	1	0	0.00	    $0.00	N	
K	11720	DEBRIDE NAIL 1-5                        	     0.53	   $19.73	      ---	   $24.88	004	1	1	0.00	    $0.00	Y	
P	11720	DEBRIDE NAIL 1-5                        	     0.53	   $19.73	      ---	       --	015	0	1	0.00	    $0.00	Y	
O	11720	DEBRIDE NAIL 1-5                        	     0.10	    $3.72	      ---	    $4.70	004	1	0	0.00	    $0.00	Y	
X	11720	DEBRIDE NAIL 1-5                        	    30.21	   $30.21	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	11721	DEBRIDE NAIL 6 OR MORE                  	    40.71	   $40.71	      ---	       --	009	1	1	0.00	    $0.00	Y	
O	11721	DEBRIDE NAIL 6 OR MORE                  	     0.18	    $6.70	      ---	    $8.45	004	1	0	0.00	    $0.00	Y	
P	11721	DEBRIDE NAIL 6 OR MORE                  	     0.90	   $33.51	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	11721	DEBRIDE NAIL 6 OR MORE                  	     0.89	   $33.13	      ---	   $41.79	004	1	1	0.00	    $0.00	Y	
K	11730	REMOVAL OF NAIL PLATE                   	     0.86	   $32.02	      ---	   $40.38	004	1	1	0.00	    $0.00	Y	
P	11730	REMOVAL OF NAIL PLATE                   	     0.86	   $32.02	      ---	       --	015	0	1	0.00	    $0.00	Y	
X	11730	REMOVAL OF NAIL PLATE                   	   107.09	  $107.09	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	11732	REMOVE NAIL PLATE ADD-ON                	    30.75	   $30.75	      ---	       --	009	1	1	0.00	    $0.00	Y	
P	11732	REMOVE NAIL PLATE ADD-ON                	     0.40	   $14.89	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	11732	REMOVE NAIL PLATE ADD-ON                	     0.40	   $14.89	      ---	   $18.78	004	1	1	0.00	    $0.00	Y	
K	11740	DRAIN BLOOD FROM UNDER NAIL             	    19.59	   $19.59	      ---	       --	042	0	1	0.00	    $0.00	Y	
P	11740	DRAIN BLOOD FROM UNDER NAIL             	    19.59	   $19.59	      ---	       --	042	0	1	0.00	    $0.00	Y	
X	11740	DRAIN BLOOD FROM UNDER NAIL             	    53.48	   $53.48	      ---	       --	009	0	1	0.00	    $0.00	Y	
X	11750	REMOVAL OF NAIL BED                     	   148.11	  $148.11	      ---	       --	009	1	1	0.00	    $0.00	Y	
P	11750	REMOVAL OF NAIL BED                     	     2.26	   $84.14	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	11750	REMOVAL OF NAIL BED                     	     2.27	   $84.51	      ---	  $106.58	004	1	1	0.00	    $0.00	Y	
K	11755	BIOPSY NAIL UNIT                        	     1.66	   $61.80	      ---	   $77.94	004	1	0	0.00	    $0.00	Y	
P	11755	BIOPSY NAIL UNIT                        	     0.00	    $0.00	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	11760	REPAIR OF NAIL BED                      	     2.71	  $100.89	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	11760	REPAIR OF NAIL BED                      	     2.70	  $100.52	      ---	  $126.77	004	1	1	0.00	    $0.00	Y	
K	11762	RECONSTRUCTION OF NAIL BED              	     4.38	  $163.07	      ---	  $205.64	004	1	0	0.00	    $0.00	Y	
P	11762	RECONSTRUCTION OF NAIL BED              	     0.00	    $0.00	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	11762	RECONSTRUCTION OF NAIL BED              	     0.88	   $32.76	      ---	   $41.32	004	1	0	0.00	    $0.00	Y	
P	11765	EXCISION OF NAIL FOLD TOE               	     1.42	   $52.87	      ---	       --	015	0	1	0.00	    $0.00	Y	
X	11765	EXCISION OF NAIL FOLD TOE               	   154.79	  $154.79	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	11765	EXCISION OF NAIL FOLD TOE               	     1.42	   $52.87	      ---	   $66.67	004	1	1	0.00	    $0.00	Y	
K	11770	REMOVE PILONIDAL CYST SIMPLE            	     2.61	   $97.17	      ---	  $122.54	004	1	0	0.00	    $0.00	Y	
K	11771	REMOVE PILONIDAL CYST EXTEN             	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
O	11771	REMOVE PILONIDAL CYST EXTEN             	     1.59	   $59.20	      ---	   $74.65	004	1	0	0.00	    $0.00	Y	
O	11772	REMOVE PILONIDAL CYST COMPL             	     2.29	   $85.26	      ---	  $107.52	004	1	0	0.00	    $0.00	Y	
K	11772	REMOVE PILONIDAL CYST COMPL             	   427.08	  $427.08	      ---	       --	042	0	0	0.00	    $0.00	Y	
K	11900	INJECT SKIN LESIONS </W 7               	     0.57	   $21.22	      ---	   $26.76	004	1	1	0.00	    $0.00	Y	
P	11900	INJECT SKIN LESIONS </W 7               	     0.57	   $21.22	      ---	       --	015	0	1	0.00	    $0.00	Y	
X	11900	INJECT SKIN LESIONS </W 7               	    52.93	   $52.93	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	11901	INJECT SKIN LESIONS >7                  	    64.31	   $64.31	      ---	       --	009	1	1	0.00	    $0.00	Y	
P	11901	INJECT SKIN LESIONS >7                  	     0.81	   $30.16	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	11901	INJECT SKIN LESIONS >7                  	     0.82	   $30.53	      ---	   $38.50	004	1	1	0.00	    $0.00	Y	
K	11960	INSERT TISSUE EXPANDER(S)               	     9.74	  $362.62	      ---	  $457.29	004	1	0	0.00	    $0.00	Y	
P	11960	INSERT TISSUE EXPANDER(S)               	     9.74	  $362.62	      ---	       --	015	1	0	0.00	    $0.00	Y	
O	11960	INSERT TISSUE EXPANDER(S)               	     1.95	   $72.60	      ---	   $91.55	004	1	0	0.00	    $0.00	Y	
O	11970	RPLCMT TISS XPNDR PERM IMPLT            	     2.07	   $77.07	      ---	   $97.19	004	1	0	0.00	    $0.00	Y	
K	11970	RPLCMT TISS XPNDR PERM IMPLT            	    10.37	  $386.08	      ---	  $486.87	004	1	0	0.00	    $0.00	Y	
K	11971	RMVL TIS XPNDR WO INSJ IMPLT            	     4.42	  $164.56	      ---	  $207.52	004	1	0	0.00	    $0.00	Y	
O	11971	RMVL TIS XPNDR WO INSJ IMPLT            	     0.88	   $32.76	      ---	   $41.32	004	1	0	0.00	    $0.00	Y	
K	11976	REMOVE CONTRACEPTIVE CAPSULE            	    99.67	   $99.67	      ---	       --	042	0	1	0.00	    $0.00	Y	
K	11980	IMPLANT HORMONE PELLET(S)               	     2.07	   $77.07	      ---	   $97.19	004	1	1	0.00	    $0.00	Y	
X	11980	IMPLANT HORMONE PELLET(S)               	    85.81	   $85.81	      ---	       --	009	1	1	0.00	    $0.00	Y	
O	11981	INSERTION DRUG DLVR IMPLANT             	     1.12	   $41.70	      ---	       --	004	0	1	0.00	    $0.00	Y	
P	11981	INSERTION DRUG DLVR IMPLANT             	     5.61	  $208.86	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	11981	INSERTION DRUG DLVR IMPLANT             	     5.61	  $208.86	      ---	       --	004	0	1	0.00	    $0.00	Y	
K	11982	REMOVE DRUG IMPLANT DEVICE              	     3.02	  $112.43	      ---	       --	004	0	1	0.00	    $0.00	Y	
P	11982	REMOVE DRUG IMPLANT DEVICE              	     3.02	  $112.43	      ---	       --	004	0	1	0.00	    $0.00	Y	
O	11982	REMOVE DRUG IMPLANT DEVICE              	     0.60	   $22.34	      ---	       --	004	0	1	0.00	    $0.00	Y	
X	11982	REMOVE DRUG IMPLANT DEVICE              	   112.43	  $112.43	      ---	       --	009	0	1	0.00	    $0.00	Y	
X	11983	REMOVE/INSERT DRUG IMPLANT              	   181.31	  $181.31	      ---	       --	009	0	1	0.00	    $0.00	Y	
O	11983	REMOVE/INSERT DRUG IMPLANT              	     0.97	   $36.11	      ---	       --	004	0	1	0.00	    $0.00	Y	
P	11983	REMOVE/INSERT DRUG IMPLANT              	     4.87	  $181.31	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	11983	REMOVE/INSERT DRUG IMPLANT              	     4.87	  $181.31	      ---	       --	004	0	1	0.00	    $0.00	Y	
K	12001	RPR S/N/AX/GEN/TRNK 2.5CM/<             	     1.88	   $69.99	      ---	   $88.27	004	1	1	0.00	    $0.00	Y	
P	12001	RPR S/N/AX/GEN/TRNK 2.5CM/<             	     1.88	   $69.99	      ---	       --	015	0	1	0.00	    $0.00	Y	
X	12001	RPR S/N/AX/GEN/TRNK 2.5CM/<             	    86.58	   $86.58	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	12002	RPR S/N/AX/GEN/TRNK2.6-7.5CM            	   104.20	  $104.20	      ---	       --	009	1	1	0.00	    $0.00	Y	
P	12002	RPR S/N/AX/GEN/TRNK2.6-7.5CM            	     2.00	   $74.46	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	12002	RPR S/N/AX/GEN/TRNK2.6-7.5CM            	     2.00	   $74.46	      ---	   $93.90	004	1	1	0.00	    $0.00	Y	
K	12004	RPR S/N/AX/GEN/TRK7.6-12.5CM            	     2.26	   $84.14	      ---	  $106.11	004	1	1	0.00	    $0.00	Y	
P	12004	RPR S/N/AX/GEN/TRK7.6-12.5CM            	     2.26	   $84.14	      ---	       --	015	0	1	0.00	    $0.00	Y	
X	12004	RPR S/N/AX/GEN/TRK7.6-12.5CM            	   120.54	  $120.54	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	12005	RPR S/N/A/GEN/TRK12.6-20.0CM            	   161.01	  $161.01	      ---	       --	009	1	1	0.00	    $0.00	Y	
P	12005	RPR S/N/A/GEN/TRK12.6-20.0CM            	     2.74	  $102.01	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	12005	RPR S/N/A/GEN/TRK12.6-20.0CM            	     2.74	  $102.01	      ---	  $128.64	004	1	1	0.00	    $0.00	Y	
K	12006	RPR S/N/A/GEN/TRK20.1-30.0CM            	     3.70	  $137.75	      ---	  $173.72	004	1	1	0.00	    $0.00	Y	
X	12006	RPR S/N/A/GEN/TRK20.1-30.0CM            	   186.47	  $186.47	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	12007	RPR S/N/AX/GEN/TRNK >30.0 CM            	   281.46	  $281.46	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	12007	RPR S/N/AX/GEN/TRNK >30.0 CM            	     7.56	  $281.46	      ---	  $354.94	004	1	1	0.00	    $0.00	Y	
K	12011	RPR F/E/E/N/L/M 2.5 CM/<                	     1.96	   $72.97	      ---	   $92.02	004	1	1	0.00	    $0.00	Y	
X	12011	RPR F/E/E/N/L/M 2.5 CM/<                	   103.33	  $103.33	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	12013	RPR F/E/E/N/L/M 2.6-5.0 CM              	   107.45	  $107.45	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	12013	RPR F/E/E/N/L/M 2.6-5.0 CM              	     2.13	   $79.30	      ---	  $100.00	004	1	1	0.00	    $0.00	Y	
K	12014	RPR F/E/E/N/L/M 5.1-7.5 CM              	     2.49	   $92.70	      ---	  $116.91	004	1	1	0.00	    $0.00	Y	
X	12014	RPR F/E/E/N/L/M 5.1-7.5 CM              	   130.43	  $130.43	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	12015	RPR F/E/E/N/L/M 7.6-12.5 CM             	   156.69	  $156.69	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	12015	RPR F/E/E/N/L/M 7.6-12.5 CM             	     3.03	  $112.81	      ---	  $142.26	004	1	1	0.00	    $0.00	Y	
K	12016	RPR FE/E/EN/L/M 12.6-20.0 CM            	     4.19	  $155.99	      ---	  $196.72	004	1	1	0.00	    $0.00	Y	
X	12016	RPR FE/E/EN/L/M 12.6-20.0 CM            	   198.99	  $198.99	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	12017	RPR FE/E/EN/L/M 20.1-30.0 CM            	   325.76	  $325.76	      ---	       --	009	1	1	0.00	    $0.00	Y	
O	12017	RPR FE/E/EN/L/M 20.1-30.0 CM            	     1.75	   $65.15	      ---	   $82.16	004	1	0	0.00	    $0.00	Y	
K	12017	RPR FE/E/EN/L/M 20.1-30.0 CM            	     8.75	  $325.76	      ---	  $410.81	004	1	1	0.00	    $0.00	Y	
K	12018	RPR F/E/E/N/L/M >30.0 CM                	    10.21	  $380.12	      ---	  $479.36	004	1	1	0.00	    $0.00	Y	
O	12018	RPR F/E/E/N/L/M >30.0 CM                	     2.04	   $75.95	      ---	   $95.78	004	1	0	0.00	    $0.00	Y	
X	12018	RPR F/E/E/N/L/M >30.0 CM                	   380.12	  $380.12	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	12020	TX SUPFC WND DEHSN SMPL CLSR            	   277.94	  $277.94	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	12020	TX SUPFC WND DEHSN SMPL CLSR            	     4.60	  $171.26	      ---	  $215.97	004	1	1	0.00	    $0.00	Y	
K	12021	TX SUPFC WND DEHSN W/PACKING            	     3.38	  $125.84	      ---	  $158.69	004	1	1	0.00	    $0.00	Y	
X	12021	TX SUPFC WND DEHSN W/PACKING            	   162.51	  $162.51	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	12031	INTMD RPR S/A/T/EXT 2.5 CM/<            	   246.24	  $246.24	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	12031	INTMD RPR S/A/T/EXT 2.5 CM/<            	     2.27	   $84.51	      ---	  $106.58	004	1	1	0.00	    $0.00	Y	
K	12032	INTMD RPR S/A/T/EXT 2.6-7.5             	     2.46	   $91.59	      ---	  $115.50	004	1	1	0.00	    $0.00	Y	
X	12032	INTMD RPR S/A/T/EXT 2.6-7.5             	   283.47	  $283.47	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	12034	INTMD RPR S/TR/EXT 7.6-12.5             	   310.50	  $310.50	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	12034	INTMD RPR S/TR/EXT 7.6-12.5             	     2.79	  $103.87	      ---	  $130.99	004	1	1	0.00	    $0.00	Y	
K	12035	INTMD RPR S/A/T/EXT 12.6-20             	     3.04	  $113.18	      ---	  $142.73	004	1	0	0.00	    $0.00	Y	
X	12035	INTMD RPR S/A/T/EXT 12.6-20             	   359.14	  $359.14	      ---	       --	009	1	0	0.00	    $0.00	Y	
X	12036	INTMD RPR S/A/T/EXT 20.1-30             	   395.87	  $395.87	      ---	       --	009	1	0	0.00	    $0.00	Y	
K	12036	INTMD RPR S/A/T/EXT 20.1-30             	     4.25	  $158.23	      ---	  $199.54	004	1	0	0.00	    $0.00	Y	
K	12037	INTMD RPR S/TR/EXT >30.0 CM             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
X	12037	INTMD RPR S/TR/EXT >30.0 CM             	   441.94	  $441.94	      ---	       --	009	1	0	0.00	    $0.00	Y	
O	12037	INTMD RPR S/TR/EXT >30.0 CM             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
P	12041	INTMD RPR N-HF/GENIT 2.5CM/<            	     2.52	   $93.82	      ---	       --	015	1	1	0.00	    $0.00	Y	
X	12041	INTMD RPR N-HF/GENIT 2.5CM/<            	   246.88	  $246.88	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	12041	INTMD RPR N-HF/GENIT 2.5CM/<            	     2.52	   $93.82	      ---	  $118.31	004	1	1	0.00	    $0.00	Y	
K	12042	INTMD RPR N-HF/GENIT2.6-7.5             	     2.68	   $99.78	      ---	  $125.83	004	1	1	0.00	    $0.00	Y	
X	12042	INTMD RPR N-HF/GENIT2.6-7.5             	   288.47	  $288.47	      ---	       --	009	1	1	0.00	    $0.00	Y	
P	12042	INTMD RPR N-HF/GENIT2.6-7.5             	     2.69	  $100.15	      ---	       --	015	1	1	0.00	    $0.00	Y	
P	12044	INTMD RPR N-HF/GENIT7.6-12.5            	     2.90	  $107.97	      ---	       --	015	1	0	0.00	    $0.00	Y	
X	12044	INTMD RPR N-HF/GENIT7.6-12.5            	   354.96	  $354.96	      ---	       --	009	1	0	0.00	    $0.00	Y	
K	12044	INTMD RPR N-HF/GENIT7.6-12.5            	     2.91	  $108.34	      ---	  $136.62	004	1	0	0.00	    $0.00	Y	
K	12045	INTMD RPR N-HF/GENIT12.6-20             	     3.30	  $122.86	      ---	  $154.94	004	1	0	0.00	    $0.00	Y	
X	12045	INTMD RPR N-HF/GENIT12.6-20             	   382.90	  $382.90	      ---	       --	009	1	0	0.00	    $0.00	Y	
P	12045	INTMD RPR N-HF/GENIT12.6-20             	     3.30	  $122.86	      ---	       --	015	1	0	0.00	    $0.00	Y	
O	12046	INTMD RPR N-HF/GENIT20.1-30             	     0.86	   $32.02	      ---	   $40.38	004	1	0	0.00	    $0.00	Y	
X	12046	INTMD RPR N-HF/GENIT20.1-30             	   457.46	  $457.46	      ---	       --	009	1	0	0.00	    $0.00	Y	
K	12046	INTMD RPR N-HF/GENIT20.1-30             	     4.34	  $161.58	      ---	  $203.76	004	1	0	0.00	    $0.00	Y	
K	12047	INTMD RPR N-HF/GENIT >30.0CM            	     9.24	  $344.01	      ---	  $433.82	004	1	0	0.00	    $0.00	Y	
X	12047	INTMD RPR N-HF/GENIT >30.0CM            	   499.89	  $499.89	      ---	       --	009	1	0	0.00	    $0.00	Y	
O	12047	INTMD RPR N-HF/GENIT >30.0CM            	     1.85	   $68.88	      ---	   $86.86	004	1	0	0.00	    $0.00	Y	
X	12051	INTMD RPR FACE/MM 2.5 CM/<              	   264.77	  $264.77	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	12051	INTMD RPR FACE/MM 2.5 CM/<              	     2.53	   $94.19	      ---	  $118.78	004	1	1	0.00	    $0.00	Y	
K	12052	INTMD RPR FACE/MM 2.6-5.0 CM            	     2.66	   $99.03	      ---	  $124.89	004	1	1	0.00	    $0.00	Y	
X	12052	INTMD RPR FACE/MM 2.6-5.0 CM            	   293.82	  $293.82	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	12053	INTMD RPR FACE/MM 5.1-7.5 CM            	   339.12	  $339.12	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	12053	INTMD RPR FACE/MM 5.1-7.5 CM            	     2.89	  $107.59	      ---	  $135.69	004	1	1	0.00	    $0.00	Y	
K	12054	INTMD RPR FACE/MM 7.6-12.5CM            	     4.19	  $155.99	      ---	  $196.72	004	1	0	0.00	    $0.00	Y	
X	12054	INTMD RPR FACE/MM 7.6-12.5CM            	   356.78	  $356.78	      ---	       --	009	1	0	0.00	    $0.00	Y	
X	12055	INTMD RPR FACE/MM 12.6-20 CM            	   469.29	  $469.29	      ---	       --	009	1	0	0.00	    $0.00	Y	
O	12055	INTMD RPR FACE/MM 12.6-20 CM            	     1.24	   $46.17	      ---	   $58.22	004	1	0	0.00	    $0.00	Y	
K	12055	INTMD RPR FACE/MM 12.6-20 CM            	     6.23	  $231.94	      ---	  $292.50	004	1	0	0.00	    $0.00	Y	
K	12056	INTMD RPR FACE/MM 20.1-30.0             	     9.56	  $355.92	      ---	  $448.84	004	1	0	0.00	    $0.00	Y	
O	12056	INTMD RPR FACE/MM 20.1-30.0             	     1.91	   $71.11	      ---	   $89.67	004	1	0	0.00	    $0.00	Y	
X	12056	INTMD RPR FACE/MM 20.1-30.0             	   535.41	  $535.41	      ---	       --	009	1	0	0.00	    $0.00	Y	
X	12057	INTMD RPR FACE/MM >30.0 CM              	   560.76	  $560.76	      ---	       --	009	1	0	0.00	    $0.00	Y	
O	12057	INTMD RPR FACE/MM >30.0 CM              	     2.02	   $75.20	      ---	   $94.84	004	1	0	0.00	    $0.00	Y	
K	12057	INTMD RPR FACE/MM >30.0 CM              	    10.10	  $376.02	      ---	  $474.20	004	1	0	0.00	    $0.00	Y	
K	13100	CMPLX RPR TRUNK 1.1-2.5 CM              	     2.97	  $110.57	      ---	  $139.44	004	1	1	0.00	    $0.00	Y	
X	13100	CMPLX RPR TRUNK 1.1-2.5 CM              	   317.61	  $317.61	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	13101	CMPLX RPR TRUNK 2.6-7.5 CM              	   370.23	  $370.23	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	13101	CMPLX RPR TRUNK 2.6-7.5 CM              	     3.48	  $129.56	      ---	  $163.39	004	1	1	0.00	    $0.00	Y	
K	13102	CMPLX RPR TRUNK ADDL 5CM/<              	     1.35	   $50.26	      ---	   $63.38	004	1	1	0.00	    $0.00	Y	
X	13102	CMPLX RPR TRUNK ADDL 5CM/<              	   107.03	  $107.03	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	13120	CMPLX RPR S/A/L 1.1-2.5 CM              	   330.85	  $330.85	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	13120	CMPLX RPR S/A/L 1.1-2.5 CM              	     3.12	  $116.16	      ---	  $146.48	004	1	1	0.00	    $0.00	Y	
K	13121	CMPLX RPR S/A/L 2.6-7.5 CM              	     4.53	  $168.65	      ---	  $212.68	004	1	1	0.00	    $0.00	Y	
X	13121	CMPLX RPR S/A/L 2.6-7.5 CM              	   395.48	  $395.48	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	13122	CMPLX RPR S/A/L ADDL 5 CM/>             	   116.48	  $116.48	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	13122	CMPLX RPR S/A/L ADDL 5 CM/>             	     1.57	   $58.45	      ---	   $73.71	004	1	1	0.00	    $0.00	Y	
K	13131	CMPLX RPR F/C/C/M/N/AX/G/H/F            	     3.47	  $129.19	      ---	  $162.92	004	1	1	0.00	    $0.00	Y	
X	13131	CMPLX RPR F/C/C/M/N/AX/G/H/F            	   360.43	  $360.43	      ---	       --	009	1	1	0.00	    $0.00	Y	
P	13131	CMPLX RPR F/C/C/M/N/AX/G/H/F            	     3.47	  $129.19	      ---	       --	015	0	1	0.00	    $0.00	Y	
P	13132	CMPLX RPR F/C/C/M/N/AX/G/H/F            	     6.80	  $253.16	      ---	       --	015	0	1	0.00	    $0.00	Y	
O	13132	CMPLX RPR F/C/C/M/N/AX/G/H/F            	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
X	13132	CMPLX RPR F/C/C/M/N/AX/G/H/F            	   436.66	  $436.66	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	13132	CMPLX RPR F/C/C/M/N/AX/G/H/F            	     6.80	  $253.16	      ---	  $319.26	004	1	1	0.00	    $0.00	Y	
K	13133	CMPLX RPR F/C/C/M/N/AX/G/H/F            	     2.33	   $86.75	      ---	  $109.39	004	1	1	0.00	    $0.00	Y	
X	13133	CMPLX RPR F/C/C/M/N/AX/G/H/F            	   153.16	  $153.16	      ---	       --	009	1	1	0.00	    $0.00	Y	
O	13133	CMPLX RPR F/C/C/M/N/AX/G/H/F            	     0.47	   $17.50	      ---	   $22.07	004	1	1	0.00	    $0.00	Y	
P	13133	CMPLX RPR F/C/C/M/N/AX/G/H/F            	     0.47	   $17.50	      ---	       --	015	1	1	0.00	    $0.00	Y	
X	13151	CMPLX RPR E/N/E/L 1.1-2.5 CM            	   391.81	  $391.81	      ---	       --	009	1	0	0.00	    $0.00	Y	
K	13151	CMPLX RPR E/N/E/L 1.1-2.5 CM            	     4.39	  $163.44	      ---	  $206.11	004	1	0	0.00	    $0.00	Y	
K	13152	CMPLX RPR E/N/E/L 2.6-7.5 CM            	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
X	13152	CMPLX RPR E/N/E/L 2.6-7.5 CM            	   458.53	  $458.53	      ---	       --	009	1	0	0.00	    $0.00	Y	
O	13152	CMPLX RPR E/N/E/L 2.6-7.5 CM            	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
O	13153	CMPLX RPR E/N/E/L ADDL 5CM/<            	     0.51	   $18.99	      ---	   $23.94	004	1	0	0.00	    $0.00	Y	
X	13153	CMPLX RPR E/N/E/L ADDL 5CM/<            	   168.45	  $168.45	      ---	       --	009	1	0	0.00	    $0.00	Y	
K	13153	CMPLX RPR E/N/E/L ADDL 5CM/<            	     2.56	   $95.31	      ---	  $120.19	004	1	0	0.00	    $0.00	Y	
K	13160	SEC CLSR SURG WND/DEHSN XTN             	    14.73	  $548.40	      ---	  $691.57	004	1	0	0.00	    $0.00	Y	
X	13160	SEC CLSR SURG WND/DEHSN XTN             	   708.75	  $708.75	      ---	       --	009	1	0	0.00	    $0.00	Y	
O	13160	SEC CLSR SURG WND/DEHSN XTN             	     2.95	  $109.83	      ---	  $138.50	004	1	0	0.00	    $0.00	Y	
P	13160	SEC CLSR SURG WND/DEHSN XTN             	    14.73	  $548.40	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	14000	TIS TRNFR TRUNK 10 SQ CM/<              	     1.20	   $44.68	      ---	   $56.34	004	1	0	0.00	    $0.00	Y	
K	14000	TIS TRNFR TRUNK 10 SQ CM/<              	     6.02	  $224.12	      ---	  $282.64	004	1	1	0.00	    $0.00	Y	
K	14001	TIS TRNFR TRUNK 10.1-30SQCM             	     7.84	  $291.88	      ---	  $368.09	004	1	0	0.00	    $0.00	Y	
O	14001	TIS TRNFR TRUNK 10.1-30SQCM             	     1.57	   $58.45	      ---	   $73.71	004	1	0	0.00	    $0.00	Y	
O	14020	TIS TRNFR S/A/L 10 SQ CM/<              	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
K	14020	TIS TRNFR S/A/L 10 SQ CM/<              	     6.80	  $253.16	      ---	  $319.26	004	1	1	0.00	    $0.00	Y	
K	14021	TIS TRNFR S/A/L 10.1-30 SQCM            	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	14021	TIS TRNFR S/A/L 10.1-30 SQCM            	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
O	14040	TIS TRNFR F/C/C/M/N/A/G/H/F             	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
P	14040	TIS TRNFR F/C/C/M/N/A/G/H/F             	     9.06	  $337.30	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	14040	TIS TRNFR F/C/C/M/N/A/G/H/F             	     9.06	  $337.30	      ---	  $425.37	004	1	1	0.00	    $0.00	Y	
K	14041	TIS TRNFR F/C/C/M/N/A/G/H/F             	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	14041	TIS TRNFR F/C/C/M/N/A/G/H/F             	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	14060	TIS TRNFR E/N/E/L 10 SQ CM/<            	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	14060	TIS TRNFR E/N/E/L 10 SQ CM/<            	    11.33	  $421.82	      ---	  $531.94	004	1	1	0.00	    $0.00	Y	
K	14061	TIS TRNFR E/N/E/L10.1-30SQCM            	    19.90	  $740.88	      ---	  $934.31	004	1	0	0.00	    $0.00	Y	
O	14061	TIS TRNFR E/N/E/L10.1-30SQCM            	     3.98	  $148.18	      ---	  $186.86	004	1	0	0.00	    $0.00	Y	
O	14301	TIS TRNFR ANY 30.1-60 SQ CM             	     4.77	  $177.59	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	14301	TIS TRNFR ANY 30.1-60 SQ CM             	    23.87	  $888.68	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	14302	TIS TRNFR ADDL 30 SQ CM                 	     5.09	  $189.50	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	14302	TIS TRNFR ADDL 30 SQ CM                 	     1.02	   $37.97	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	14350	FILLETED FINGER/TOE FLAP                	     2.70	  $100.52	      ---	  $126.77	004	1	0	0.00	    $0.00	Y	
P	14350	FILLETED FINGER/TOE FLAP                	    13.51	  $502.98	      ---	       --	015	1	1	0.00	    $0.00	Y	
K	14350	FILLETED FINGER/TOE FLAP                	    13.51	  $502.98	      ---	  $634.29	004	1	1	0.00	    $0.00	Y	
N	1494F	COGNIT ASSESSED AND REVIEWED            	    29.00	   $29.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	15002	WOUND PREP TRK/ARM/LEG                  	     1.45	   $53.98	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	15002	WOUND PREP TRK/ARM/LEG                  	     7.26	  $270.29	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	15003	WOUND PREP ADDL 100 CM                  	     1.61	   $59.94	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	15003	WOUND PREP ADDL 100 CM                  	     0.32	   $11.91	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	15004	WOUND PREP F/N/HF/G                     	     1.75	   $65.15	      ---	       --	004	0	0	0.00	    $0.00	Y	
P	15004	WOUND PREP F/N/HF/G                     	     8.73	  $325.02	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	15004	WOUND PREP F/N/HF/G                     	     8.73	  $325.02	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	15005	WND PREP F/N/HF/G ADDL CM               	     2.69	  $100.15	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	15005	WND PREP F/N/HF/G ADDL CM               	     0.54	   $20.10	      ---	       --	004	0	0	0.00	    $0.00	Y	
P	15011	HRV SKN CLL SSP AGRFT 1ST 25            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
1	15011	HRV SKN CLL SSP AGRFT 1ST 25            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	15012	HRV SKN CLL SSP AGRFT EA ADD            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	15012	HRV SKN CLL SSP AGRFT EA ADD            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	15013	PREPJ SKN CLL SSP AGRFT 1ST             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	15013	PREPJ SKN CLL SSP AGRFT 1ST             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	15014	PREPJ SKN CLL SSP AGRFT EA              	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	15014	PREPJ SKN CLL SSP AGRFT EA              	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	15015	APP SKN CL SSP AGRFT T/A/L 1            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	15015	APP SKN CL SSP AGRFT T/A/L 1            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	15016	APP SKN CL SSP AGRF T/A/L EA            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	15016	APP SKN CL SSP AGRF T/A/L EA            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	15017	APP SKN CLL SSP F/N/G/HF 1ST            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	15017	APP SKN CLL SSP F/N/G/HF 1ST            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	15018	APP SKN CLL SSP F/N/G/HF EA             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	15018	APP SKN CLL SSP F/N/G/HF EA             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	15040	HARVEST CULTURED SKIN GRAFT             	     5.79	  $215.56	      ---	  $271.84	004	1	0	0.00	    $0.00	Y	
O	15040	HARVEST CULTURED SKIN GRAFT             	     1.16	   $43.19	      ---	   $54.46	004	1	0	0.00	    $0.00	Y	
O	15050	PINCH GRAFT UP TO 2 CM DIAM             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
P	15050	PINCH GRAFT UP TO 2 CM DIAM             	     4.26	  $158.60	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	15050	PINCH GRAFT UP TO 2 CM DIAM             	     4.26	  $158.60	      ---	  $200.01	004	1	1	0.00	    $0.00	Y	
K	15100	SPLT AGRFT T/A/L 1ST 100SQCM            	     7.13	  $265.45	      ---	  $334.75	004	1	0	0.00	    $0.00	Y	
P	15100	SPLT AGRFT T/A/L 1ST 100SQCM            	     7.13	  $265.45	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	15100	SPLT AGRFT T/A/L 1ST 100SQCM            	     1.43	   $53.24	      ---	   $67.14	004	1	0	0.00	    $0.00	Y	
O	15101	SPLT AGRFT T/A/L EA ADDL 100            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	15101	SPLT AGRFT T/A/L EA ADDL 100            	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
K	15110	EPIDRM AGRFT T/A/L 1ST 100              	    17.90	  $666.42	      ---	  $840.41	004	1	0	0.00	    $0.00	Y	
O	15110	EPIDRM AGRFT T/A/L 1ST 100              	     3.58	  $133.28	      ---	  $168.08	004	1	0	0.00	    $0.00	Y	
O	15111	EPIDRM AGRFT T/A/L EA ADDL              	     0.56	   $20.85	      ---	   $26.29	004	1	0	0.00	    $0.00	Y	
K	15111	EPIDRM AGRFT T/A/L EA ADDL              	     2.79	  $103.87	      ---	  $130.99	004	1	0	0.00	    $0.00	Y	
K	15115	EPDRM AGRFT F/S/N/H/F/G/M 1             	    16.77	  $624.35	      ---	  $787.35	004	1	0	0.00	    $0.00	Y	
O	15115	EPDRM AGRFT F/S/N/H/F/G/M 1             	     3.35	  $124.72	      ---	  $157.28	004	1	0	0.00	    $0.00	Y	
P	15115	EPDRM AGRFT F/S/N/H/F/G/M 1             	    16.77	  $624.35	      ---	       --	015	1	0	0.00	    $0.00	Y	
P	15116	EPDRM AGRFT F/S/N/H/F/G/M EA            	     3.61	  $134.40	      ---	       --	015	1	0	0.00	    $0.00	Y	
O	15116	EPDRM AGRFT F/S/N/H/F/G/M EA            	     0.72	   $26.81	      ---	   $33.80	004	1	0	0.00	    $0.00	Y	
K	15116	EPDRM AGRFT F/S/N/H/F/G/M EA            	     3.61	  $134.40	      ---	  $169.49	004	1	0	0.00	    $0.00	Y	
K	15120	SPLT AGRFT F/S/N/H/F/G/M 1ST            	    12.46	  $463.89	      ---	  $585.00	004	1	0	0.00	    $0.00	Y	
O	15120	SPLT AGRFT F/S/N/H/F/G/M 1ST            	     2.49	   $92.70	      ---	  $116.91	004	1	0	0.00	    $0.00	Y	
P	15120	SPLT AGRFT F/S/N/H/F/G/M 1ST            	    12.46	  $463.89	      ---	       --	015	1	0	0.00	    $0.00	Y	
P	15121	SPLT AGRFT F/S/N/H/F/G/M EA             	     2.27	   $84.51	      ---	       --	015	1	0	0.00	    $0.00	Y	
O	15121	SPLT AGRFT F/S/N/H/F/G/M EA             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	15121	SPLT AGRFT F/S/N/H/F/G/M EA             	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	15130	DRM AGRFT T/A/L 1ST 100 SQCM            	    14.97	  $557.33	      ---	  $702.84	004	1	0	0.00	    $0.00	Y	
O	15130	DRM AGRFT T/A/L 1ST 100 SQCM            	     2.99	  $111.32	      ---	  $140.38	004	1	0	0.00	    $0.00	Y	
O	15131	DRM AGRFT T/A/L EA ADDL                 	     0.46	   $17.13	      ---	   $21.60	004	1	0	0.00	    $0.00	Y	
K	15131	DRM AGRFT T/A/L EA ADDL                 	     2.28	   $84.88	      ---	  $107.05	004	1	0	0.00	    $0.00	Y	
K	15135	DRM AGRFT F/S/N/H/F/G/M 1ST             	    17.95	  $668.28	      ---	  $842.75	004	1	0	0.00	    $0.00	Y	
O	15135	DRM AGRFT F/S/N/H/F/G/M 1ST             	     3.59	  $133.66	      ---	  $168.55	004	1	0	0.00	    $0.00	Y	
P	15135	DRM AGRFT F/S/N/H/F/G/M 1ST             	    17.95	  $668.28	      ---	       --	015	1	0	0.00	    $0.00	Y	
P	15136	DRM AGRFT F/S/N/H/F/G/M EA              	     2.12	   $78.93	      ---	       --	015	1	0	0.00	    $0.00	Y	
O	15136	DRM AGRFT F/S/N/H/F/G/M EA              	     0.42	   $15.64	      ---	   $19.72	004	1	0	0.00	    $0.00	Y	
K	15136	DRM AGRFT F/S/N/H/F/G/M EA              	     2.12	   $78.93	      ---	   $99.53	004	1	0	0.00	    $0.00	Y	
K	15150	TIS CLTR SKN AGRFT T/A/L 1ST            	    14.83	  $552.12	      ---	  $696.27	004	1	0	0.00	    $0.00	Y	
K	15151	TIS CLTR SKN AGRFT T/A/L ADD            	     2.94	  $109.46	      ---	  $138.03	004	1	0	0.00	    $0.00	Y	
K	15152	TIS CLTR SKN AGRFT T/A/L EA             	     3.61	  $134.40	      ---	  $169.49	004	1	0	0.00	    $0.00	Y	
K	15155	TIS CLTR AGRFT F/S/N/H/F/G 1            	    14.81	  $551.38	      ---	  $695.33	004	1	0	0.00	    $0.00	Y	
P	15155	TIS CLTR AGRFT F/S/N/H/F/G 1            	    14.81	  $551.38	      ---	       --	015	1	0	0.00	    $0.00	Y	
P	15156	TIS CLT AGRFT F/S/N/H/F/G AD            	     3.81	  $141.85	      ---	       --	015	1	0	0.00	    $0.00	Y	
K	15156	TIS CLT AGRFT F/S/N/H/F/G AD            	     3.81	  $141.85	      ---	  $178.88	004	1	0	0.00	    $0.00	Y	
K	15157	TIS CLT AGRFT F/S/N/H/F/G EA            	     4.23	  $157.48	      ---	  $198.60	004	1	0	0.00	    $0.00	Y	
P	15157	TIS CLT AGRFT F/S/N/H/F/G EA            	     4.23	  $157.48	      ---	       --	015	1	0	0.00	    $0.00	Y	
O	15200	FTH/GFT FR TRNK 20 SQ CM/<              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	15200	FTH/GFT FR TRNK 20 SQ CM/<              	     7.90	  $294.12	      ---	  $370.91	004	1	0	0.00	    $0.00	Y	
K	15201	FTH/GFT FR TRNK EACH ADDL               	     2.06	   $76.69	      ---	   $96.72	004	1	0	0.00	    $0.00	Y	
O	15201	FTH/GFT FR TRNK EACH ADDL               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	15220	FTH/GFT FR S/A/L 20 SQ CM/<             	     1.58	   $58.82	      ---	   $74.18	004	1	0	0.00	    $0.00	Y	
K	15220	FTH/GFT FR S/A/L 20 SQ CM/<             	     7.92	  $294.86	      ---	  $371.84	004	1	0	0.00	    $0.00	Y	
K	15221	FTH/GFT FR S/A/L EACH ADDL              	     3.00	  $111.69	      ---	  $140.85	004	1	0	0.00	    $0.00	Y	
O	15221	FTH/GFT FR S/A/L EACH ADDL              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	15240	FTH/GFT F/C/C/M/N/AX/G/H/F20            	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
P	15240	FTH/GFT F/C/C/M/N/AX/G/H/F20            	     9.06	  $337.30	      ---	       --	015	1	0	0.00	    $0.00	Y	
K	15240	FTH/GFT F/C/C/M/N/AX/G/H/F20            	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
K	15241	FTH/GFT F/C/C/M/N/A/G/H/F EA            	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
P	15241	FTH/GFT F/C/C/M/N/A/G/H/F EA            	     4.00	  $148.92	      ---	       --	015	1	0	0.00	    $0.00	Y	
O	15241	FTH/GFT F/C/C/M/N/A/G/H/F EA            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	15260	FTH/GFT FR N/E/E/L 20 SQCM/<            	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	15260	FTH/GFT FR N/E/E/L 20 SQCM/<            	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	15261	FTH/GFT FR N/E/E/L EACH ADDL            	     5.00	  $186.15	      ---	  $234.75	004	1	0	0.00	    $0.00	Y	
O	15261	FTH/GFT FR N/E/E/L EACH ADDL            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	15271	SKIN SUB GRAFT TRNK/ARM/LEG             	     1.94	   $72.23	      ---	   $91.08	004	1	0	0.00	    $0.00	Y	
K	15272	SKIN SUB GRAFT T/A/L ADD-ON             	     0.38	   $14.15	      ---	   $17.84	004	1	0	0.00	    $0.00	Y	
K	15273	SKIN SUB GRFT T/ARM/LG CHILD            	     4.62	  $172.00	      ---	  $216.91	004	1	0	0.00	    $0.00	Y	
K	15274	SKN SUB GRFT T/A/L CHILD ADD            	     0.98	   $36.49	      ---	   $46.01	004	1	0	0.00	    $0.00	Y	
K	15275	SKIN SUB GRAFT FACE/NK/HF/G             	     2.23	   $83.02	      ---	  $104.70	004	1	0	0.00	    $0.00	Y	
P	15275	SKIN SUB GRAFT FACE/NK/HF/G             	     2.23	   $83.02	      ---	       --	015	1	0	0.00	    $0.00	Y	
P	15276	SKIN SUB GRAFT F/N/HF/G ADDL            	     0.55	   $20.48	      ---	       --	015	1	0	0.00	    $0.00	Y	
K	15276	SKIN SUB GRAFT F/N/HF/G ADDL            	     0.55	   $20.48	      ---	   $25.82	004	1	0	0.00	    $0.00	Y	
K	15277	SKN SUB GRFT F/N/HF/G CHILD             	     4.76	  $177.21	      ---	  $223.48	004	1	0	0.00	    $0.00	Y	
P	15277	SKN SUB GRFT F/N/HF/G CHILD             	     4.76	  $177.21	      ---	       --	015	1	0	0.00	    $0.00	Y	
P	15278	SKN SUB GRFT F/N/HF/G CH ADD            	     1.22	   $45.42	      ---	       --	015	1	0	0.00	    $0.00	Y	
K	15278	SKN SUB GRFT F/N/HF/G CH ADD            	     1.22	   $45.42	      ---	   $57.28	004	1	0	0.00	    $0.00	Y	
K	15570	SKIN PEDICLE FLAP TRUNK                 	    15.50	  $577.07	      ---	  $727.73	004	1	0	0.00	    $0.00	Y	
O	15570	SKIN PEDICLE FLAP TRUNK                 	     3.10	  $115.41	      ---	  $145.55	004	1	0	0.00	    $0.00	Y	
O	15572	SKIN PEDICLE FLAP ARMS/LEGS             	     2.94	  $109.46	      ---	  $138.03	004	1	0	0.00	    $0.00	Y	
K	15572	SKIN PEDICLE FLAP ARMS/LEGS             	    14.70	  $547.28	      ---	  $690.17	004	1	0	0.00	    $0.00	Y	
K	15574	PEDCLE FH/CH/CH/M/N/AX/G/H/F            	    15.59	  $580.42	      ---	  $731.95	004	1	0	0.00	    $0.00	Y	
O	15574	PEDCLE FH/CH/CH/M/N/AX/G/H/F            	     3.12	  $116.16	      ---	  $146.48	004	1	0	0.00	    $0.00	Y	
P	15574	PEDCLE FH/CH/CH/M/N/AX/G/H/F            	    15.59	  $580.42	      ---	       --	015	1	0	0.00	    $0.00	Y	
O	15576	PEDICLE E/N/E/L/NTRORAL                 	     1.70	   $63.29	      ---	   $79.82	004	1	0	0.00	    $0.00	Y	
K	15576	PEDICLE E/N/E/L/NTRORAL                 	     8.49	  $316.08	      ---	  $398.61	004	1	0	0.00	    $0.00	Y	
K	15600	DELAY FLAP TRUNK                        	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
O	15600	DELAY FLAP TRUNK                        	     0.90	   $33.51	      ---	   $42.26	004	1	0	0.00	    $0.00	Y	
O	15610	DELAY FLAP ARMS/LEGS                    	     1.00	   $37.23	      ---	   $46.95	004	1	0	0.00	    $0.00	Y	
K	15610	DELAY FLAP ARMS/LEGS                    	     5.00	  $186.15	      ---	  $234.75	004	1	0	0.00	    $0.00	Y	
K	15620	DELAY FLAP F/C/C/N/AX/G/H/F             	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
O	15620	DELAY FLAP F/C/C/N/AX/G/H/F             	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
P	15620	DELAY FLAP F/C/C/N/AX/G/H/F             	     6.80	  $253.16	      ---	       --	015	1	0	0.00	    $0.00	Y	
O	15630	DELAY FLAP EYE/NOS/EAR/LIP              	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
K	15630	DELAY FLAP EYE/NOS/EAR/LIP              	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
K	15650	TRANSFER SKIN PEDICLE FLAP              	   176.86	  $176.86	      ---	       --	042	0	0	0.00	    $0.00	Y	
O	15650	TRANSFER SKIN PEDICLE FLAP              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	15730	MDFC FLAP W/PRSRV VASC PEDCL            	    37.44	 $1393.89	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	15731	FOREHEAD FLAP W/VASC PEDICLE            	    24.08	  $896.50	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	15731	FOREHEAD FLAP W/VASC PEDICLE            	     4.82	  $179.45	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	15733	MUSC MYOQ/FSCQ FLP H&N PEDCL            	    24.59	  $915.49	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	15734	MUSCLE-SKIN GRAFT TRUNK                 	    25.24	  $939.69	      ---	 $1185.02	004	1	0	0.00	    $0.00	Y	
O	15734	MUSCLE-SKIN GRAFT TRUNK                 	     5.05	  $188.01	      ---	  $237.10	004	1	0	0.00	    $0.00	Y	
O	15736	MUSCLE-SKIN GRAFT ARM                   	     4.66	  $173.49	      ---	  $218.79	004	1	0	0.00	    $0.00	Y	
K	15736	MUSCLE-SKIN GRAFT ARM                   	    23.30	  $867.46	      ---	 $1093.94	004	1	0	0.00	    $0.00	Y	
K	15738	MUSCLE-SKIN GRAFT LEG                   	    25.27	  $940.80	      ---	 $1186.43	004	1	0	0.00	    $0.00	Y	
O	15738	MUSCLE-SKIN GRAFT LEG                   	     5.05	  $188.01	      ---	  $237.10	004	1	0	0.00	    $0.00	Y	
O	15740	ISLAND PEDICLE FLAP GRAFT               	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	15740	ISLAND PEDICLE FLAP GRAFT               	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	15750	NEUROVASCULAR PEDICLE FLAP              	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	15750	NEUROVASCULAR PEDICLE FLAP              	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	15756	FREE MYO/SKIN FLAP MICROVASC            	     9.93	  $369.69	      ---	  $466.21	004	1	0	0.00	    $0.00	Y	
K	15756	FREE MYO/SKIN FLAP MICROVASC            	    49.66	 $1848.84	      ---	 $2331.54	004	1	0	0.00	    $0.00	Y	
K	15757	FREE SKIN FLAP MICROVASC                	    49.99	 $1861.13	      ---	 $2347.03	004	1	0	0.00	    $0.00	Y	
O	15757	FREE SKIN FLAP MICROVASC                	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
O	15758	FREE FASCIAL FLAP MICROVASC             	     9.95	  $370.44	      ---	  $467.15	004	1	0	0.00	    $0.00	Y	
K	15758	FREE FASCIAL FLAP MICROVASC             	    49.74	 $1851.82	      ---	 $2335.29	004	1	0	0.00	    $0.00	Y	
K	15760	COMPOSITE SKIN GRAFT                    	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	15760	COMPOSITE SKIN GRAFT                    	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	15769	GRFG AUTOL SOFT TISS DIR EXC            	     2.27	   $84.51	      ---	       --	004	0	0	0.00	    $0.00	Y	
P	15769	GRFG AUTOL SOFT TISS DIR EXC            	    11.39	  $424.05	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	15769	GRFG AUTOL SOFT TISS DIR EXC            	    11.39	  $424.05	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	15770	DERMA-FAT-FASCIA GRAFT                  	    12.00	  $446.76	      ---	  $563.40	004	1	0	0.00	    $0.00	Y	
O	15770	DERMA-FAT-FASCIA GRAFT                  	     2.40	   $89.35	      ---	  $112.68	004	1	0	0.00	    $0.00	Y	
K	15771	GRFG AUTOL FAT LIPO 50 CC/<             	    13.80	  $513.77	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	15772	GRFG AUTOL FAT LIPO EA ADDL             	     4.29	  $159.72	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	15773	GRFG AUTOL FAT LIPO 25 CC/<             	    13.93	  $518.61	      ---	       --	004	0	0	0.00	    $0.00	Y	
P	15773	GRFG AUTOL FAT LIPO 25 CC/<             	    13.93	  $518.61	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	15774	GFRG AUTOL FAT LIPO EA ADDL             	     4.17	  $155.25	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	15774	GFRG AUTOL FAT LIPO EA ADDL             	     4.17	  $155.25	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	15777	ACELLULAR DERM MATRIX IMPLT             	     4.66	  $173.49	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	15778	IMPL ABSRB MSH/PRSTH DLY CLS            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	15778	IMPL ABSRB MSH/PRSTH DLY CLS            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	15780	DERMABRASION TOTAL FACE                 	     2.44	   $90.84	      ---	  $114.56	004	1	0	0.00	    $0.00	Y	
K	15780	DERMABRASION TOTAL FACE                 	    12.19	  $453.83	      ---	  $572.32	004	1	0	0.00	    $0.00	Y	
K	15781	DERMABRASION SEGMENTAL FACE             	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
O	15781	DERMABRASION SEGMENTAL FACE             	     0.91	   $33.88	      ---	   $42.72	004	1	0	0.00	    $0.00	Y	
O	15782	DERMABRASION OTHER THAN FACE            	     0.91	   $33.88	      ---	   $42.72	004	1	0	0.00	    $0.00	Y	
K	15782	DERMABRASION OTHER THAN FACE            	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	15783	DERMABRASION SUPRFL ANY SITE            	     4.05	  $150.78	      ---	  $190.15	004	1	0	0.00	    $0.00	Y	
K	15786	ABRASION LESION SINGLE                  	     1.73	   $64.41	      ---	   $81.22	004	1	1	0.00	    $0.00	Y	
O	15786	ABRASION LESION SINGLE                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	15787	ABRASION LESIONS ADD-ON                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	15787	ABRASION LESIONS ADD-ON                 	     0.28	   $10.42	      ---	   $13.15	004	1	1	0.00	    $0.00	Y	
K	15788	CHEMICAL PEEL FACIAL EPIDRM             	     3.07	  $114.30	      ---	  $144.14	004	1	0	0.00	    $0.00	Y	
O	15788	CHEMICAL PEEL FACIAL EPIDRM             	     0.61	   $22.71	      ---	   $28.64	004	1	0	0.00	    $0.00	Y	
O	15789	CHEMICAL PEEL FACIAL DERMAL             	     0.98	   $36.49	      ---	   $46.01	004	1	0	0.00	    $0.00	Y	
K	15789	CHEMICAL PEEL FACIAL DERMAL             	     4.91	  $182.80	      ---	  $230.52	004	1	0	0.00	    $0.00	Y	
K	15792	CHEM PEEL NONFACIAL EPIDRM              	     2.15	   $80.04	      ---	  $100.94	004	1	0	0.00	    $0.00	Y	
O	15792	CHEM PEEL NONFACIAL EPIDRM              	     0.43	   $16.01	      ---	   $20.19	004	1	0	0.00	    $0.00	Y	
O	15793	CHEMICAL PEEL NONFACIAL DRM             	     0.67	   $24.94	      ---	   $31.46	004	1	0	0.00	    $0.00	Y	
K	15793	CHEMICAL PEEL NONFACIAL DRM             	     3.31	  $123.23	      ---	  $155.40	004	1	0	0.00	    $0.00	Y	
K	15820	BLEPHAROPLASTY LOWER EYELID             	    12.00	  $446.76	      ---	  $563.40	004	1	0	0.00	    $0.00	Y	
O	15820	BLEPHAROPLASTY LOWER EYELID             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	15821	BLEPHARP LWR EYELID FAT PAD             	     2.80	  $104.24	      ---	  $131.46	004	1	0	0.00	    $0.00	Y	
K	15821	BLEPHARP LWR EYELID FAT PAD             	    13.98	  $520.48	      ---	  $656.36	004	1	0	0.00	    $0.00	Y	
K	15822	BLEPHAROPLASTY UPPER EYELID             	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	15822	BLEPHAROPLASTY UPPER EYELID             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	15823	BLEPHARP UPR EYELID XCSV SKN            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	15823	BLEPHARP UPR EYELID XCSV SKN            	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
K	15840	NERVE PALSY FASCIAL GRAFT               	    30.00	 $1116.90	      ---	 $1408.50	004	1	0	0.00	    $0.00	Y	
O	15840	NERVE PALSY FASCIAL GRAFT               	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
O	15841	NERVE PALSY MUSCLE GRAFT                	     6.70	  $249.44	      ---	  $314.57	004	1	0	0.00	    $0.00	Y	
K	15841	NERVE PALSY MUSCLE GRAFT                	    33.52	 $1247.95	      ---	 $1573.76	004	1	0	0.00	    $0.00	Y	
K	15842	NERVE PALSY MICROSURG GRAFT             	    33.98	 $1265.08	      ---	 $1595.36	004	1	0	0.00	    $0.00	Y	
O	15842	NERVE PALSY MICROSURG GRAFT             	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
O	15845	SKIN AND MUSCLE REPAIR FACE             	     4.01	  $149.29	      ---	  $188.27	004	1	0	0.00	    $0.00	Y	
K	15845	SKIN AND MUSCLE REPAIR FACE             	    20.07	  $747.21	      ---	  $942.29	004	1	0	0.00	    $0.00	Y	
K	15851	REMOVAL SUTR/STAPLE REQ ANES            	     1.13	   $42.07	      ---	   $53.05	004	1	0	0.00	    $0.00	Y	
P	15851	REMOVAL SUTR/STAPLE REQ ANES            	     1.13	   $42.07	      ---	       --	015	0	0	0.00	    $0.00	Y	
X	15851	REMOVAL SUTR/STAPLE REQ ANES            	    50.40	   $50.40	      ---	       --	009	1	0	0.00	    $0.00	Y	
K	15860	TEST FOR BLOOD FLOW IN GRAFT            	     2.78	  $103.50	      ---	  $130.52	004	1	0	0.00	    $0.00	Y	
K	15920	EXC COCCYGL PR ULC PRIM SUTR            	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
O	15920	EXC COCCYGL PR ULC PRIM SUTR            	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
O	15922	EXC COCCYGL PR ULC FLAP CLSR            	     3.09	  $115.04	      ---	  $145.08	004	1	0	0.00	    $0.00	Y	
K	15922	EXC COCCYGL PR ULC FLAP CLSR            	    15.43	  $574.46	      ---	  $724.44	004	1	0	0.00	    $0.00	Y	
K	15931	EXC SACRAL PR ULC PRIM SUTR             	    10.19	  $379.37	      ---	  $478.42	004	1	0	0.00	    $0.00	Y	
O	15931	EXC SACRAL PR ULC PRIM SUTR             	     2.04	   $75.95	      ---	   $95.78	004	1	0	0.00	    $0.00	Y	
O	15933	EXC SAC PR ULC PRIM STR OSTC            	     2.90	  $107.97	      ---	  $136.16	004	1	0	0.00	    $0.00	Y	
K	15933	EXC SAC PR ULC PRIM STR OSTC            	    14.50	  $539.84	      ---	  $680.78	004	1	0	0.00	    $0.00	Y	
K	15934	EXC SACRAL PR ULC SKN FLAP              	    18.21	  $677.96	      ---	  $854.96	004	1	0	0.00	    $0.00	Y	
O	15934	EXC SACRAL PR ULC SKN FLAP              	     3.64	  $135.52	      ---	  $170.90	004	1	0	0.00	    $0.00	Y	
O	15935	EXC SAC PR ULC SKN FLP OSTC             	     4.47	  $166.42	      ---	  $209.87	004	1	0	0.00	    $0.00	Y	
K	15935	EXC SAC PR ULC SKN FLP OSTC             	    22.35	  $832.09	      ---	 $1049.33	004	1	0	0.00	    $0.00	Y	
K	15936	EXC SAC PR ULC PREP MUS FLAP            	    18.35	  $683.17	      ---	  $861.53	004	1	0	0.00	    $0.00	Y	
O	15936	EXC SAC PR ULC PREP MUS FLAP            	     3.67	  $136.63	      ---	  $172.31	004	1	0	0.00	    $0.00	Y	
O	15937	EXC SAC PR ULC PREP MUS OSTC            	     4.20	  $156.37	      ---	  $197.19	004	1	0	0.00	    $0.00	Y	
K	15937	EXC SAC PR ULC PREP MUS OSTC            	    21.00	  $781.83	      ---	  $985.95	004	1	0	0.00	    $0.00	Y	
K	15940	EXC ISCHIAL PR ULC PRIM SUTR            	    13.25	  $493.30	      ---	  $622.09	004	1	0	0.00	    $0.00	Y	
O	15940	EXC ISCHIAL PR ULC PRIM SUTR            	     2.65	   $98.66	      ---	  $124.42	004	1	0	0.00	    $0.00	Y	
O	15941	EXC ISCH PR ULC PRM SUT OSTC            	     3.75	  $139.61	      ---	  $176.06	004	1	0	0.00	    $0.00	Y	
K	15941	EXC ISCH PR ULC PRM SUT OSTC            	    18.76	  $698.43	      ---	  $880.78	004	1	0	0.00	    $0.00	Y	
K	15944	EXC ISCH PR ULC SKN FLP CLSR            	    17.20	  $640.36	      ---	  $807.54	004	1	0	0.00	    $0.00	Y	
O	15944	EXC ISCH PR ULC SKN FLP CLSR            	     3.44	  $128.07	      ---	  $161.51	004	1	0	0.00	    $0.00	Y	
O	15945	EXC ISCH PR ULC SKN FLP OSTC            	     3.81	  $141.85	      ---	  $178.88	004	1	0	0.00	    $0.00	Y	
K	15945	EXC ISCH PR ULC SKN FLP OSTC            	    19.06	  $709.60	      ---	  $894.87	004	1	0	0.00	    $0.00	Y	
K	15946	EXC ISCH PR ULC PREP MUS FLP            	    26.62	  $991.06	      ---	 $1249.81	004	1	0	0.00	    $0.00	Y	
O	15946	EXC ISCH PR ULC PREP MUS FLP            	     5.32	  $198.06	      ---	  $249.77	004	1	0	0.00	    $0.00	Y	
O	15950	EXC TRCHNTR PR ULC PRIM SUTR            	     2.23	   $83.02	      ---	  $104.70	004	1	0	0.00	    $0.00	Y	
K	15950	EXC TRCHNTR PR ULC PRIM SUTR            	    11.13	  $414.37	      ---	  $522.55	004	1	0	0.00	    $0.00	Y	
K	15951	EXC TRCHNTR PR ULC OSTC                 	    17.05	  $634.77	      ---	  $800.50	004	1	0	0.00	    $0.00	Y	
O	15951	EXC TRCHNTR PR ULC OSTC                 	     3.41	  $126.95	      ---	  $160.10	004	1	0	0.00	    $0.00	Y	
O	15952	EXC TRCHNTR PR ULC FLP CLSR             	     3.41	  $126.95	      ---	  $160.10	004	1	0	0.00	    $0.00	Y	
K	15952	EXC TRCHNTR PR ULC FLP CLSR             	    17.04	  $634.40	      ---	  $800.03	004	1	0	0.00	    $0.00	Y	
K	15953	EXC TRCHNTR PR ULC FLP OSTC             	    21.30	  $793.00	      ---	 $1000.04	004	1	0	0.00	    $0.00	Y	
O	15953	EXC TRCHNTR PR ULC FLP OSTC             	     4.26	  $158.60	      ---	  $200.01	004	1	0	0.00	    $0.00	Y	
O	15956	EXC TRCHNTR PR ULC PREP FLAP            	     4.37	  $162.70	      ---	  $205.17	004	1	0	0.00	    $0.00	Y	
K	15956	EXC TRCHNTR PR ULC PREP FLAP            	    21.86	  $813.85	      ---	 $1026.33	004	1	0	0.00	    $0.00	Y	
K	15958	EXC TRCHNTR PR ULC PREP OSTC            	    22.53	  $838.79	      ---	 $1057.78	004	1	0	0.00	    $0.00	Y	
O	15958	EXC TRCHNTR PR ULC PREP OSTC            	     4.51	  $167.91	      ---	  $211.74	004	1	0	0.00	    $0.00	Y	
O	15999	UNLISTED PX EXC PRESSURE ULC            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	15999	UNLISTED PX EXC PRESSURE ULC            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	16000	INITIAL TREATMENT OF BURN(S)            	     0.86	   $32.02	      ---	   $40.38	004	1	1	0.00	    $0.00	Y	
P	16000	INITIAL TREATMENT OF BURN(S)            	     0.86	   $32.02	      ---	       --	015	0	1	0.00	    $0.00	Y	
P	16020	DRESS/DEBRID P-THICK BURN S             	     0.85	   $31.65	      ---	       --	015	0	1	0.00	    $0.00	Y	
O	16020	DRESS/DEBRID P-THICK BURN S             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
X	16020	DRESS/DEBRID P-THICK BURN S             	    78.90	   $78.90	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	16020	DRESS/DEBRID P-THICK BURN S             	     0.85	   $31.65	      ---	   $39.91	004	1	1	0.00	    $0.00	Y	
K	16025	DRESS/DEBRID P-THICK BURN M             	     1.62	   $60.31	      ---	   $76.06	004	1	0	0.00	    $0.00	Y	
O	16025	DRESS/DEBRID P-THICK BURN M             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	16030	DRESS/DEBRID P-THICK BURN L             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	16030	DRESS/DEBRID P-THICK BURN L             	     2.19	   $81.53	      ---	  $102.82	004	1	0	0.00	    $0.00	Y	
K	16035	INCISION OF BURN SCAB INITI             	     6.76	  $251.67	      ---	  $317.38	004	1	0	0.00	    $0.00	Y	
O	16035	INCISION OF BURN SCAB INITI             	     1.35	   $50.26	      ---	   $63.38	004	1	0	0.00	    $0.00	Y	
P	16035	INCISION OF BURN SCAB INITI             	     6.76	  $251.67	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	16036	ESCHAROTOMY ADDL INCISION               	     0.40	   $14.89	      ---	   $18.78	004	1	0	0.00	    $0.00	Y	
K	16036	ESCHAROTOMY ADDL INCISION               	     1.99	   $74.09	      ---	   $93.43	004	1	0	0.00	    $0.00	Y	
K	17000	DESTRUCT PREMALG LESION                 	     1.87	   $69.62	      ---	   $87.80	004	1	1	0.00	    $0.00	Y	
P	17000	DESTRUCT PREMALG LESION                 	     1.87	   $69.62	      ---	       --	015	0	1	0.00	    $0.00	Y	
X	17000	DESTRUCT PREMALG LESION                 	    69.80	   $69.80	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	17003	DESTRUCT PREMALG LES 2-14               	     6.33	    $6.33	      ---	       --	009	1	0	0.00	    $0.00	Y	
P	17003	DESTRUCT PREMALG LES 2-14               	     0.16	    $5.96	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	17003	DESTRUCT PREMALG LES 2-14               	     0.16	    $5.96	      ---	    $7.51	004	1	0	0.00	    $0.00	Y	
K	17004	DESTROY PREMAL LESIONS 15/>             	     3.88	  $144.45	      ---	  $182.17	004	1	1	0.00	    $0.00	Y	
P	17004	DESTROY PREMAL LESIONS 15/>             	     3.88	  $144.45	      ---	       --	015	1	0	0.00	    $0.00	Y	
X	17004	DESTROY PREMAL LESIONS 15/>             	   157.33	  $157.33	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	17106	DESTRUCTION OF SKIN LESIONS             	   316.32	  $316.32	      ---	       --	009	1	1	0.00	    $0.00	Y	
P	17106	DESTRUCTION OF SKIN LESIONS             	     4.99	  $185.78	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	17106	DESTRUCTION OF SKIN LESIONS             	     4.98	  $185.41	      ---	  $233.81	004	1	1	0.00	    $0.00	Y	
K	17107	DESTRUCTION OF SKIN LESIONS             	     8.49	  $316.08	      ---	  $398.61	004	1	1	0.00	    $0.00	Y	
P	17107	DESTRUCTION OF SKIN LESIONS             	     8.50	  $316.46	      ---	       --	015	0	0	0.00	    $0.00	Y	
X	17107	DESTRUCTION OF SKIN LESIONS             	   410.23	  $410.23	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	17108	DESTRUCTION OF SKIN LESIONS             	   686.15	  $686.15	      ---	       --	009	1	1	0.00	    $0.00	Y	
P	17108	DESTRUCTION OF SKIN LESIONS             	    18.42	  $685.78	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	17108	DESTRUCTION OF SKIN LESIONS             	    18.43	  $686.15	      ---	  $865.29	004	1	1	0.00	    $0.00	Y	
K	17110	DESTRUCT B9 LESION 1-14                 	     2.68	   $99.78	      ---	  $125.83	004	1	1	0.00	    $0.00	Y	
P	17110	DESTRUCT B9 LESION 1-14                 	     2.68	   $99.78	      ---	       --	015	0	1	0.00	    $0.00	Y	
X	17110	DESTRUCT B9 LESION 1-14                 	   106.86	  $106.86	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	17111	DESTRUCT LESION 15 OR MORE              	   124.18	  $124.18	      ---	       --	009	1	0	0.00	    $0.00	Y	
P	17111	DESTRUCT LESION 15 OR MORE              	     3.17	  $118.02	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	17111	DESTRUCT LESION 15 OR MORE              	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
K	17250	CHEM CAUT OF GRANLTJ TISSUE             	     0.54	   $20.10	      ---	   $25.35	004	1	0	0.00	    $0.00	Y	
X	17250	CHEM CAUT OF GRANLTJ TISSUE             	    82.10	   $82.10	      ---	       --	009	1	0	0.00	    $0.00	Y	
K	17260	DSTRJ MAL LES T/A/L 0.5 CM/<            	     1.01	   $37.60	      ---	   $47.42	004	1	1	0.00	    $0.00	Y	
K	17261	DSTRJ MAL LES T/A/L .6-1.0CM            	     1.18	   $43.93	      ---	   $55.40	004	1	1	0.00	    $0.00	Y	
K	17262	DSTRJ MAL LES T/A/L 1.1-2.0             	     1.63	   $60.68	      ---	   $76.53	004	1	1	0.00	    $0.00	Y	
K	17263	DSTRJ MAL LES T/A/L 2.1-3.0             	     1.85	   $68.88	      ---	   $86.86	004	1	1	0.00	    $0.00	Y	
K	17264	DSTRJ MAL LES T/A/L 3.1-4.0             	     2.02	   $75.20	      ---	   $94.84	004	1	1	0.00	    $0.00	Y	
K	17266	DSTRJ MAL LES T/A/L >4.0 CM             	     2.43	   $90.47	      ---	  $114.09	004	1	1	0.00	    $0.00	Y	
K	17270	DSTR MAL LES S/N/H/F/G .5 /<            	     1.29	   $48.03	      ---	   $60.57	004	1	1	0.00	    $0.00	Y	
P	17270	DSTR MAL LES S/N/H/F/G .5 /<            	     1.28	   $47.65	      ---	       --	015	0	1	0.00	    $0.00	Y	
P	17271	DSTR MAL LES S/N/H/F/G 0.6-1            	     1.53	   $56.96	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	17271	DSTR MAL LES S/N/H/F/G 0.6-1            	     1.53	   $56.96	      ---	   $71.83	004	1	1	0.00	    $0.00	Y	
K	17272	DSTR MAL LES S/N/H/F/G 1.1-2            	     1.82	   $67.76	      ---	   $85.45	004	1	1	0.00	    $0.00	Y	
P	17272	DSTR MAL LES S/N/H/F/G 1.1-2            	     1.83	   $68.13	      ---	       --	015	0	1	0.00	    $0.00	Y	
P	17273	DSTR MAL LES S/N/H/F/G 2.1-3            	     2.15	   $80.04	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	17273	DSTR MAL LES S/N/H/F/G 2.1-3            	     2.15	   $80.04	      ---	  $100.94	004	1	1	0.00	    $0.00	Y	
K	17274	DSTR MAL LES S/N/H/F/G 3.1-4            	     2.70	  $100.52	      ---	  $126.77	004	1	1	0.00	    $0.00	Y	
P	17274	DSTR MAL LES S/N/H/F/G 3.1-4            	     2.70	  $100.52	      ---	       --	015	0	1	0.00	    $0.00	Y	
P	17276	DSTR MAL LES S/N/H/F/G >4.0             	     3.35	  $124.72	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	17276	DSTR MAL LES S/N/H/F/G >4.0             	     3.35	  $124.72	      ---	  $157.28	004	1	1	0.00	    $0.00	Y	
K	17280	DSTR MAL LS F/E/E/N/L/M .5/<            	     1.18	   $43.93	      ---	   $55.40	004	1	1	0.00	    $0.00	Y	
K	17281	DSTR MAL LS F/E/E/N/L/M .6-1            	     1.77	   $65.90	      ---	   $83.10	004	1	1	0.00	    $0.00	Y	
X	17281	DSTR MAL LS F/E/E/N/L/M .6-1            	   166.91	  $166.91	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	17282	DSTR MAL LS F/E/E/N/L/M1.1-2            	     2.12	   $78.93	      ---	   $99.53	004	1	1	0.00	    $0.00	Y	
K	17283	DSTR MAL LS F/E/E/N/L/M2.1-3            	     2.75	  $102.38	      ---	  $129.11	004	1	1	0.00	    $0.00	Y	
K	17284	DSTR MAL LS F/E/E/N/L/M3.1-4            	     3.59	  $133.66	      ---	  $168.55	004	1	1	0.00	    $0.00	Y	
K	17286	DSTR MAL LS F/E/E/N/L/M>4.0             	     4.66	  $173.49	      ---	  $218.79	004	1	1	0.00	    $0.00	Y	
K	17311	MOHS 1 STAGE H/N/HF/G                   	    15.50	  $577.07	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	17312	MOHS ADDL STAGE                         	     9.36	  $348.47	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	17313	MOHS 1 STAGE T/A/L                      	    14.16	  $527.18	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	17314	MOHS ADDL STAGE T/A/L                   	     8.67	  $322.78	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	17315	MOHS SURG ADDL BLOCK                    	     1.83	   $68.13	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	17340	CRYOTHERAPY FOR ACNE                    	     1.00	   $37.23	      ---	   $46.95	004	1	1	0.00	    $0.00	Y	
X	17340	CRYOTHERAPY FOR ACNE                    	    47.42	   $47.42	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	17360	CHEMICAL EXFOLIATION ACNE               	     1.37	   $51.01	      ---	   $64.32	004	1	1	0.00	    $0.00	Y	
K	17999	UNLISTD PX SKN MUC MEMB SUBQ            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
P	17999	UNLISTD PX SKN MUC MEMB SUBQ            	     0.00	    $0.00	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	17999	UNLISTD PX SKN MUC MEMB SUBQ            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	19000	PUNCTURE ASPIR CYST BREAST              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
X	19000	PUNCTURE ASPIR CYST BREAST              	    94.83	   $94.83	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	19000	PUNCTURE ASPIR CYST BREAST              	     0.94	   $35.00	      ---	   $44.13	004	1	1	0.00	    $0.00	Y	
K	19001	PUNCTURE ASPIR CYST BRST EA             	     0.56	   $20.85	      ---	   $26.29	004	1	1	0.00	    $0.00	Y	
O	19001	PUNCTURE ASPIR CYST BRST EA             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	19020	MASTOTOMY EXPL DRG ABSC DP              	     0.94	   $35.00	      ---	   $44.13	004	1	0	0.00	    $0.00	Y	
K	19020	MASTOTOMY EXPL DRG ABSC DP              	     4.68	  $174.24	      ---	  $219.73	004	1	0	0.00	    $0.00	Y	
K	19030	NJX PX ONLY MAM DUCTO/GLCTO             	     5.20	  $193.60	      ---	  $244.14	004	1	0	0.00	    $0.00	Y	
K	19081	BX BREAST 1ST LESION STRTCTC            	    16.98	  $632.17	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	19082	BX BREAST ADD LESION STRTCTC            	    14.15	  $526.80	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	19083	BX BREAST 1ST LESION US IMAG            	    16.49	  $613.92	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	19084	BX BREAST ADD LESION US IMAG            	    13.61	  $506.70	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	19085	BX BREAST 1ST LESION MR IMAG            	     4.47	  $166.42	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	19086	BX BREAST ADD LESION MR IMAG            	     2.08	   $77.44	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	19100	BX BREAST PERCUT W/O IMAGE              	     2.04	   $75.95	      ---	   $95.78	004	1	1	0.00	    $0.00	Y	
X	19100	BX BREAST PERCUT W/O IMAGE              	   138.62	  $138.62	      ---	       --	009	1	1	0.00	    $0.00	Y	
O	19101	BIOPSY OF BREAST OPEN                   	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	19101	BIOPSY OF BREAST OPEN                   	     5.53	  $205.88	      ---	  $259.63	004	1	1	0.00	    $0.00	Y	
K	19110	NIPPLE EXPLORATION                      	    10.31	  $383.84	      ---	  $484.05	004	1	1	0.00	    $0.00	Y	
O	19110	NIPPLE EXPLORATION                      	     2.06	   $76.69	      ---	   $96.72	004	1	0	0.00	    $0.00	Y	
O	19112	EXCISE BREAST DUCT FISTULA              	     1.83	   $68.13	      ---	   $85.92	004	1	0	0.00	    $0.00	Y	
K	19112	EXCISE BREAST DUCT FISTULA              	     9.17	  $341.40	      ---	  $430.53	004	1	1	0.00	    $0.00	Y	
K	19120	REMOVAL OF BREAST LESION                	     5.66	  $210.72	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	19120	REMOVAL OF BREAST LESION                	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	19125	EXCISION BREAST LESION                  	     1.29	   $48.03	      ---	   $60.57	004	1	0	0.00	    $0.00	Y	
K	19125	EXCISION BREAST LESION                  	     6.46	  $240.51	      ---	  $303.30	004	1	0	0.00	    $0.00	Y	
K	19126	EXCISION ADDL BREAST LESION             	     3.24	  $120.63	      ---	  $152.12	004	1	0	0.00	    $0.00	Y	
O	19126	EXCISION ADDL BREAST LESION             	     0.65	   $24.20	      ---	   $30.52	004	1	0	0.00	    $0.00	Y	
K	19281	PERQ DEVICE BREAST 1ST IMAG             	     5.80	  $215.93	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	19282	PERQ DEVICE BREAST EA IMAG              	     4.07	  $151.53	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	19283	PERQ DEV BREAST 1ST STRTCTC             	     6.57	  $244.60	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	19284	PERQ DEV BREAST ADD STRTCTC             	     5.00	  $186.15	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	19285	PERQ DEV BREAST 1ST US IMAG             	    12.79	  $476.17	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	19286	PERQ DEV BREAST ADD US IMAG             	    11.23	  $418.09	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	19287	PERQ DEV BREAST 1ST MR GUIDE            	     3.19	  $118.76	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	19288	PERQ DEV BREAST ADD MR GUIDE            	     1.48	   $55.10	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	19294	PREPJ TUM CAV IORT PRTL MAST            	     3.70	  $137.75	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	19294	PREPJ TUM CAV IORT PRTL MAST            	     0.74	   $27.55	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	19296	PLACE PO BREAST CATH FOR RAD            	   119.27	 $4440.42	      ---	 $5599.73	004	1	0	0.00	    $0.00	Y	
K	19297	PLACE BREAST CATH FOR RAD               	     1.56	   $58.08	      ---	   $73.24	004	1	0	0.00	    $0.00	Y	
K	19298	PLACE BREAST RAD TUBE/CATHS             	    44.32	 $1650.03	      ---	 $2080.82	004	1	0	0.00	    $0.00	Y	
K	19300	MASTECTOMY FOR GYNECOMASTIA             	    12.29	  $457.56	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	19300	MASTECTOMY FOR GYNECOMASTIA             	     2.46	   $91.59	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	19301	PARTIAL MASTECTOMY                      	     1.79	   $66.64	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	19301	PARTIAL MASTECTOMY                      	     8.96	  $333.58	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	19302	P-MASTECTOMY W/LN REMOVAL               	    18.60	  $692.48	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	19302	P-MASTECTOMY W/LN REMOVAL               	     3.72	  $138.50	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	19303	MAST SIMPLE COMPLETE                    	     4.10	  $152.64	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	19303	MAST SIMPLE COMPLETE                    	    20.49	  $762.84	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	19305	MAST RADICAL                            	    23.38	  $870.44	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	19305	MAST RADICAL                            	     4.69	  $174.61	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	19306	MAST RAD URBAN TYPE                     	     4.89	  $182.05	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	19306	MAST RAD URBAN TYPE                     	    24.43	  $909.53	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	19307	MAST MOD RAD                            	    24.69	  $919.21	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	19307	MAST MOD RAD                            	     4.94	  $183.92	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	19316	MASTOPEXY                               	     2.47	   $91.96	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	19316	MASTOPEXY                               	    12.74	  $474.31	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	19318	BREAST REDUCTION                        	    26.70	  $994.04	      ---	 $1253.57	004	1	0	0.00	    $0.00	Y	
O	19318	BREAST REDUCTION                        	     5.30	  $197.32	      ---	  $248.84	004	1	0	0.00	    $0.00	Y	
O	19325	BREAST AUGMENTATION W/IMPLT             	     3.60	  $134.03	      ---	  $169.02	004	1	0	0.00	    $0.00	Y	
K	19325	BREAST AUGMENTATION W/IMPLT             	    18.00	  $670.14	      ---	  $845.10	004	1	0	0.00	    $0.00	Y	
K	19328	RMVL INTACT BREAST IMPLANT              	     8.67	  $322.78	      ---	  $407.06	004	1	1	0.00	    $0.00	Y	
O	19328	RMVL INTACT BREAST IMPLANT              	     1.73	   $64.41	      ---	   $81.22	004	1	0	0.00	    $0.00	Y	
O	19330	RMVL RUPTURED BREAST IMPLANT            	     2.30	   $85.63	      ---	  $107.99	004	1	0	0.00	    $0.00	Y	
K	19330	RMVL RUPTURED BREAST IMPLANT            	    11.50	  $428.15	      ---	  $539.93	004	1	1	0.00	    $0.00	Y	
K	19340	INSJ BREAST IMPLT SM D MAST             	    14.00	  $521.22	      ---	  $657.30	004	1	0	0.00	    $0.00	Y	
O	19340	INSJ BREAST IMPLT SM D MAST             	     2.80	  $104.24	      ---	  $131.46	004	1	0	0.00	    $0.00	Y	
O	19342	INSJ/RPLCMT BRST IMPLT SEP D            	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	19342	INSJ/RPLCMT BRST IMPLT SEP D            	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	19350	NIPPLE/AREOLA RECONSTRUCTION            	    17.96	  $668.65	      ---	  $843.22	004	1	0	0.00	    $0.00	Y	
O	19350	NIPPLE/AREOLA RECONSTRUCTION            	     3.59	  $133.66	      ---	  $168.55	004	1	0	0.00	    $0.00	Y	
O	19357	TISS XPNDR PLMT BRST RCNSTJ             	     3.81	  $141.85	      ---	  $178.88	004	1	0	0.00	    $0.00	Y	
K	19357	TISS XPNDR PLMT BRST RCNSTJ             	    19.04	  $708.86	      ---	  $893.93	004	1	0	0.00	    $0.00	Y	
K	19361	BRST RCNSTJ LATSMS DRSI FLAP            	    37.62	 $1400.59	      ---	 $1766.26	004	1	0	0.00	    $0.00	Y	
O	19361	BRST RCNSTJ LATSMS DRSI FLAP            	     7.52	  $279.97	      ---	  $353.06	004	1	0	0.00	    $0.00	Y	
O	19364	BRST RCNSTJ FREE FLAP                   	     9.17	  $341.40	      ---	  $430.53	004	1	0	0.00	    $0.00	Y	
K	19364	BRST RCNSTJ FREE FLAP                   	    45.87	 $1707.74	      ---	 $2153.60	004	1	0	0.00	    $0.00	Y	
K	19367	BRST RCNSTJ 1 PDCL TRAM FLAP            	    28.32	 $1054.35	      ---	 $1329.62	004	1	0	0.00	    $0.00	Y	
O	19367	BRST RCNSTJ 1 PDCL TRAM FLAP            	     5.66	  $210.72	      ---	  $265.74	004	1	0	0.00	    $0.00	Y	
O	19368	BRST RCNSTJ 1PDCL TRAM ANAST            	     7.88	  $293.37	      ---	  $369.97	004	1	0	0.00	    $0.00	Y	
K	19368	BRST RCNSTJ 1PDCL TRAM ANAST            	    39.40	 $1466.86	      ---	 $1849.83	004	1	0	0.00	    $0.00	Y	
K	19369	BRST RCNSTJ 2 PDCL TRAM FLAP            	    46.33	 $1724.87	      ---	 $2175.19	004	1	0	0.00	    $0.00	Y	
O	19369	BRST RCNSTJ 2 PDCL TRAM FLAP            	     9.27	  $345.12	      ---	  $435.23	004	1	0	0.00	    $0.00	Y	
O	19370	REVJ PERI-IMPLT CAPSULE BRST            	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
K	19370	REVJ PERI-IMPLT CAPSULE BRST            	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
K	19371	PERI-IMPLT CAPSLC BRST COMPL            	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	19371	PERI-IMPLT CAPSLC BRST COMPL            	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	19380	REVJ RECONSTRUCTED BREAST               	     2.75	  $102.38	      ---	  $129.11	004	1	0	0.00	    $0.00	Y	
K	19380	REVJ RECONSTRUCTED BREAST               	    13.76	  $512.28	      ---	  $646.03	004	1	0	0.00	    $0.00	Y	
K	19396	DESIGN CUSTOM BREAST IMPLANT            	     5.78	  $215.19	      ---	  $271.37	004	1	0	0.00	    $0.00	Y	
O	19396	DESIGN CUSTOM BREAST IMPLANT            	     1.16	   $43.19	      ---	   $54.46	004	1	0	0.00	    $0.00	Y	
O	19499	UNLISTED PROCEDURE BREAST               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	19499	UNLISTED PROCEDURE BREAST               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	20100	EXPL PENTRG WOUND NECK                  	     9.39	  $349.59	      ---	  $440.86	004	1	0	0.00	    $0.00	Y	
O	20100	EXPL PENTRG WOUND NECK                  	     1.88	   $69.99	      ---	   $88.27	004	1	0	0.00	    $0.00	Y	
O	20101	EXPL PENTRG WOUND CHEST                 	     0.60	   $22.34	      ---	   $28.17	004	1	0	0.00	    $0.00	Y	
K	20101	EXPL PENTRG WOUND CHEST                 	     3.01	  $112.06	      ---	  $141.32	004	1	0	0.00	    $0.00	Y	
K	20102	EXPL PENTRG WND ABD/FLNK/BK             	     3.64	  $135.52	      ---	  $170.90	004	1	0	0.00	    $0.00	Y	
O	20102	EXPL PENTRG WND ABD/FLNK/BK             	     0.72	   $26.81	      ---	   $33.80	004	1	0	0.00	    $0.00	Y	
O	20103	EXPL PENTRG WOUND EXTREMITY             	     0.97	   $36.11	      ---	   $45.54	004	1	0	0.00	    $0.00	Y	
P	20103	EXPL PENTRG WOUND EXTREMITY             	     4.90	  $182.43	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	20103	EXPL PENTRG WOUND EXTREMITY             	     4.89	  $182.05	      ---	  $229.59	004	1	0	0.00	    $0.00	Y	
K	20150	EXCISION EPIPHYSEAL BAR                 	    19.76	  $735.66	      ---	  $927.73	004	1	0	0.00	    $0.00	Y	
O	20150	EXCISION EPIPHYSEAL BAR                 	     3.95	  $147.06	      ---	  $185.45	004	1	0	0.00	    $0.00	Y	
P	20200	MUSCLE BIOPSY SUPERFICIAL               	     1.46	   $54.36	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	20200	MUSCLE BIOPSY SUPERFICIAL               	     1.46	   $54.36	      ---	   $68.55	004	1	1	0.00	    $0.00	Y	
K	20205	DEEP MUSCLE BIOPSY                      	     2.93	  $109.08	      ---	  $137.56	004	1	0	0.00	    $0.00	Y	
P	20205	DEEP MUSCLE BIOPSY                      	     2.92	  $108.71	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	20205	DEEP MUSCLE BIOPSY                      	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	20206	BIOPSY MUSCLE PERQ NEEDLE               	     1.77	   $65.90	      ---	   $83.10	004	1	0	0.00	    $0.00	Y	
K	20220	BONE BIOPSY TROCAR/NDL SUPFC            	     2.29	   $85.26	      ---	  $107.52	004	1	0	0.00	    $0.00	Y	
K	20225	BONE BIOPSY TROCAR/NDL DEEP             	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
O	20225	BONE BIOPSY TROCAR/NDL DEEP             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	20240	BONE BIOPSY OPEN SUPERFICIAL            	     3.40	  $126.58	      ---	  $159.63	004	1	0	0.00	    $0.00	Y	
K	20245	BONE BIOPSY OPEN DEEP                   	     5.66	  $210.72	      ---	  $265.74	004	1	0	0.00	    $0.00	Y	
O	20245	BONE BIOPSY OPEN DEEP                   	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	20250	BIOPSY VRT BDY OPEN THORACIC            	     1.56	   $58.08	      ---	   $73.24	004	1	0	0.00	    $0.00	Y	
K	20250	BIOPSY VRT BDY OPEN THORACIC            	     7.78	  $289.65	      ---	  $365.27	004	1	0	0.00	    $0.00	Y	
K	20251	BIOPSY VRT BDY OPEN LMBR/CRV            	     9.70	  $361.13	      ---	  $455.42	004	1	0	0.00	    $0.00	Y	
O	20251	BIOPSY VRT BDY OPEN LMBR/CRV            	     1.94	   $72.23	      ---	   $91.08	004	1	0	0.00	    $0.00	Y	
P	20500	INJECTION OF SINUS TRACT                	     2.84	  $105.73	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	20500	INJECTION OF SINUS TRACT                	     2.85	  $106.11	      ---	  $133.81	004	1	1	0.00	    $0.00	Y	
K	20501	INJECT SINUS TRACT FOR X-RAY            	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
P	20501	INJECT SINUS TRACT FOR X-RAY            	     6.00	  $223.38	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	20520	REMOVAL OF FOREIGN BODY                 	     3.02	  $112.43	      ---	       --	015	0	1	0.00	    $0.00	Y	
X	20520	REMOVAL OF FOREIGN BODY                 	   201.01	  $201.01	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	20520	REMOVAL OF FOREIGN BODY                 	     3.02	  $112.43	      ---	  $141.79	004	1	1	0.00	    $0.00	Y	
K	20525	REMOVAL OF FOREIGN BODY                 	     7.79	  $290.02	      ---	  $365.74	004	1	0	0.00	    $0.00	Y	
P	20525	REMOVAL OF FOREIGN BODY                 	     7.79	  $290.02	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	20525	REMOVAL OF FOREIGN BODY                 	     1.56	   $58.08	      ---	   $73.24	004	1	0	0.00	    $0.00	Y	
K	20526	THER INJECTION CARP TUNNEL              	     1.41	   $52.49	      ---	   $66.20	004	1	1	0.00	    $0.00	Y	
K	20527	INJ DUPUYTREN CORD W/ENZYME             	     1.32	   $49.14	      ---	   $61.97	004	1	1	0.00	    $0.00	Y	
K	20550	INJ TENDON SHEATH/LIGAMENT              	     1.23	   $45.79	      ---	   $57.75	004	1	1	0.00	    $0.00	Y	
P	20550	INJ TENDON SHEATH/LIGAMENT              	     1.23	   $45.79	      ---	       --	015	0	1	0.00	    $0.00	Y	
X	20550	INJ TENDON SHEATH/LIGAMENT              	    52.58	   $52.58	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	20551	INJ TENDON ORIGIN/INSERTION             	    52.58	   $52.58	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	20551	INJ TENDON ORIGIN/INSERTION             	     1.41	   $52.49	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	20551	INJ TENDON ORIGIN/INSERTION             	     1.41	   $52.49	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	20552	INJ TRIGGER POINT 1/2 MUSCL             	     1.41	   $52.49	      ---	       --	004	0	0	0.00	    $0.00	Y	
P	20552	INJ TRIGGER POINT 1/2 MUSCL             	     1.41	   $52.49	      ---	       --	015	0	0	0.00	    $0.00	Y	
X	20552	INJ TRIGGER POINT 1/2 MUSCL             	    52.49	   $52.49	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	20553	INJECT TRIGGER POINTS 3/>               	    56.22	   $56.22	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	20553	INJECT TRIGGER POINTS 3/>               	     1.51	   $56.22	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	20553	INJECT TRIGGER POINTS 3/>               	     1.51	   $56.22	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	20555	PLACE NDL MUSC/TIS FOR RT               	     6.61	  $246.09	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	20560	NDL INSJ W/O NJX 1 OR 2 MUSC            	     0.62	   $23.08	      ---	       --	004	0	0	0.00	    $0.00	Y	
P	20560	NDL INSJ W/O NJX 1 OR 2 MUSC            	     0.62	   $23.08	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	20561	NDL INSJ W/O NJX 3+ MUSC                	     0.92	   $34.25	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	20561	NDL INSJ W/O NJX 3+ MUSC                	     0.92	   $34.25	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	20600	DRAIN/INJ JOINT/BURSA W/O US            	     0.87	   $32.39	      ---	   $40.85	004	1	1	0.00	    $0.00	Y	
P	20600	DRAIN/INJ JOINT/BURSA W/O US            	     0.87	   $32.39	      ---	       --	015	0	1	0.00	    $0.00	Y	
X	20600	DRAIN/INJ JOINT/BURSA W/O US            	    48.23	   $48.23	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	20604	DRAIN/INJ JOINT/BURSA W/US              	    75.69	   $75.69	      ---	       --	009	1	1	0.00	    $0.00	Y	
P	20604	DRAIN/INJ JOINT/BURSA W/US              	     1.06	   $39.46	      ---	   $49.77	004	1	1	0.00	    $0.00	Y	
K	20604	DRAIN/INJ JOINT/BURSA W/US              	     1.06	   $39.46	      ---	   $49.77	004	1	1	0.00	    $0.00	Y	
K	20605	DRAIN/INJ JOINT/BURSA W/O US            	     1.02	   $37.97	      ---	   $47.89	004	1	1	0.00	    $0.00	Y	
P	20605	DRAIN/INJ JOINT/BURSA W/O US            	     1.02	   $37.97	      ---	       --	015	0	1	0.00	    $0.00	Y	
X	20605	DRAIN/INJ JOINT/BURSA W/O US            	    50.14	   $50.14	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	20606	DRAIN/INJ JOINT/BURSA W/US              	    81.92	   $81.92	      ---	       --	009	1	1	0.00	    $0.00	Y	
P	20606	DRAIN/INJ JOINT/BURSA W/US              	     1.21	   $45.05	      ---	   $56.81	004	1	1	0.00	    $0.00	Y	
K	20606	DRAIN/INJ JOINT/BURSA W/US              	     1.21	   $45.05	      ---	   $56.81	004	1	1	0.00	    $0.00	Y	
K	20610	DRAIN/INJ JOINT/BURSA W/O US            	     1.23	   $45.79	      ---	   $57.75	004	1	1	0.00	    $0.00	Y	
X	20610	DRAIN/INJ JOINT/BURSA W/O US            	    58.61	   $58.61	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	20611	DRAIN/INJ JOINT/BURSA W/US              	    91.25	   $91.25	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	20611	DRAIN/INJ JOINT/BURSA W/US              	     1.42	   $52.87	      ---	   $66.67	004	1	1	0.00	    $0.00	Y	
K	20612	ASPIRATE/INJ GANGLION CYST              	     1.46	   $54.36	      ---	   $68.55	004	1	1	0.00	    $0.00	Y	
X	20612	ASPIRATE/INJ GANGLION CYST              	    58.74	   $58.74	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	20615	TREATMENT OF BONE CYST                  	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	20650	INSERT AND REMOVE BONE PIN              	     2.80	  $104.24	      ---	  $131.46	004	1	0	0.00	    $0.00	Y	
P	20650	INSERT AND REMOVE BONE PIN              	     2.81	  $104.62	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	20660	APPLY REM FIXATION DEVICE               	     3.40	  $126.58	      ---	  $159.63	004	1	0	0.00	    $0.00	Y	
K	20661	APPLICATION HALO CRANIAL                	     5.31	  $197.69	      ---	  $249.30	004	1	0	0.00	    $0.00	Y	
O	20661	APPLICATION HALO CRANIAL                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	20662	APPLICATION HALO PELVIC                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	20662	APPLICATION HALO PELVIC                 	     5.21	  $193.97	      ---	  $244.61	004	1	0	0.00	    $0.00	Y	
K	20663	APPLICATION HALO FEMORAL                	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
O	20663	APPLICATION HALO FEMORAL                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	20664	APPL HALO CRANIAL 6+PINS                	     1.91	   $71.11	      ---	   $89.67	004	1	0	0.00	    $0.00	Y	
K	20664	APPL HALO CRANIAL 6+PINS                	     9.59	  $357.04	      ---	  $450.25	004	1	0	0.00	    $0.00	Y	
K	20665	RMVL TONGS/HALO ANTHR INDIV             	     1.64	   $61.06	      ---	   $77.00	004	1	0	0.00	    $0.00	Y	
K	20670	REMOVAL IMPLANT SUPERFICIAL             	     3.11	  $115.79	      ---	  $146.01	004	1	1	0.00	    $0.00	Y	
P	20670	REMOVAL IMPLANT SUPERFICIAL             	     3.11	  $115.79	      ---	       --	015	0	1	0.00	    $0.00	Y	
P	20680	REMOVAL OF IMPLANT DEEP                 	     4.08	  $151.90	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	20680	REMOVAL OF IMPLANT DEEP                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	20680	REMOVAL OF IMPLANT DEEP                 	     4.08	  $151.90	      ---	  $191.56	004	1	0	0.00	    $0.00	Y	
K	20690	APPL UNIPLN UNI EXT FIXJ SYS            	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	20692	APPL MLTPLN UNI EXT FIXJ SYS            	     7.14	  $265.82	      ---	  $335.22	004	1	1	0.00	    $0.00	Y	
K	20693	ADJMT/REVJ EXT FIXJ SYS ANES            	     7.56	  $281.46	      ---	  $354.94	004	1	1	0.00	    $0.00	Y	
K	20694	RMVL EXT FIXJ SYS UNDER ANES            	     5.39	  $200.67	      ---	  $253.06	004	1	1	0.00	    $0.00	Y	
K	20696	APP MLTPLN UNI XTRNL FIX 1ST            	    19.85	  $739.02	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	20696	APP MLTPLN UNI XTRNL FIX 1ST            	     3.97	  $147.80	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	20697	APP MLTPLN UNI XTRNL FIX XCH            	     5.72	  $212.96	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	20697	APP MLTPLN UNI XTRNL FIX XCH            	    28.61	 $1065.15	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	20700	MNL PREP&INSJ DP RX DLVR DEV            	     1.95	   $72.60	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	20701	RMVL DEEP RX DELIVERY DEVICE            	     1.45	   $53.98	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	20702	MNL PREP&INSJ IMED RX DEV               	     3.24	  $120.63	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	20703	RMVL IMED RX DELIVERY DEVICE            	     2.32	   $86.37	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	20704	MNL PREP&INSJ I-ARTIC RX DEV            	     3.37	  $125.47	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	20705	RMVL I-ARTIC RX DELIVERY DEV            	     2.78	  $103.50	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	20802	REPLANTATION ARM COMPLETE               	    61.93	 $2305.65	      ---	 $2907.61	004	1	0	0.00	    $0.00	Y	
O	20802	REPLANTATION ARM COMPLETE               	    12.39	  $461.28	      ---	  $581.71	004	1	0	0.00	    $0.00	Y	
O	20805	REPLANT FOREARM COMPLETE                	    17.06	  $635.14	      ---	  $800.97	004	1	0	0.00	    $0.00	Y	
K	20805	REPLANT FOREARM COMPLETE                	    85.32	 $3176.46	      ---	 $4005.77	004	1	0	0.00	    $0.00	Y	
K	20808	REPLANTATION HAND COMPLETE              	    94.60	 $3521.96	      ---	 $4441.47	004	1	0	0.00	    $0.00	Y	
O	20808	REPLANTATION HAND COMPLETE              	    18.92	  $704.39	      ---	  $888.29	004	1	0	0.00	    $0.00	Y	
O	20816	REPLANTATION DIGIT COMPLETE             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	20816	REPLANTATION DIGIT COMPLETE             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	20822	REPLANTATION DIGIT COMPLETE             	    51.27	 $1908.78	      ---	 $2407.13	004	1	0	0.00	    $0.00	Y	
O	20822	REPLANTATION DIGIT COMPLETE             	    10.25	  $381.61	      ---	  $481.24	004	1	0	0.00	    $0.00	Y	
O	20824	REPLANTATION THUMB COMPLETE             	    12.60	  $469.10	      ---	  $591.57	004	1	0	0.00	    $0.00	Y	
K	20824	REPLANTATION THUMB COMPLETE             	    62.99	 $2345.12	      ---	 $2957.38	004	1	0	0.00	    $0.00	Y	
K	20827	REPLANTATION THUMB COMPLETE             	    55.02	 $2048.39	      ---	 $2583.19	004	1	0	0.00	    $0.00	Y	
O	20827	REPLANTATION THUMB COMPLETE             	    11.00	  $409.53	      ---	  $516.45	004	1	0	0.00	    $0.00	Y	
O	20838	REPLANTATION FOOT COMPLETE              	    13.72	  $510.80	      ---	  $644.15	004	1	0	0.00	    $0.00	Y	
P	20838	REPLANTATION FOOT COMPLETE              	     0.00	    $0.00	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	20838	REPLANTATION FOOT COMPLETE              	    68.62	 $2554.72	      ---	 $3221.71	004	1	0	0.00	    $0.00	Y	
K	20900	REMOVAL OF BONE FOR GRAFT               	     5.18	  $192.85	      ---	  $243.20	004	1	0	0.00	    $0.00	Y	
O	20900	REMOVAL OF BONE FOR GRAFT               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	20902	REMOVAL OF BONE FOR GRAFT               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	20902	REMOVAL OF BONE FOR GRAFT               	     7.34	  $273.27	      ---	  $344.61	004	1	0	0.00	    $0.00	Y	
K	20910	REMOVE CARTILAGE FOR GRAFT              	     5.69	  $211.84	      ---	  $267.15	004	1	0	0.00	    $0.00	Y	
O	20910	REMOVE CARTILAGE FOR GRAFT              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	20912	REMOVE CARTILAGE FOR GRAFT              	     2.40	   $89.35	      ---	  $112.68	004	1	0	0.00	    $0.00	Y	
K	20912	REMOVE CARTILAGE FOR GRAFT              	    12.00	  $446.76	      ---	  $563.40	004	1	0	0.00	    $0.00	Y	
K	20920	REMOVAL OF FASCIA FOR GRAFT             	     4.88	  $181.68	      ---	  $229.12	004	1	0	0.00	    $0.00	Y	
O	20920	REMOVAL OF FASCIA FOR GRAFT             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	20922	REMOVAL OF FASCIA FOR GRAFT             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	20922	REMOVAL OF FASCIA FOR GRAFT             	     7.56	  $281.46	      ---	  $354.94	004	1	0	0.00	    $0.00	Y	
K	20924	REMOVAL OF TENDON FOR GRAFT             	    11.69	  $435.22	      ---	  $548.85	004	1	0	0.00	    $0.00	Y	
O	20924	REMOVAL OF TENDON FOR GRAFT             	     2.34	   $87.12	      ---	  $109.86	004	1	0	0.00	    $0.00	Y	
O	20930	SP BONE ALGRFT MORSEL ADD-ON            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	20930	SP BONE ALGRFT MORSEL ADD-ON            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	20931	SP BONE ALGRFT STRUCT ADD-ON            	     2.25	   $83.77	      ---	  $105.64	004	1	0	0.00	    $0.00	Y	
O	20931	SP BONE ALGRFT STRUCT ADD-ON            	     0.45	   $16.75	      ---	   $21.13	004	1	0	0.00	    $0.00	Y	
K	20932	OSTEOART ALGRFT W/SURF & B1             	    16.31	  $607.22	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	20933	HEMICRT INTRCLRY ALGRFT PRTL            	    14.96	  $556.96	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	20934	INTERCALARY ALGRFT COMPL                	    16.30	  $606.85	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	20936	SP BONE AGRFT LOCAL ADD-ON              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	20936	SP BONE AGRFT LOCAL ADD-ON              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	20937	SP BONE AGRFT MORSEL ADD-ON             	     0.69	   $25.69	      ---	   $32.40	004	1	0	0.00	    $0.00	Y	
K	20937	SP BONE AGRFT MORSEL ADD-ON             	     3.48	  $129.56	      ---	  $163.39	004	1	0	0.00	    $0.00	Y	
K	20938	SP BONE AGRFT STRUCT ADD-ON             	     3.75	  $139.61	      ---	  $176.06	004	1	0	0.00	    $0.00	Y	
O	20938	SP BONE AGRFT STRUCT ADD-ON             	     0.75	   $27.92	      ---	   $35.21	004	1	0	0.00	    $0.00	Y	
O	20939	BONE MARROW ASPIR BONE GRFG             	     0.30	   $11.17	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	20939	BONE MARROW ASPIR BONE GRFG             	     1.54	   $57.33	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	20950	FLUID PRESSURE MUSCLE                   	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	20955	FIBULA BONE GRAFT MICROVASC             	    62.29	 $2319.06	      ---	 $2924.52	004	1	0	0.00	    $0.00	Y	
O	20955	FIBULA BONE GRAFT MICROVASC             	    12.46	  $463.89	      ---	  $585.00	004	1	0	0.00	    $0.00	Y	
O	20956	ILIAC BONE GRAFT MICROVASC              	    10.70	  $398.36	      ---	  $502.37	004	1	0	0.00	    $0.00	Y	
K	20956	ILIAC BONE GRAFT MICROVASC              	    53.52	 $1992.55	      ---	 $2512.76	004	1	0	0.00	    $0.00	Y	
K	20957	MT BONE GRAFT MICROVASC                 	    52.49	 $1954.20	      ---	 $2464.41	004	1	0	0.00	    $0.00	Y	
O	20957	MT BONE GRAFT MICROVASC                 	    10.50	  $390.92	      ---	  $492.98	004	1	0	0.00	    $0.00	Y	
O	20962	OTHER BONE GRAFT MICROVASC              	    12.23	  $455.32	      ---	  $574.20	004	1	0	0.00	    $0.00	Y	
K	20962	OTHER BONE GRAFT MICROVASC              	    61.16	 $2276.99	      ---	 $2871.46	004	1	0	0.00	    $0.00	Y	
K	20969	BONE/SKIN GRAFT MICROVASC               	    64.37	 $2396.50	      ---	 $3022.17	004	1	0	0.00	    $0.00	Y	
O	20969	BONE/SKIN GRAFT MICROVASC               	    12.87	  $479.15	      ---	  $604.25	004	1	0	0.00	    $0.00	Y	
O	20970	BONE/SKIN GRAFT ILIAC CREST             	    13.24	  $492.93	      ---	  $621.62	004	1	0	0.00	    $0.00	Y	
K	20970	BONE/SKIN GRAFT ILIAC CREST             	    66.22	 $2465.37	      ---	 $3109.03	004	1	0	0.00	    $0.00	Y	
K	20972	BONE/SKIN GRAFT METATARSAL              	    59.71	 $2223.00	      ---	 $2803.38	004	1	0	0.00	    $0.00	Y	
O	20972	BONE/SKIN GRAFT METATARSAL              	    11.94	  $444.53	      ---	  $560.58	004	1	0	0.00	    $0.00	Y	
O	20973	BONE/SKIN GRAFT GREAT TOE               	    13.70	  $510.05	      ---	  $643.22	004	1	0	0.00	    $0.00	Y	
K	20973	BONE/SKIN GRAFT GREAT TOE               	    68.49	 $2549.88	      ---	 $3215.61	004	1	0	0.00	    $0.00	Y	
K	20974	ELECTRICAL BONE STIMULATION             	     1.12	   $41.70	      ---	   $52.58	004	1	0	0.00	    $0.00	Y	
K	20975	ELECTRICAL BONE STIMULATION             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	20975	ELECTRICAL BONE STIMULATION             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	20979	US BONE STIMULATION                     	     0.29	   $10.80	      ---	   $13.62	004	1	0	0.00	    $0.00	Y	
K	20982	ABLATE BONE TUMOR(S) PERQ               	    98.79	 $3677.95	      ---	 $4638.19	004	1	0	0.00	    $0.00	Y	
K	20983	ABLATE BONE TUMOR(S) PERQ               	     9.21	  $342.89	      ---	  $432.41	004	1	0	0.00	    $0.00	Y	
K	20985	CPTR-ASST DIR MS PX                     	     2.98	  $110.95	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	20985	CPTR-ASST DIR MS PX                     	     0.60	   $22.34	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	20999	UNLISTED PX MUSCSKEL GENERAL            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	20999	UNLISTED PX MUSCSKEL GENERAL            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
R	2101 	REV - ACUPUNCTURE                       	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
O	21010	INCISION OF JAW JOINT                   	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	21010	INCISION OF JAW JOINT                   	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	21011	EXC FACE LES SC <2 CM                   	     7.25	  $269.92	      ---	  $340.39	004	1	0	0.00	    $0.00	Y	
O	21011	EXC FACE LES SC <2 CM                   	     1.45	   $53.98	      ---	   $68.08	004	1	0	0.00	    $0.00	Y	
O	21012	EXC FACE LES SBQ 2 CM/>                 	     1.51	   $56.22	      ---	   $70.89	004	1	0	0.00	    $0.00	Y	
K	21012	EXC FACE LES SBQ 2 CM/>                 	     7.55	  $281.09	      ---	  $354.47	004	1	0	0.00	    $0.00	Y	
K	21013	EXC FACE TUM DEEP < 2 CM                	    11.13	  $414.37	      ---	  $522.55	004	1	0	0.00	    $0.00	Y	
O	21013	EXC FACE TUM DEEP < 2 CM                	     2.23	   $83.02	      ---	  $104.70	004	1	0	0.00	    $0.00	Y	
O	21014	EXC FACE TUM DEEP 2 CM/>                	     2.32	   $86.37	      ---	  $108.92	004	1	0	0.00	    $0.00	Y	
K	21014	EXC FACE TUM DEEP 2 CM/>                	    11.62	  $432.61	      ---	  $545.56	004	1	0	0.00	    $0.00	Y	
K	21015	RESECT FACE/SCALP TUM < 2 CM            	    13.26	  $493.67	      ---	  $622.56	004	1	0	0.00	    $0.00	Y	
O	21015	RESECT FACE/SCALP TUM < 2 CM            	     2.65	   $98.66	      ---	  $124.42	004	1	0	0.00	    $0.00	Y	
O	21016	RESECT FACE/SCALP TUM 2 CM/>            	     4.62	  $172.00	      ---	  $216.91	004	1	0	0.00	    $0.00	Y	
K	21016	RESECT FACE/SCALP TUM 2 CM/>            	    23.10	  $860.01	      ---	 $1084.55	004	1	0	0.00	    $0.00	Y	
K	21025	EXCISION OF BONE LOWER JAW              	     7.95	  $295.98	      ---	  $373.25	004	1	0	0.00	    $0.00	Y	
O	21025	EXCISION OF BONE LOWER JAW              	     1.59	   $59.20	      ---	   $74.65	004	1	0	0.00	    $0.00	Y	
O	21026	EXCISION OF FACIAL BONE(S)              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	21026	EXCISION OF FACIAL BONE(S)              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	21029	CONTOUR OF FACE BONE LESION             	    12.00	  $446.76	      ---	  $563.40	004	1	0	0.00	    $0.00	Y	
O	21029	CONTOUR OF FACE BONE LESION             	     2.40	   $89.35	      ---	  $112.68	004	1	0	0.00	    $0.00	Y	
O	21030	EXCISE MAX/ZYGOMA B9 TUMOR              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	21030	EXCISE MAX/ZYGOMA B9 TUMOR              	     5.41	  $201.41	      ---	  $254.00	004	1	0	0.00	    $0.00	Y	
K	21031	REMOVE EXOSTOSIS MANDIBLE               	     5.59	  $208.12	      ---	  $262.45	004	1	0	0.00	    $0.00	Y	
O	21031	REMOVE EXOSTOSIS MANDIBLE               	     1.12	   $41.70	      ---	   $52.58	004	1	0	0.00	    $0.00	Y	
O	21032	REMOVE EXOSTOSIS MAXILLA                	     1.11	   $41.33	      ---	   $52.11	004	1	0	0.00	    $0.00	Y	
K	21032	REMOVE EXOSTOSIS MAXILLA                	     5.57	  $207.37	      ---	  $261.51	004	1	0	0.00	    $0.00	Y	
K	21034	EXCISE MAX/ZYGOMA MAL TUMOR             	    11.95	  $444.90	      ---	  $561.05	004	1	0	0.00	    $0.00	Y	
O	21034	EXCISE MAX/ZYGOMA MAL TUMOR             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	21040	EXCISE MANDIBLE LESION                  	     1.00	   $37.23	      ---	   $46.95	004	1	0	0.00	    $0.00	Y	
K	21040	EXCISE MANDIBLE LESION                  	     5.00	  $186.15	      ---	  $234.75	004	1	0	0.00	    $0.00	Y	
K	21044	REMOVAL OF JAW BONE LESION              	     9.13	  $339.91	      ---	  $428.65	004	1	0	0.00	    $0.00	Y	
O	21044	REMOVAL OF JAW BONE LESION              	     1.83	   $68.13	      ---	   $85.92	004	1	0	0.00	    $0.00	Y	
O	21045	EXTENSIVE JAW SURGERY                   	     4.54	  $169.02	      ---	  $213.15	004	1	0	0.00	    $0.00	Y	
K	21045	EXTENSIVE JAW SURGERY                   	    22.71	  $845.49	      ---	 $1066.23	004	1	0	0.00	    $0.00	Y	
K	21046	REMOVE MANDIBLE CYST COMPLEX            	    11.11	  $413.63	      ---	  $521.61	004	1	0	0.00	    $0.00	Y	
O	21046	REMOVE MANDIBLE CYST COMPLEX            	     2.22	   $82.65	      ---	  $104.23	004	1	0	0.00	    $0.00	Y	
O	21047	EXCISE LWR JAW CYST W/REPAIR            	     3.21	  $119.51	      ---	  $150.71	004	1	0	0.00	    $0.00	Y	
K	21047	EXCISE LWR JAW CYST W/REPAIR            	    16.07	  $598.29	      ---	  $754.49	004	1	0	0.00	    $0.00	Y	
K	21048	REMOVE MAXILLA CYST COMPLEX             	    11.51	  $428.52	      ---	  $540.39	004	1	0	0.00	    $0.00	Y	
O	21048	REMOVE MAXILLA CYST COMPLEX             	     2.30	   $85.63	      ---	  $107.99	004	1	0	0.00	    $0.00	Y	
O	21049	EXCIS UPPR JAW CYST W/REPAIR            	     3.03	  $112.81	      ---	  $142.26	004	1	0	0.00	    $0.00	Y	
K	21049	EXCIS UPPR JAW CYST W/REPAIR            	    15.13	  $563.29	      ---	  $710.35	004	1	0	0.00	    $0.00	Y	
K	21050	REMOVAL OF JAW JOINT                    	    18.83	  $701.04	      ---	  $884.07	004	1	0	0.00	    $0.00	Y	
K	21060	REMOVE JAW JOINT CARTILAGE              	    18.00	  $670.14	      ---	  $845.10	004	1	0	0.00	    $0.00	Y	
O	21060	REMOVE JAW JOINT CARTILAGE              	     3.60	  $134.03	      ---	  $169.02	004	1	0	0.00	    $0.00	Y	
O	21070	REMOVE CORONOID PROCESS                 	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	21070	REMOVE CORONOID PROCESS                 	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	21073	MNPJ OF TMJ W/ANESTH                    	     7.42	  $276.25	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	21100	MAXILLOFACIAL FIXATION                  	     4.11	  $153.02	      ---	  $192.96	004	1	0	0.00	    $0.00	Y	
O	21100	MAXILLOFACIAL FIXATION                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	21110	INTERDENTAL FIXATION                    	     1.78	   $66.27	      ---	   $83.57	004	1	0	0.00	    $0.00	Y	
K	21110	INTERDENTAL FIXATION                    	     8.89	  $330.97	      ---	  $417.39	004	1	1	0.00	    $0.00	Y	
K	21116	INJECTION JAW JOINT X-RAY               	     3.68	  $137.01	      ---	  $172.78	004	1	0	0.00	    $0.00	Y	
K	21120	GENIOPLASTY AUGMENTATION                	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
O	21120	GENIOPLASTY AUGMENTATION                	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
O	21121	GENIOP SLDG OSTEOT 1                    	     3.60	  $134.03	      ---	  $169.02	004	1	0	0.00	    $0.00	Y	
K	21121	GENIOP SLDG OSTEOT 1                    	    18.00	  $670.14	      ---	  $845.10	004	1	0	0.00	    $0.00	Y	
K	21122	GENIOP SLDG OSTEOT 2/>                  	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
O	21122	GENIOP SLDG OSTEOT 2/>                  	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
O	21123	GENIOP SLDG AUGMENTATION                	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
K	21123	GENIOP SLDG AUGMENTATION                	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
K	21127	AUGMENTATION MNDBLR B1 GRF              	    25.60	  $953.09	      ---	 $1201.92	004	1	0	0.00	    $0.00	Y	
O	21127	AUGMENTATION MNDBLR B1 GRF              	     5.12	  $190.62	      ---	  $240.38	004	1	0	0.00	    $0.00	Y	
O	21137	RDCTJ FOREHEAD CNTRG ONLY               	     3.60	  $134.03	      ---	  $169.02	004	1	0	0.00	    $0.00	Y	
K	21137	RDCTJ FOREHEAD CNTRG ONLY               	    18.00	  $670.14	      ---	  $845.10	004	1	0	0.00	    $0.00	Y	
K	21138	RDCTJ FOREHEAD CNTRG&PROSTC             	    22.00	  $819.06	      ---	 $1032.90	004	1	0	0.00	    $0.00	Y	
O	21138	RDCTJ FOREHEAD CNTRG&PROSTC             	     4.40	  $163.81	      ---	  $206.58	004	1	0	0.00	    $0.00	Y	
O	21139	RDCTJ FOREHEAD CNTRG&SETBACK            	     4.40	  $163.81	      ---	  $206.58	004	1	0	0.00	    $0.00	Y	
K	21139	RDCTJ FOREHEAD CNTRG&SETBACK            	    22.00	  $819.06	      ---	 $1032.90	004	1	0	0.00	    $0.00	Y	
K	21141	LEFORT I-1 PIECE W/O GRAFT              	    27.92	 $1039.46	      ---	 $1310.84	004	1	0	0.00	    $0.00	Y	
O	21141	LEFORT I-1 PIECE W/O GRAFT              	     5.58	  $207.74	      ---	  $261.98	004	1	0	0.00	    $0.00	Y	
O	21142	LEFORT I-2 PIECE W/O GRAFT              	     5.79	  $215.56	      ---	  $271.84	004	1	0	0.00	    $0.00	Y	
K	21142	LEFORT I-2 PIECE W/O GRAFT              	    28.95	 $1077.81	      ---	 $1359.20	004	1	0	0.00	    $0.00	Y	
K	21143	LEFORT I-3/> PIECE W/O GRAFT            	    30.10	 $1120.62	      ---	 $1413.20	004	1	0	0.00	    $0.00	Y	
O	21143	LEFORT I-3/> PIECE W/O GRAFT            	     6.02	  $224.12	      ---	  $282.64	004	1	0	0.00	    $0.00	Y	
O	21145	LEFORT I-1 PIECE W/ GRAFT               	     4.98	  $185.41	      ---	  $233.81	004	1	0	0.00	    $0.00	Y	
K	21145	LEFORT I-1 PIECE W/ GRAFT               	    24.92	  $927.77	      ---	 $1169.99	004	1	0	0.00	    $0.00	Y	
K	21146	LEFORT I-2 PIECE W/ GRAFT               	    27.31	 $1016.75	      ---	 $1282.20	004	1	0	0.00	    $0.00	Y	
O	21146	LEFORT I-2 PIECE W/ GRAFT               	     5.46	  $203.28	      ---	  $256.35	004	1	0	0.00	    $0.00	Y	
O	21147	LEFORT I-3/> PIECE W/ GRAFT             	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
K	21147	LEFORT I-3/> PIECE W/ GRAFT             	    30.00	 $1116.90	      ---	 $1408.50	004	1	0	0.00	    $0.00	Y	
K	21150	LEFORT II ANTERIOR INTRUSION            	    33.06	 $1230.82	      ---	 $1552.17	004	1	0	0.00	    $0.00	Y	
O	21150	LEFORT II ANTERIOR INTRUSION            	     6.61	  $246.09	      ---	  $310.34	004	1	0	0.00	    $0.00	Y	
O	21151	LEFORT II W/BONE GRAFTS                 	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
K	21151	LEFORT II W/BONE GRAFTS                 	    27.18	 $1011.91	      ---	 $1276.10	004	1	0	0.00	    $0.00	Y	
K	21154	LEFORT III W/O LEFORT I                 	    29.45	 $1096.42	      ---	 $1382.68	004	1	0	0.00	    $0.00	Y	
O	21154	LEFORT III W/O LEFORT I                 	     5.89	  $219.28	      ---	  $276.54	004	1	0	0.00	    $0.00	Y	
O	21155	LEFORT III W/ LEFORT I                  	     5.89	  $219.28	      ---	  $276.54	004	1	0	0.00	    $0.00	Y	
K	21155	LEFORT III W/ LEFORT I                  	    29.45	 $1096.42	      ---	 $1382.68	004	1	0	0.00	    $0.00	Y	
K	21159	LEFORT III W/FHDW/O LEFORT I            	    36.24	 $1349.22	      ---	 $1701.47	004	1	0	0.00	    $0.00	Y	
O	21159	LEFORT III W/FHDW/O LEFORT I            	     7.25	  $269.92	      ---	  $340.39	004	1	0	0.00	    $0.00	Y	
O	21160	LEFORT III W/FHD W/ LEFORT I            	     7.25	  $269.92	      ---	  $340.39	004	1	0	0.00	    $0.00	Y	
K	21160	LEFORT III W/FHD W/ LEFORT I            	    36.24	 $1349.22	      ---	 $1701.47	004	1	0	0.00	    $0.00	Y	
K	21172	RECONSTRUCT ORBIT/FOREHEAD              	    36.24	 $1349.22	      ---	 $1701.47	004	1	0	0.00	    $0.00	Y	
O	21172	RECONSTRUCT ORBIT/FOREHEAD              	     7.25	  $269.92	      ---	  $340.39	004	1	0	0.00	    $0.00	Y	
O	21175	RECONSTRUCT ORBIT/FOREHEAD              	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
K	21175	RECONSTRUCT ORBIT/FOREHEAD              	    39.64	 $1475.80	      ---	 $1861.10	004	1	0	0.00	    $0.00	Y	
K	21179	RECONSTRUCT ENTIRE FOREHEAD             	    33.77	 $1257.26	      ---	 $1585.50	004	1	0	0.00	    $0.00	Y	
O	21179	RECONSTRUCT ENTIRE FOREHEAD             	     6.75	  $251.30	      ---	  $316.91	004	1	0	0.00	    $0.00	Y	
O	21180	RECONSTRUCT ENTIRE FOREHEAD             	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
K	21180	RECONSTRUCT ENTIRE FOREHEAD             	    33.98	 $1265.08	      ---	 $1595.36	004	1	0	0.00	    $0.00	Y	
K	21181	CONTOUR CRANIAL BONE LESION             	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
O	21181	CONTOUR CRANIAL BONE LESION             	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
O	21182	RECONSTRUCT CRANIAL BONE                	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
K	21182	RECONSTRUCT CRANIAL BONE                	    39.64	 $1475.80	      ---	 $1861.10	004	1	0	0.00	    $0.00	Y	
K	21183	RECONSTRUCT CRANIAL BONE                	    39.64	 $1475.80	      ---	 $1861.10	004	1	0	0.00	    $0.00	Y	
O	21183	RECONSTRUCT CRANIAL BONE                	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
O	21184	RECONSTRUCT CRANIAL BONE                	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
K	21184	RECONSTRUCT CRANIAL BONE                	    39.64	 $1475.80	      ---	 $1861.10	004	1	0	0.00	    $0.00	Y	
K	21188	RECONSTRUCTION OF MIDFACE               	    32.72	 $1218.17	      ---	 $1536.20	004	1	0	0.00	    $0.00	Y	
O	21188	RECONSTRUCTION OF MIDFACE               	     6.54	  $243.48	      ---	  $307.05	004	1	0	0.00	    $0.00	Y	
O	21193	RECONST LWR JAW W/O GRAFT               	     4.80	  $178.70	      ---	  $225.36	004	1	0	0.00	    $0.00	Y	
K	21193	RECONST LWR JAW W/O GRAFT               	    24.00	  $893.52	      ---	 $1126.80	004	1	0	0.00	    $0.00	Y	
K	21194	RECONST LWR JAW W/GRAFT                 	    30.00	 $1116.90	      ---	 $1408.50	004	1	0	0.00	    $0.00	Y	
O	21194	RECONST LWR JAW W/GRAFT                 	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
O	21195	RECONST LWR JAW W/O FIXATION            	     4.98	  $185.41	      ---	  $233.81	004	1	0	0.00	    $0.00	Y	
K	21195	RECONST LWR JAW W/O FIXATION            	    24.92	  $927.77	      ---	 $1169.99	004	1	0	0.00	    $0.00	Y	
K	21196	RECONST LWR JAW W/FIXATION              	    28.00	 $1042.44	      ---	 $1314.60	004	1	0	0.00	    $0.00	Y	
O	21196	RECONST LWR JAW W/FIXATION              	     5.60	  $208.49	      ---	  $262.92	004	1	0	0.00	    $0.00	Y	
O	21198	RECONSTR LWR JAW SEGMENT                	     2.38	   $88.61	      ---	  $111.74	004	1	0	0.00	    $0.00	Y	
K	21198	RECONSTR LWR JAW SEGMENT                	    11.90	  $443.04	      ---	  $558.71	004	1	0	0.00	    $0.00	Y	
K	21199	RECONSTR LWR JAW W/ADVANCE              	    24.01	  $893.89	      ---	 $1127.27	004	1	0	0.00	    $0.00	Y	
O	21199	RECONSTR LWR JAW W/ADVANCE              	     4.80	  $178.70	      ---	  $225.36	004	1	0	0.00	    $0.00	Y	
O	21206	RECONSTRUCT UPPER JAW BONE              	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
K	21206	RECONSTRUCT UPPER JAW BONE              	    30.00	 $1116.90	      ---	 $1408.50	004	1	0	0.00	    $0.00	Y	
K	21208	AUGMENTATION OF FACIAL BONES            	    16.64	  $619.51	      ---	  $781.25	004	1	0	0.00	    $0.00	Y	
O	21208	AUGMENTATION OF FACIAL BONES            	     3.33	  $123.98	      ---	  $156.34	004	1	0	0.00	    $0.00	Y	
O	21209	REDUCTION OF FACIAL BONES               	     2.56	   $95.31	      ---	  $120.19	004	1	0	0.00	    $0.00	Y	
K	21209	REDUCTION OF FACIAL BONES               	    12.82	  $477.29	      ---	  $601.90	004	1	0	0.00	    $0.00	Y	
K	21210	FACE BONE GRAFT                         	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
O	21210	FACE BONE GRAFT                         	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
O	21215	LOWER JAW BONE GRAFT                    	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
K	21215	LOWER JAW BONE GRAFT                    	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
K	21230	RIB CARTILAGE GRAFT                     	    18.00	  $670.14	      ---	  $845.10	004	1	0	0.00	    $0.00	Y	
O	21230	RIB CARTILAGE GRAFT                     	     3.60	  $134.03	      ---	  $169.02	004	1	0	0.00	    $0.00	Y	
O	21235	EAR CARTILAGE GRAFT                     	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	21235	EAR CARTILAGE GRAFT                     	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	21240	RECONSTRUCTION OF JAW JOINT             	    23.74	  $883.84	      ---	 $1114.59	004	1	0	0.00	    $0.00	Y	
O	21240	RECONSTRUCTION OF JAW JOINT             	     4.75	  $176.84	      ---	  $223.01	004	1	0	0.00	    $0.00	Y	
O	21242	RECONSTRUCTION OF JAW JOINT             	     4.47	  $166.42	      ---	  $209.87	004	1	0	0.00	    $0.00	Y	
K	21242	RECONSTRUCTION OF JAW JOINT             	    22.36	  $832.46	      ---	 $1049.80	004	1	0	0.00	    $0.00	Y	
K	21243	RECONSTRUCTION OF JAW JOINT             	    31.70	 $1180.19	      ---	 $1488.32	004	1	0	0.00	    $0.00	Y	
O	21243	RECONSTRUCTION OF JAW JOINT             	     6.34	  $236.04	      ---	  $297.66	004	1	0	0.00	    $0.00	Y	
O	21244	RECONSTRUCTION OF LOWER JAW             	     4.23	  $157.48	      ---	  $198.60	004	1	0	0.00	    $0.00	Y	
K	21244	RECONSTRUCTION OF LOWER JAW             	    21.13	  $786.67	      ---	  $992.05	004	1	0	0.00	    $0.00	Y	
K	21245	RECONSTRUCTION OF JAW                   	    21.34	  $794.49	      ---	 $1001.91	004	1	0	0.00	    $0.00	Y	
O	21245	RECONSTRUCTION OF JAW                   	     4.27	  $158.97	      ---	  $200.48	004	1	0	0.00	    $0.00	Y	
O	21246	RECONSTRUCTION OF JAW                   	     3.83	  $142.59	      ---	  $179.82	004	1	0	0.00	    $0.00	Y	
K	21246	RECONSTRUCTION OF JAW                   	    19.17	  $713.70	      ---	  $900.03	004	1	0	0.00	    $0.00	Y	
K	21247	RECONSTRUCT LOWER JAW BONE              	    33.27	 $1238.64	      ---	 $1562.03	004	1	0	0.00	    $0.00	Y	
O	21247	RECONSTRUCT LOWER JAW BONE              	     6.65	  $247.58	      ---	  $312.22	004	1	0	0.00	    $0.00	Y	
O	21248	RECONSTRUCTION OF JAW                   	     3.43	  $127.70	      ---	  $161.04	004	1	0	0.00	    $0.00	Y	
K	21248	RECONSTRUCTION OF JAW                   	    17.13	  $637.75	      ---	  $804.25	004	1	0	0.00	    $0.00	Y	
K	21249	RECONSTRUCTION OF JAW                   	    27.22	 $1013.40	      ---	 $1277.98	004	1	0	0.00	    $0.00	Y	
O	21249	RECONSTRUCTION OF JAW                   	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
O	21255	RECONSTRUCT LOWER JAW BONE              	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
K	21255	RECONSTRUCT LOWER JAW BONE              	    30.00	 $1116.90	      ---	 $1408.50	004	1	0	0.00	    $0.00	Y	
K	21256	RECONSTRUCTION OF ORBIT                 	    30.00	 $1116.90	      ---	 $1408.50	004	1	0	0.00	    $0.00	Y	
O	21256	RECONSTRUCTION OF ORBIT                 	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
O	21260	REVISE EYE SOCKETS                      	     4.25	  $158.23	      ---	  $199.54	004	1	0	0.00	    $0.00	Y	
K	21260	REVISE EYE SOCKETS                      	    21.23	  $790.39	      ---	  $996.75	004	1	0	0.00	    $0.00	Y	
K	21261	REVISE EYE SOCKETS                      	    44.62	 $1661.20	      ---	 $2094.91	004	1	0	0.00	    $0.00	Y	
O	21261	REVISE EYE SOCKETS                      	     8.92	  $332.09	      ---	  $418.79	004	1	0	0.00	    $0.00	Y	
O	21263	REVISE EYE SOCKETS                      	     8.36	  $311.24	      ---	  $392.50	004	1	0	0.00	    $0.00	Y	
K	21263	REVISE EYE SOCKETS                      	    41.79	 $1555.84	      ---	 $1962.04	004	1	0	0.00	    $0.00	Y	
K	21267	REVISE EYE SOCKETS                      	    38.52	 $1434.10	      ---	 $1808.51	004	1	0	0.00	    $0.00	Y	
O	21267	REVISE EYE SOCKETS                      	     7.70	  $286.67	      ---	  $361.52	004	1	0	0.00	    $0.00	Y	
O	21268	REVISE EYE SOCKETS                      	     8.54	  $317.94	      ---	  $400.95	004	1	0	0.00	    $0.00	Y	
K	21268	REVISE EYE SOCKETS                      	    42.71	 $1590.09	      ---	 $2005.23	004	1	0	0.00	    $0.00	Y	
K	21270	AUGMENTATION CHEEK BONE                 	    15.83	  $589.35	      ---	  $743.22	004	1	0	0.00	    $0.00	Y	
O	21270	AUGMENTATION CHEEK BONE                 	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
O	21275	REVISION ORBITOFACIAL BONES             	     4.79	  $178.33	      ---	  $224.89	004	1	0	0.00	    $0.00	Y	
K	21275	REVISION ORBITOFACIAL BONES             	    23.96	  $892.03	      ---	 $1124.92	004	1	0	0.00	    $0.00	Y	
K	21280	MEDIAL CANTHOPEXY                       	    10.52	  $391.66	      ---	  $493.91	004	1	0	0.00	    $0.00	Y	
O	21280	MEDIAL CANTHOPEXY                       	     2.10	   $78.18	      ---	   $98.60	004	1	0	0.00	    $0.00	Y	
O	21282	LATERAL CANTHOPEXY                      	     2.07	   $77.07	      ---	   $97.19	004	1	0	0.00	    $0.00	Y	
K	21282	LATERAL CANTHOPEXY                      	    10.36	  $385.70	      ---	  $486.40	004	1	0	0.00	    $0.00	Y	
K	21295	REVISION OF JAW MUSCLE/BONE             	     6.21	  $231.20	      ---	  $291.56	004	1	0	0.00	    $0.00	Y	
O	21295	REVISION OF JAW MUSCLE/BONE             	     1.24	   $46.17	      ---	   $58.22	004	1	0	0.00	    $0.00	Y	
O	21296	REVISION OF JAW MUSCLE/BONE             	     1.73	   $64.41	      ---	   $81.22	004	1	0	0.00	    $0.00	Y	
K	21296	REVISION OF JAW MUSCLE/BONE             	     8.66	  $322.41	      ---	  $406.59	004	1	0	0.00	    $0.00	Y	
K	21299	UNLISTED CRANFCL&MAXLFCL PX             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	21299	UNLISTED CRANFCL&MAXLFCL PX             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	21315	CLSD TX NSL FX MNPJ WO STBLJ            	     2.13	   $79.30	      ---	  $100.00	004	1	1	0.00	    $0.00	Y	
K	21320	CLSD TX NSL FX W/MNPJ&STABLJ            	     3.40	  $126.58	      ---	  $159.63	004	1	0	0.00	    $0.00	Y	
K	21325	OPEN TX NOSE FX UNCOMPLICATD            	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
O	21325	OPEN TX NOSE FX UNCOMPLICATD            	     0.90	   $33.51	      ---	   $42.26	004	1	0	0.00	    $0.00	Y	
O	21330	OPEN TX NOSE FX W/SKELE FIXJ            	     1.90	   $70.74	      ---	   $89.21	004	1	0	0.00	    $0.00	Y	
K	21330	OPEN TX NOSE FX W/SKELE FIXJ            	     9.50	  $353.69	      ---	  $446.03	004	1	0	0.00	    $0.00	Y	
K	21335	OPEN TX NOSE & SEPTAL FX                	    17.00	  $632.91	      ---	  $798.15	004	1	0	0.00	    $0.00	Y	
O	21335	OPEN TX NOSE & SEPTAL FX                	     3.40	  $126.58	      ---	  $159.63	004	1	0	0.00	    $0.00	Y	
O	21336	OPEN TX SEPTAL FX W/WO STABJ            	     1.28	   $47.65	      ---	   $60.10	004	1	0	0.00	    $0.00	Y	
K	21336	OPEN TX SEPTAL FX W/WO STABJ            	     6.38	  $237.53	      ---	  $299.54	004	1	0	0.00	    $0.00	Y	
K	21337	CLOSED TX SEPTAL&NOSE FX                	     3.51	  $130.68	      ---	  $164.79	004	1	0	0.00	    $0.00	Y	
K	21338	OPEN NASOETHMOID FX W/O FIXJ            	    12.95	  $482.13	      ---	  $608.00	004	1	0	0.00	    $0.00	Y	
O	21338	OPEN NASOETHMOID FX W/O FIXJ            	     2.59	   $96.43	      ---	  $121.60	004	1	0	0.00	    $0.00	Y	
O	21339	OPEN NASOETHMOID FX W/ FIXJ             	     2.98	  $110.95	      ---	  $139.91	004	1	0	0.00	    $0.00	Y	
K	21339	OPEN NASOETHMOID FX W/ FIXJ             	    14.90	  $554.73	      ---	  $699.56	004	1	0	0.00	    $0.00	Y	
K	21340	PERQ TX NASOETHMOID FX                  	    19.91	  $741.25	      ---	  $934.77	004	1	0	0.00	    $0.00	Y	
O	21340	PERQ TX NASOETHMOID FX                  	     3.98	  $148.18	      ---	  $186.86	004	1	0	0.00	    $0.00	Y	
O	21343	OPEN TX DPRSD FRONT SINUS FX            	     4.37	  $162.70	      ---	  $205.17	004	1	0	0.00	    $0.00	Y	
K	21343	OPEN TX DPRSD FRONT SINUS FX            	    21.84	  $813.10	      ---	 $1025.39	004	1	0	0.00	    $0.00	Y	
K	21344	OPEN TX COMPL FRONT SINUS FX            	    19.16	  $713.33	      ---	  $899.56	004	1	0	0.00	    $0.00	Y	
O	21344	OPEN TX COMPL FRONT SINUS FX            	     3.83	  $142.59	      ---	  $179.82	004	1	0	0.00	    $0.00	Y	
O	21345	CLOSED TX NOSE/JAW FX                   	     1.59	   $59.20	      ---	   $74.65	004	1	0	0.00	    $0.00	Y	
K	21345	CLOSED TX NOSE/JAW FX                   	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
K	21346	OPN TX NASOMAX FX W/FIXJ                	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	21346	OPN TX NASOMAX FX W/FIXJ                	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
O	21347	OPN TX NASOMAX FX MULTPLE               	     5.23	  $194.71	      ---	  $245.55	004	1	0	0.00	    $0.00	Y	
K	21347	OPN TX NASOMAX FX MULTPLE               	    26.16	  $973.94	      ---	 $1228.21	004	1	0	0.00	    $0.00	Y	
K	21348	OPN TX NASOMAX FX W/GRAFT               	    12.51	  $465.75	      ---	  $587.34	004	1	0	0.00	    $0.00	Y	
O	21348	OPN TX NASOMAX FX W/GRAFT               	     2.50	   $93.08	      ---	  $117.38	004	1	0	0.00	    $0.00	Y	
K	21355	PERQ TX MALAR FRACTURE                  	     3.46	  $128.82	      ---	  $162.45	004	1	0	0.00	    $0.00	Y	
K	21356	OPN TX DPRSD ZYGOMATIC ARCH             	     7.42	  $276.25	      ---	  $348.37	004	1	0	0.00	    $0.00	Y	
O	21356	OPN TX DPRSD ZYGOMATIC ARCH             	     1.48	   $55.10	      ---	   $69.49	004	1	0	0.00	    $0.00	Y	
O	21360	OPN TX DPRSD MALAR FRACTURE             	     1.59	   $59.20	      ---	   $74.65	004	1	0	0.00	    $0.00	Y	
K	21360	OPN TX DPRSD MALAR FRACTURE             	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
K	21365	OPN TX COMPLX MALAR FX                  	    14.72	  $548.03	      ---	  $691.10	004	1	0	0.00	    $0.00	Y	
O	21365	OPN TX COMPLX MALAR FX                  	     2.94	  $109.46	      ---	  $138.03	004	1	0	0.00	    $0.00	Y	
O	21366	OPN TX COMPLX MALAR W/GRFT              	     2.98	  $110.95	      ---	  $139.91	004	1	0	0.00	    $0.00	Y	
K	21366	OPN TX COMPLX MALAR W/GRFT              	    14.91	  $555.10	      ---	  $700.02	004	1	0	0.00	    $0.00	Y	
K	21385	OPN TX ORBIT FX TRANSANTRAL             	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	21385	OPN TX ORBIT FX TRANSANTRAL             	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
O	21386	OPN TX ORBIT FX PERIORBITAL             	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	21386	OPN TX ORBIT FX PERIORBITAL             	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	21387	OPN TX ORBIT FX COMBINED                	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	21387	OPN TX ORBIT FX COMBINED                	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
O	21390	OPN TX ORBIT PERIORBTL IMPLT            	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
K	21390	OPN TX ORBIT PERIORBTL IMPLT            	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
K	21395	OPN TX ORBIT PERIORBT W/GRFT            	    19.07	  $709.98	      ---	  $895.34	004	1	0	0.00	    $0.00	Y	
O	21395	OPN TX ORBIT PERIORBT W/GRFT            	     3.81	  $141.85	      ---	  $178.88	004	1	0	0.00	    $0.00	Y	
O	21400	CLOSED TX ORBIT W/O MANIPULJ            	     1.09	   $40.58	      ---	   $51.18	004	1	0	0.00	    $0.00	Y	
K	21400	CLOSED TX ORBIT W/O MANIPULJ            	     5.46	  $203.28	      ---	  $256.35	004	1	0	0.00	    $0.00	Y	
K	21401	CLOSED TX ORBIT W/MANIPULJ              	     7.03	  $261.73	      ---	  $330.06	004	1	0	0.00	    $0.00	Y	
O	21401	CLOSED TX ORBIT W/MANIPULJ              	     1.41	   $52.49	      ---	   $66.20	004	1	0	0.00	    $0.00	Y	
O	21406	OPN TX ORBIT FX W/O IMPLANT             	     2.81	  $104.62	      ---	  $131.93	004	1	0	0.00	    $0.00	Y	
K	21406	OPN TX ORBIT FX W/O IMPLANT             	    14.03	  $522.34	      ---	  $658.71	004	1	0	0.00	    $0.00	Y	
K	21407	OPN TX ORBIT FX W/IMPLANT               	    14.00	  $521.22	      ---	  $657.30	004	1	0	0.00	    $0.00	Y	
O	21407	OPN TX ORBIT FX W/IMPLANT               	     2.80	  $104.24	      ---	  $131.46	004	1	0	0.00	    $0.00	Y	
O	21408	OPN TX ORBIT FX W/BONE GRFT             	     2.53	   $94.19	      ---	  $118.78	004	1	0	0.00	    $0.00	Y	
K	21408	OPN TX ORBIT FX W/BONE GRFT             	    12.64	  $470.59	      ---	  $593.45	004	1	0	0.00	    $0.00	Y	
K	21421	CLTX PALATAL/MAX FX WIRE FIX            	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
O	21421	CLTX PALATAL/MAX FX WIRE FIX            	     1.59	   $59.20	      ---	   $74.65	004	1	0	0.00	    $0.00	Y	
O	21422	OPTX PALATAL/MAX FRACTURE               	     2.62	   $97.54	      ---	  $123.01	004	1	0	0.00	    $0.00	Y	
K	21422	OPTX PALATAL/MAX FRACTURE               	    13.12	  $488.46	      ---	  $615.98	004	1	0	0.00	    $0.00	Y	
K	21423	OPTX PALATAL/MAX FX COMP                	    14.17	  $527.55	      ---	  $665.28	004	1	0	0.00	    $0.00	Y	
O	21423	OPTX PALATAL/MAX FX COMP                	     2.83	  $105.36	      ---	  $132.87	004	1	0	0.00	    $0.00	Y	
O	21431	CLTX CRANIOFACIAL SEPARATION            	     1.59	   $59.20	      ---	   $74.65	004	1	0	0.00	    $0.00	Y	
K	21431	CLTX CRANIOFACIAL SEPARATION            	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
K	21432	OPTX CRANFCL SEP W/WIRING               	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	21432	OPTX CRANFCL SEP W/WIRING               	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
O	21433	OPTX CRANFCL SEP COMP MLT               	     7.17	  $266.94	      ---	  $336.63	004	1	0	0.00	    $0.00	Y	
K	21433	OPTX CRANFCL SEP COMP MLT               	    35.85	 $1334.70	      ---	 $1683.16	004	1	0	0.00	    $0.00	Y	
K	21435	OPTX CRNFC SEP COMP INT&/XTR            	   959.20	  $959.20	      ---	       --	042	0	0	0.00	    $0.00	Y	
O	21435	OPTX CRNFC SEP COMP INT&/XTR            	   191.73	  $191.73	      ---	       --	042	0	0	0.00	    $0.00	Y	
O	21436	OPTX CRNFCL SEP COMP MLT INT            	     5.78	  $215.19	      ---	  $271.37	004	1	0	0.00	    $0.00	Y	
K	21436	OPTX CRNFCL SEP COMP MLT INT            	    28.86	 $1074.46	      ---	 $1354.98	004	1	0	0.00	    $0.00	Y	
K	21440	CLTX MNDBLR/MAX ALV RIDGE FX            	     3.57	  $132.91	      ---	  $167.61	004	1	0	0.00	    $0.00	Y	
K	21445	OPTX MNDBLR/MAX ALV RIDGE FX            	     5.66	  $210.72	      ---	  $265.74	004	1	0	0.00	    $0.00	Y	
O	21445	OPTX MNDBLR/MAX ALV RIDGE FX            	     1.13	   $42.07	      ---	   $53.05	004	1	0	0.00	    $0.00	Y	
O	21450	CLTX MNDBLR FX W/O MNPJ                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	21450	CLTX MNDBLR FX W/O MNPJ                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	21451	CLTX MNDBLR FX W/MNPJ                   	    10.18	  $379.00	      ---	  $477.95	004	1	0	0.00	    $0.00	Y	
O	21451	CLTX MNDBLR FX W/MNPJ                   	     2.04	   $75.95	      ---	   $95.78	004	1	0	0.00	    $0.00	Y	
O	21452	PERQ TX MNDBLR FX XTRNL FIXJ            	     1.79	   $66.64	      ---	   $84.04	004	1	0	0.00	    $0.00	Y	
K	21452	PERQ TX MNDBLR FX XTRNL FIXJ            	     8.94	  $332.84	      ---	  $419.73	004	1	0	0.00	    $0.00	Y	
K	21453	CLTX MNDBLR FX NTRDNTL FIXJ             	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	21453	CLTX MNDBLR FX NTRDNTL FIXJ             	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
O	21454	OPTX MNDBLR FX XTRNL FIXJ               	     1.99	   $74.09	      ---	   $93.43	004	1	0	0.00	    $0.00	Y	
K	21454	OPTX MNDBLR FX XTRNL FIXJ               	     9.93	  $369.69	      ---	  $466.21	004	1	0	0.00	    $0.00	Y	
K	21461	OPTX MNDBLR FX WO NTRDNTL               	    16.00	  $595.68	      ---	  $751.20	004	1	0	0.00	    $0.00	Y	
O	21461	OPTX MNDBLR FX WO NTRDNTL               	     3.20	  $119.14	      ---	  $150.24	004	1	0	0.00	    $0.00	Y	
O	21462	OPTX MNDBLR FX W/NTRDNTL                	     3.25	  $121.00	      ---	  $152.59	004	1	0	0.00	    $0.00	Y	
K	21462	OPTX MNDBLR FX W/NTRDNTL                	    16.23	  $604.24	      ---	  $762.00	004	1	0	0.00	    $0.00	Y	
K	21465	OPTX MNDBLR CNDYLR FX                   	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	21465	OPTX MNDBLR CNDYLR FX                   	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
O	21470	OPTX COMPLICATED MNDBLR FX              	   190.00	  $190.00	      ---	       --	042	0	0	0.00	    $0.00	Y	
K	21470	OPTX COMPLICATED MNDBLR FX              	   950.00	  $950.00	      ---	       --	042	0	0	0.00	    $0.00	Y	
K	21480	CLTX TMPRMAND DISLC 1ST/SBSQ            	     1.90	   $70.74	      ---	   $89.21	004	1	1	0.00	    $0.00	Y	
O	21480	CLTX TMPRMAND DISLC 1ST/SBSQ            	     0.38	   $14.15	      ---	   $17.84	004	1	0	0.00	    $0.00	Y	
O	21485	CLTX TMPRMAND DISLC COMP                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	21485	CLTX TMPRMAND DISLC COMP                	     6.58	  $244.97	      ---	  $308.93	004	1	0	0.00	    $0.00	Y	
K	21490	OPTX TMPRMAND DISLOCATION               	    18.28	  $680.56	      ---	  $858.25	004	1	0	0.00	    $0.00	Y	
O	21490	OPTX TMPRMAND DISLOCATION               	     3.66	  $136.26	      ---	  $171.84	004	1	0	0.00	    $0.00	Y	
O	21497	INTERDENTAL WIRG OTH/THN FX             	     1.43	   $53.24	      ---	   $67.14	004	1	0	0.00	    $0.00	Y	
K	21497	INTERDENTAL WIRG OTH/THN FX             	     7.16	  $266.57	      ---	  $336.16	004	1	1	0.00	    $0.00	Y	
K	21499	UNLISTED MUSCSKEL PX HEAD               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	21499	UNLISTED MUSCSKEL PX HEAD               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	21501	I&D DP ABSC/HMTMA SFT TS NCK            	     1.37	   $51.01	      ---	   $64.32	004	1	0	0.00	    $0.00	Y	
K	21501	I&D DP ABSC/HMTMA SFT TS NCK            	     6.86	  $255.40	      ---	  $322.08	004	1	0	0.00	    $0.00	Y	
K	21502	I&D DP ABS/HMTM NCK RIB OSTC            	     6.94	  $258.38	      ---	  $325.83	004	1	0	0.00	    $0.00	Y	
O	21502	I&D DP ABS/HMTM NCK RIB OSTC            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	21510	INC DEEP OPNG B1 CRTX THORAX            	     2.35	   $87.49	      ---	  $110.33	004	1	0	0.00	    $0.00	Y	
K	21510	INC DEEP OPNG B1 CRTX THORAX            	    11.73	  $436.71	      ---	  $550.72	004	1	0	0.00	    $0.00	Y	
K	21550	BIOPSY OF NECK/CHEST                    	     2.00	   $74.46	      ---	   $93.90	004	1	0	0.00	    $0.00	Y	
K	21552	EXC NECK LES SC 3 CM/>                  	     9.94	  $370.07	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	21552	EXC NECK LES SC 3 CM/>                  	     1.99	   $74.09	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	21554	EXC NECK TUM DEEP 5 CM/>                	     3.25	  $121.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	21554	EXC NECK TUM DEEP 5 CM/>                	    16.26	  $605.36	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	21555	EXC NECK LES SC < 3 CM                  	     8.89	  $330.97	      ---	  $417.39	004	1	0	0.00	    $0.00	Y	
O	21555	EXC NECK LES SC < 3 CM                  	     1.78	   $66.27	      ---	   $83.57	004	1	0	0.00	    $0.00	Y	
O	21556	EXC NECK TUM DEEP < 5 CM                	     2.14	   $79.67	      ---	  $100.47	004	1	0	0.00	    $0.00	Y	
K	21556	EXC NECK TUM DEEP < 5 CM                	    10.72	  $399.11	      ---	  $503.30	004	1	0	0.00	    $0.00	Y	
K	21557	RESECT NECK THORAX TUMOR<5CM            	    17.97	  $669.02	      ---	  $843.69	004	1	0	0.00	    $0.00	Y	
O	21557	RESECT NECK THORAX TUMOR<5CM            	     3.59	  $133.66	      ---	  $168.55	004	1	0	0.00	    $0.00	Y	
O	21558	RESECT NECK TUMOR 5 CM/>                	     6.08	  $226.36	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	21558	RESECT NECK TUMOR 5 CM/>                	    30.41	 $1132.16	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	21600	PARTIAL REMOVAL OF RIB                  	     7.31	  $272.15	      ---	  $343.20	004	1	0	0.00	    $0.00	Y	
O	21600	PARTIAL REMOVAL OF RIB                  	     1.46	   $54.36	      ---	   $68.55	004	1	0	0.00	    $0.00	Y	
O	21601	EXC CHEST WALL TUMOR W/RIBS             	     5.49	  $204.39	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	21601	EXC CHEST WALL TUMOR W/RIBS             	    27.45	 $1021.96	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	21602	EXC CH WAL TUM W/O LYMPHADEC            	    37.18	 $1384.21	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	21602	EXC CH WAL TUM W/O LYMPHADEC            	     7.43	  $276.62	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	21603	EXC CH WAL TUM W/LYMPHADEC              	     8.19	  $304.91	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	21603	EXC CH WAL TUM W/LYMPHADEC              	    40.98	 $1525.69	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	21610	PARTIAL REMOVAL OF RIB                  	    11.99	  $446.39	      ---	  $562.93	004	1	0	0.00	    $0.00	Y	
O	21610	PARTIAL REMOVAL OF RIB                  	     2.40	   $89.35	      ---	  $112.68	004	1	0	0.00	    $0.00	Y	
O	21615	REMOVAL OF RIB                          	     3.46	  $128.82	      ---	  $162.45	004	1	0	0.00	    $0.00	Y	
K	21615	REMOVAL OF RIB                          	    17.11	  $637.01	      ---	  $803.31	004	1	0	0.00	    $0.00	Y	
K	21616	REMOVAL OF RIB AND NERVES               	    18.46	  $687.27	      ---	  $866.70	004	1	0	0.00	    $0.00	Y	
O	21616	REMOVAL OF RIB AND NERVES               	     3.74	  $139.24	      ---	  $175.59	004	1	0	0.00	    $0.00	Y	
O	21620	PARTIAL REMOVAL OF STERNUM              	     3.01	  $112.06	      ---	  $141.32	004	1	0	0.00	    $0.00	Y	
K	21620	PARTIAL REMOVAL OF STERNUM              	    15.04	  $559.94	      ---	  $706.13	004	1	0	0.00	    $0.00	Y	
K	21627	STERNAL DEBRIDEMENT                     	    19.67	  $732.31	      ---	  $923.51	004	1	0	0.00	    $0.00	Y	
O	21627	STERNAL DEBRIDEMENT                     	     3.93	  $146.31	      ---	  $184.51	004	1	0	0.00	    $0.00	Y	
O	21630	RADICAL RESECTION STERNUM               	     6.51	  $242.37	      ---	  $305.64	004	1	0	0.00	    $0.00	Y	
K	21630	RADICAL RESECTION STERNUM               	    32.54	 $1211.46	      ---	 $1527.75	004	1	0	0.00	    $0.00	Y	
K	21685	HYOID MYOTOMY & SUSPENSION              	    11.38	  $423.68	      ---	  $534.29	004	1	0	0.00	    $0.00	Y	
K	21700	REVISION OF NECK MUSCLE                 	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	21700	REVISION OF NECK MUSCLE                 	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	21705	REVISION OF NECK MUSCLE/RIB             	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	21705	REVISION OF NECK MUSCLE/RIB             	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	21720	REVISION OF NECK MUSCLE                 	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	21720	REVISION OF NECK MUSCLE                 	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
O	21725	REVISION OF NECK MUSCLE                 	     2.04	   $75.95	      ---	   $95.78	004	1	0	0.00	    $0.00	Y	
K	21725	REVISION OF NECK MUSCLE                 	    10.19	  $379.37	      ---	  $478.42	004	1	0	0.00	    $0.00	Y	
K	21740	RECONSTRUCTION OF STERNUM               	    28.96	 $1078.18	      ---	 $1359.67	004	1	0	0.00	    $0.00	Y	
O	21740	RECONSTRUCTION OF STERNUM               	     5.79	  $215.56	      ---	  $271.84	004	1	0	0.00	    $0.00	Y	
O	21742	REPAIR STERN/NUSS W/O SCOPE             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	21742	REPAIR STERN/NUSS W/O SCOPE             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	21743	REPAIR STERNUM/NUSS W/SCOPE             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	21743	REPAIR STERNUM/NUSS W/SCOPE             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	21750	REPAIR OF STERNUM SEPARATION            	     4.36	  $162.32	      ---	  $204.70	004	1	0	0.00	    $0.00	Y	
K	21750	REPAIR OF STERNUM SEPARATION            	    21.79	  $811.24	      ---	 $1023.04	004	1	0	0.00	    $0.00	Y	
K	21811	OPTX OF RIB FX W/FIXJ SCOPE             	    13.83	  $514.89	      ---	  $649.32	004	1	0	0.00	    $0.00	Y	
O	21811	OPTX OF RIB FX W/FIXJ SCOPE             	     2.76	  $102.75	      ---	  $129.58	004	1	0	0.00	    $0.00	Y	
O	21812	TREATMENT OF RIB FRACTURE               	     3.31	  $123.23	      ---	  $155.40	004	1	0	0.00	    $0.00	Y	
K	21812	TREATMENT OF RIB FRACTURE               	    16.57	  $616.90	      ---	  $777.96	004	1	0	0.00	    $0.00	Y	
K	21813	TREATMENT OF RIB FRACTURE               	    22.57	  $840.28	      ---	 $1059.66	004	1	0	0.00	    $0.00	Y	
O	21813	TREATMENT OF RIB FRACTURE               	     4.51	  $167.91	      ---	  $211.74	004	1	0	0.00	    $0.00	Y	
O	21820	TREAT STERNUM FRACTURE                  	     0.62	   $23.08	      ---	   $29.11	004	1	0	0.00	    $0.00	Y	
K	21820	TREAT STERNUM FRACTURE                  	     3.11	  $115.79	      ---	  $146.01	004	1	1	0.00	    $0.00	Y	
K	21825	TREAT STERNUM FRACTURE                  	    16.93	  $630.30	      ---	  $794.86	004	1	0	0.00	    $0.00	Y	
O	21825	TREAT STERNUM FRACTURE                  	     3.39	  $126.21	      ---	  $159.16	004	1	0	0.00	    $0.00	Y	
O	21899	UNLISTED PX NECK/THORAX                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	21899	UNLISTED PX NECK/THORAX                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	21920	BIOPSY SOFT TISSUE OF BACK              	     2.06	   $76.69	      ---	   $96.72	004	1	0	0.00	    $0.00	Y	
O	21920	BIOPSY SOFT TISSUE OF BACK              	     0.41	   $15.26	      ---	   $19.25	004	1	0	0.00	    $0.00	Y	
O	21925	BIOPSY SOFT TISSUE OF BACK              	     1.45	   $53.98	      ---	   $68.08	004	1	0	0.00	    $0.00	Y	
K	21925	BIOPSY SOFT TISSUE OF BACK              	     7.23	  $269.17	      ---	  $339.45	004	1	0	0.00	    $0.00	Y	
K	21930	EXC BACK LES SC < 3 CM                  	     9.97	  $371.18	      ---	  $468.09	004	1	0	0.00	    $0.00	Y	
O	21930	EXC BACK LES SC < 3 CM                  	     1.99	   $74.09	      ---	   $93.43	004	1	0	0.00	    $0.00	Y	
O	21931	EXC BACK LES SC 3 CM/>                  	     2.07	   $77.07	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	21931	EXC BACK LES SC 3 CM/>                  	    10.37	  $386.08	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	21932	EXC BACK TUM DEEP < 5 CM                	    14.89	  $554.35	      ---	  $699.09	004	1	0	0.00	    $0.00	Y	
O	21932	EXC BACK TUM DEEP < 5 CM                	     2.98	  $110.95	      ---	  $139.91	004	1	0	0.00	    $0.00	Y	
O	21933	EXC BACK TUM DEEP 5 CM/>                	     3.27	  $121.74	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	21933	EXC BACK TUM DEEP 5 CM/>                	    16.36	  $609.08	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	21935	RESECT BACK TUM < 5 CM                  	    22.44	  $835.44	      ---	 $1053.56	004	1	0	0.00	    $0.00	Y	
O	21935	RESECT BACK TUM < 5 CM                  	     4.49	  $167.16	      ---	  $210.81	004	1	0	0.00	    $0.00	Y	
O	21936	RESECT BACK TUM 5 CM/>                  	     6.31	  $234.92	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	21936	RESECT BACK TUM 5 CM/>                  	    31.56	 $1174.98	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	22010	I&D P-SPINE C/T/CERV-THOR               	    17.83	  $663.81	      ---	  $837.12	004	1	0	0.00	    $0.00	Y	
O	22010	I&D P-SPINE C/T/CERV-THOR               	     3.57	  $132.91	      ---	  $167.61	004	1	0	0.00	    $0.00	Y	
O	22015	I&D ABSCESS P-SPINE L/S/LS              	     3.54	  $131.79	      ---	  $166.20	004	1	0	0.00	    $0.00	Y	
K	22015	I&D ABSCESS P-SPINE L/S/LS              	    17.68	  $658.23	      ---	  $830.08	004	1	0	0.00	    $0.00	Y	
K	22100	REMOVE PART OF NECK VERTEBRA            	    12.90	  $480.27	      ---	  $605.66	004	1	0	0.00	    $0.00	Y	
O	22100	REMOVE PART OF NECK VERTEBRA            	     2.58	   $96.05	      ---	  $121.13	004	1	0	0.00	    $0.00	Y	
O	22101	REMOVE PART THORAX VERTEBRA             	     2.67	   $99.40	      ---	  $125.36	004	1	0	0.00	    $0.00	Y	
K	22101	REMOVE PART THORAX VERTEBRA             	    13.35	  $497.02	      ---	  $626.78	004	1	0	0.00	    $0.00	Y	
K	22102	REMOVE PART LUMBAR VERTEBRA             	    10.28	  $382.72	      ---	  $482.65	004	1	0	0.00	    $0.00	Y	
O	22102	REMOVE PART LUMBAR VERTEBRA             	     2.06	   $76.69	      ---	   $96.72	004	1	0	0.00	    $0.00	Y	
O	22103	REMOVE EXTRA SPINE SEGMENT              	     0.63	   $23.45	      ---	   $29.58	004	1	0	0.00	    $0.00	Y	
K	22103	REMOVE EXTRA SPINE SEGMENT              	     3.19	  $118.76	      ---	  $149.77	004	1	0	0.00	    $0.00	Y	
K	22110	REMOVE PART OF NECK VERTEBRA            	    16.66	  $620.25	      ---	  $782.19	004	1	0	0.00	    $0.00	Y	
O	22110	REMOVE PART OF NECK VERTEBRA            	     3.33	  $123.98	      ---	  $156.34	004	1	0	0.00	    $0.00	Y	
O	22112	REMOVE PART THORAX VERTEBRA             	     3.35	  $124.72	      ---	  $157.28	004	1	0	0.00	    $0.00	Y	
K	22112	REMOVE PART THORAX VERTEBRA             	    16.79	  $625.09	      ---	  $788.29	004	1	0	0.00	    $0.00	Y	
K	22114	REMOVE PART LUMBAR VERTEBRA             	    14.52	  $540.58	      ---	  $681.71	004	1	0	0.00	    $0.00	Y	
O	22114	REMOVE PART LUMBAR VERTEBRA             	     2.90	  $107.97	      ---	  $136.16	004	1	0	0.00	    $0.00	Y	
O	22116	REMOVE EXTRA SPINE SEGMENT              	     0.63	   $23.45	      ---	   $29.58	004	1	0	0.00	    $0.00	Y	
K	22116	REMOVE EXTRA SPINE SEGMENT              	     3.14	  $116.90	      ---	  $147.42	004	1	0	0.00	    $0.00	Y	
K	22206	INCIS SPINE 3 COLUMN THORAC             	    46.29	 $1723.38	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	22206	INCIS SPINE 3 COLUMN THORAC             	     9.26	  $344.75	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	22207	INCIS SPINE 3 COLUMN LUMBAR             	     9.13	  $339.91	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	22207	INCIS SPINE 3 COLUMN LUMBAR             	    45.72	 $1702.16	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	22208	INCIS SPINE 3 COLUMN ADL SEG            	    11.55	  $430.01	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	22208	INCIS SPINE 3 COLUMN ADL SEG            	     2.31	   $86.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	22210	INCIS 1 VERTEBRAL SEG CERV              	     5.63	  $209.60	      ---	  $264.33	004	1	0	0.00	    $0.00	Y	
K	22210	INCIS 1 VERTEBRAL SEG CERV              	    28.15	 $1048.02	      ---	 $1321.64	004	1	0	0.00	    $0.00	Y	
K	22212	INCIS 1 VERTEBRAL SEG THORAC            	    27.77	 $1033.88	      ---	 $1303.80	004	1	0	0.00	    $0.00	Y	
O	22212	INCIS 1 VERTEBRAL SEG THORAC            	     5.55	  $206.63	      ---	  $260.57	004	1	0	0.00	    $0.00	Y	
O	22214	INCIS 1 VERTEBRAL SEG LUMBAR            	     5.22	  $194.34	      ---	  $245.08	004	1	0	0.00	    $0.00	Y	
K	22214	INCIS 1 VERTEBRAL SEG LUMBAR            	    26.08	  $970.96	      ---	 $1224.46	004	1	0	0.00	    $0.00	Y	
K	22216	INCIS ADDL SPINE SEGMENT                	     8.24	  $306.78	      ---	  $386.87	004	1	0	0.00	    $0.00	Y	
O	22216	INCIS ADDL SPINE SEGMENT                	     1.65	   $61.43	      ---	   $77.47	004	1	0	0.00	    $0.00	Y	
O	22220	OSTEOT DSC ANT 1 VRT SGM CRV            	     5.72	  $212.96	      ---	  $268.55	004	1	0	0.00	    $0.00	Y	
K	22220	OSTEOT DSC ANT 1 VRT SGM CRV            	    28.61	 $1065.15	      ---	 $1343.24	004	1	0	0.00	    $0.00	Y	
K	22222	OSTEOT DSC ANT 1VRT SGM THRC            	    25.65	  $954.95	      ---	 $1204.27	004	1	0	0.00	    $0.00	Y	
O	22222	OSTEOT DSC ANT 1VRT SGM THRC            	     5.13	  $190.99	      ---	  $240.85	004	1	0	0.00	    $0.00	Y	
O	22224	OSTEOT DSC ANT 1VRT SGM LMBR            	     5.45	  $202.90	      ---	  $255.88	004	1	0	0.00	    $0.00	Y	
K	22224	OSTEOT DSC ANT 1VRT SGM LMBR            	    27.22	 $1013.40	      ---	 $1277.98	004	1	0	0.00	    $0.00	Y	
K	22226	OSTEOT DSC ANT 1VRT SGM EA              	     8.18	  $304.54	      ---	  $384.05	004	1	0	0.00	    $0.00	Y	
O	22226	OSTEOT DSC ANT 1VRT SGM EA              	     1.64	   $61.06	      ---	   $77.00	004	1	0	0.00	    $0.00	Y	
O	22310	CLOSED TX VERT FX W/O MANJ              	     0.74	   $27.55	      ---	   $34.74	004	1	0	0.00	    $0.00	Y	
K	22310	CLOSED TX VERT FX W/O MANJ              	     3.68	  $137.01	      ---	  $172.78	004	1	0	0.00	    $0.00	Y	
K	22315	CLOSED TX VERT FX W/MANJ                	    10.69	  $397.99	      ---	  $501.90	004	1	0	0.00	    $0.00	Y	
O	22315	CLOSED TX VERT FX W/MANJ                	     2.14	   $79.67	      ---	  $100.47	004	1	0	0.00	    $0.00	Y	
O	22318	TREAT ODONTOID FX W/O GRAFT             	     5.25	  $195.46	      ---	  $246.49	004	1	0	0.00	    $0.00	Y	
K	22318	TREAT ODONTOID FX W/O GRAFT             	    26.23	  $976.54	      ---	 $1231.50	004	1	0	0.00	    $0.00	Y	
K	22319	TREAT ODONTOID FX W/GRAFT               	    29.66	 $1104.24	      ---	 $1392.54	004	1	0	0.00	    $0.00	Y	
O	22319	TREAT ODONTOID FX W/GRAFT               	     5.93	  $220.77	      ---	  $278.41	004	1	0	0.00	    $0.00	Y	
O	22325	TREAT SPINE FRACTURE                    	     3.90	  $145.20	      ---	  $183.11	004	1	0	0.00	    $0.00	Y	
K	22325	TREAT SPINE FRACTURE                    	    19.49	  $725.61	      ---	  $915.06	004	1	0	0.00	    $0.00	Y	
K	22326	TREAT NECK SPINE FRACTURE               	    27.18	 $1011.91	      ---	 $1276.10	004	1	0	0.00	    $0.00	Y	
O	22326	TREAT NECK SPINE FRACTURE               	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
O	22327	TREAT THORAX SPINE FRACTURE             	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
K	22327	TREAT THORAX SPINE FRACTURE             	    27.18	 $1011.91	      ---	 $1276.10	004	1	0	0.00	    $0.00	Y	
K	22328	TREAT EACH ADD SPINE FX                 	     6.31	  $234.92	      ---	  $296.25	004	1	0	0.00	    $0.00	Y	
O	22328	TREAT EACH ADD SPINE FX                 	     1.26	   $46.91	      ---	   $59.16	004	1	0	0.00	    $0.00	Y	
K	22505	MANIPULATION OF SPINE                   	     2.80	  $104.24	      ---	  $131.46	004	1	0	0.00	    $0.00	Y	
K	22510	PERQ CERVICOTHORACIC INJECT             	    10.58	  $393.89	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	22511	PERQ LUMBOSACRAL INJECTION              	     9.94	  $370.07	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	22512	VERTEBROPLASTY ADDL INJECT              	     4.88	  $181.68	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	22513	PERQ VERTEBRAL AUGMENTATION             	    12.54	  $466.86	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	22513	PERQ VERTEBRAL AUGMENTATION             	     2.50	   $93.08	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	22514	PERQ VERTEBRAL AUGMENTATION             	     2.34	   $87.12	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	22514	PERQ VERTEBRAL AUGMENTATION             	    11.70	  $435.59	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	22515	PERQ VERTEBRAL AUGMENTATION             	     5.24	  $195.09	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	22515	PERQ VERTEBRAL AUGMENTATION             	     1.04	   $38.72	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	22532	ARTHRD LAT XTRCVTRY TQ THRC             	     4.42	  $164.56	      ---	  $207.52	004	1	0	0.00	    $0.00	Y	
K	22532	ARTHRD LAT XTRCVTRY TQ THRC             	    22.12	  $823.53	      ---	 $1038.53	004	1	0	0.00	    $0.00	Y	
K	22533	ARTHRD LAT XTRCVTRY TQ LMBR             	    20.96	  $780.34	      ---	  $984.07	004	1	0	0.00	    $0.00	Y	
O	22533	ARTHRD LAT XTRCVTRY TQ LMBR             	     4.19	  $155.99	      ---	  $196.72	004	1	0	0.00	    $0.00	Y	
O	22534	ARTHRD LAT XTRCVTRY TQ EA AD            	     1.11	   $41.33	      ---	   $52.11	004	1	0	0.00	    $0.00	Y	
K	22534	ARTHRD LAT XTRCVTRY TQ EA AD            	     5.56	  $207.00	      ---	  $261.04	004	1	0	0.00	    $0.00	Y	
K	22548	ARTHRD ANT TORAL/XORAL C1-C2            	    36.75	 $1368.20	      ---	 $1725.41	004	1	0	0.00	    $0.00	Y	
O	22548	ARTHRD ANT TORAL/XORAL C1-C2            	     7.35	  $273.64	      ---	  $345.08	004	1	0	0.00	    $0.00	Y	
O	22551	ARTHRD ANT NTRBDY CERVICAL              	     7.64	  $284.44	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	22551	ARTHRD ANT NTRBDY CERVICAL              	    38.22	 $1422.93	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	22552	ARTHRD ANT NTRBD CERVICAL EA            	     8.83	  $328.74	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	22552	ARTHRD ANT NTRBD CERVICAL EA            	     1.77	   $65.90	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	22554	ARTHRD ANT NTRBD MIN DSC CRV            	     5.82	  $216.68	      ---	  $273.25	004	1	0	0.00	    $0.00	Y	
K	22554	ARTHRD ANT NTRBD MIN DSC CRV            	    29.10	 $1083.39	      ---	 $1366.25	004	1	0	0.00	    $0.00	Y	
K	22556	ARTHRD ANT NTRBD MIN DSC THC            	    34.50	 $1284.44	      ---	 $1619.78	004	1	0	0.00	    $0.00	Y	
O	22556	ARTHRD ANT NTRBD MIN DSC THC            	     6.90	  $256.89	      ---	  $323.96	004	1	0	0.00	    $0.00	Y	
O	22558	ARTHRD ANT NTRBD MIN DSC LUM            	     6.50	  $242.00	      ---	  $305.18	004	1	0	0.00	    $0.00	Y	
K	22558	ARTHRD ANT NTRBD MIN DSC LUM            	    32.49	 $1209.60	      ---	 $1525.41	004	1	0	0.00	    $0.00	Y	
K	22585	ARTHRD ANT NTRBD MIN DSC EA             	     7.60	  $282.95	      ---	  $356.82	004	1	0	0.00	    $0.00	Y	
O	22585	ARTHRD ANT NTRBD MIN DSC EA             	     1.52	   $56.59	      ---	   $71.36	004	1	0	0.00	    $0.00	Y	
O	22586	ARTHRD PRE-SAC NTRBDY L5-S1             	     6.57	  $244.60	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	22586	ARTHRD PRE-SAC NTRBDY L5-S1             	    32.88	 $1224.12	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	22590	ARTHRD PST TQ CRANIOCERVICAL            	    32.07	 $1193.97	      ---	 $1505.69	004	1	0	0.00	    $0.00	Y	
O	22590	ARTHRD PST TQ CRANIOCERVICAL            	     6.42	  $239.02	      ---	  $301.42	004	1	0	0.00	    $0.00	Y	
O	22595	ARTHRD PST TQ ATLAS-AXIS                	     6.05	  $225.24	      ---	  $284.05	004	1	0	0.00	    $0.00	Y	
K	22595	ARTHRD PST TQ ATLAS-AXIS                	    30.22	 $1125.09	      ---	 $1418.83	004	1	0	0.00	    $0.00	Y	
K	22600	ARTHRD PST TQ 1NTRSPC CRV               	    25.68	  $956.07	      ---	 $1205.68	004	1	0	0.00	    $0.00	Y	
O	22600	ARTHRD PST TQ 1NTRSPC CRV               	     5.14	  $191.36	      ---	  $241.32	004	1	0	0.00	    $0.00	Y	
O	22610	ARTHRD PST TQ 1NTRSPC THRC              	     5.07	  $188.76	      ---	       --	004	0	0	0.00	    $0.00	N	
K	22610	ARTHRD PST TQ 1NTRSPC THRC              	    25.35	  $943.78	      ---	       --	004	0	0	0.00	    $0.00	N	
K	22612	ARTHRD PST TQ 1NTRSPC LUMBAR            	    32.03	 $1192.48	      ---	       --	004	0	0	0.00	    $0.00	N	
O	22612	ARTHRD PST TQ 1NTRSPC LUMBAR            	     6.41	  $238.64	      ---	       --	004	0	0	0.00	    $0.00	N	
O	22614	ARTHRD PST TQ 1NTRSPC EA ADD            	     1.76	   $65.52	      ---	   $82.63	004	1	0	0.00	    $0.00	Y	
K	22614	ARTHRD PST TQ 1NTRSPC EA ADD            	     8.80	  $327.62	      ---	  $413.16	004	1	0	0.00	    $0.00	Y	
K	22630	ARTHRD PST TQ 1NTRSPC LUM               	    30.21	 $1124.72	      ---	 $1418.36	004	1	0	0.00	    $0.00	Y	
O	22630	ARTHRD PST TQ 1NTRSPC LUM               	     6.04	  $224.87	      ---	  $283.58	004	1	0	0.00	    $0.00	Y	
O	22632	ARTHRD PST TQ 1NTRSPC LM EA             	     1.43	   $53.24	      ---	   $67.14	004	1	0	0.00	    $0.00	Y	
K	22632	ARTHRD PST TQ 1NTRSPC LM EA             	     7.15	  $266.19	      ---	  $335.69	004	1	0	0.00	    $0.00	Y	
K	22633	ARTHRD CMBN 1NTRSPC LUMBAR              	    40.69	 $1514.89	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	22633	ARTHRD CMBN 1NTRSPC LUMBAR              	     8.14	  $303.05	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	22634	ARTHRD CMBN 1NTRSPC EA ADDL             	     2.16	   $80.42	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	22634	ARTHRD CMBN 1NTRSPC EA ADDL             	    10.81	  $402.46	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	22800	ARTHRD PST DFRM<6 VRT SGM               	    27.79	 $1034.62	      ---	 $1304.74	004	1	0	0.00	    $0.00	Y	
O	22800	ARTHRD PST DFRM<6 VRT SGM               	     5.55	  $206.63	      ---	  $260.57	004	1	0	0.00	    $0.00	Y	
O	22802	ARTHRD PST DFRM 7-12 VRT SGM            	     9.08	  $338.05	      ---	  $426.31	004	1	0	0.00	    $0.00	Y	
K	22802	ARTHRD PST DFRM 7-12 VRT SGM            	    45.39	 $1689.87	      ---	 $2131.06	004	1	0	0.00	    $0.00	Y	
K	22804	ARTHRD PST DFRM 13+ VRT SGM             	    49.30	 $1835.44	      ---	 $2314.64	004	1	0	0.00	    $0.00	Y	
O	22804	ARTHRD PST DFRM 13+ VRT SGM             	     9.86	  $367.09	      ---	  $462.93	004	1	0	0.00	    $0.00	Y	
O	22808	ARTHRD ANT DFRM 2-3 VRT SGM             	     6.76	  $251.67	      ---	  $317.38	004	1	0	0.00	    $0.00	Y	
K	22808	ARTHRD ANT DFRM 2-3 VRT SGM             	    33.80	 $1258.37	      ---	 $1586.91	004	1	0	0.00	    $0.00	Y	
K	22810	ARTHRD ANT DFRM 4-7 VRT SGM             	    36.70	 $1366.34	      ---	 $1723.07	004	1	0	0.00	    $0.00	Y	
O	22810	ARTHRD ANT DFRM 4-7 VRT SGM             	     7.34	  $273.27	      ---	  $344.61	004	1	0	0.00	    $0.00	Y	
O	22812	ARTHRD ANT DFRM 8+ VRT SGM              	     8.88	  $330.60	      ---	  $416.92	004	1	0	0.00	    $0.00	Y	
K	22812	ARTHRD ANT DFRM 8+ VRT SGM              	    44.40	 $1653.01	      ---	 $2084.58	004	1	0	0.00	    $0.00	Y	
K	22818	KYPHECTOMY 1-2 SEGMENTS                 	    46.20	 $1720.03	      ---	 $2169.09	004	1	0	0.00	    $0.00	Y	
O	22818	KYPHECTOMY 1-2 SEGMENTS                 	     9.24	  $344.01	      ---	  $433.82	004	1	0	0.00	    $0.00	Y	
O	22819	KYPHECTOMY 3 OR MORE                    	    10.36	  $385.70	      ---	  $486.40	004	1	0	0.00	    $0.00	Y	
K	22819	KYPHECTOMY 3 OR MORE                    	    51.81	 $1928.89	      ---	 $2432.48	004	1	0	0.00	    $0.00	Y	
K	22830	EXPLORATION OF SPINAL FUSION            	    17.96	  $668.65	      ---	  $843.22	004	1	0	0.00	    $0.00	Y	
O	22830	EXPLORATION OF SPINAL FUSION            	     3.59	  $133.66	      ---	  $168.55	004	1	0	0.00	    $0.00	Y	
O	22836	ANT THRC VRT BODY TETHRG <7             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	22836	ANT THRC VRT BODY TETHRG <7             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	22837	ANT THRC VRT BODY TETHRG 8+             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	22837	ANT THRC VRT BODY TETHRG 8+             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	22838	REV RPLC/RMV THRC VRT TETHRG            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	22838	REV RPLC/RMV THRC VRT TETHRG            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	22840	INSERT SPINE FIXATION DEVICE            	     9.88	  $367.83	      ---	  $463.87	004	1	0	0.00	    $0.00	Y	
O	22840	INSERT SPINE FIXATION DEVICE            	     1.98	   $73.72	      ---	   $92.96	004	1	0	0.00	    $0.00	Y	
O	22841	INSERT SPINE FIXATION DEVICE            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	22841	INSERT SPINE FIXATION DEVICE            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	22842	INSERT SPINE FIXATION DEVICE            	    11.01	  $409.90	      ---	  $516.92	004	1	0	0.00	    $0.00	Y	
O	22842	INSERT SPINE FIXATION DEVICE            	     2.20	   $81.91	      ---	  $103.29	004	1	0	0.00	    $0.00	Y	
O	22843	INSERT SPINE FIXATION DEVICE            	     2.75	  $102.38	      ---	  $129.11	004	1	0	0.00	    $0.00	Y	
K	22843	INSERT SPINE FIXATION DEVICE            	    13.74	  $511.54	      ---	  $645.09	004	1	0	0.00	    $0.00	Y	
K	22844	INSERT SPINE FIXATION DEVICE            	    16.79	  $625.09	      ---	  $788.29	004	1	0	0.00	    $0.00	Y	
O	22844	INSERT SPINE FIXATION DEVICE            	     3.35	  $124.72	      ---	  $157.28	004	1	0	0.00	    $0.00	Y	
O	22845	INSERT SPINE FIXATION DEVICE            	     1.93	   $71.85	      ---	   $90.61	004	1	0	0.00	    $0.00	Y	
K	22845	INSERT SPINE FIXATION DEVICE            	     9.61	  $357.78	      ---	  $451.19	004	1	0	0.00	    $0.00	Y	
K	22846	INSERT SPINE FIXATION DEVICE            	    12.69	  $472.45	      ---	  $595.80	004	1	0	0.00	    $0.00	Y	
O	22846	INSERT SPINE FIXATION DEVICE            	     2.54	   $94.56	      ---	  $119.25	004	1	0	0.00	    $0.00	Y	
O	22847	INSERT SPINE FIXATION DEVICE            	     2.82	  $104.99	      ---	  $132.40	004	1	0	0.00	    $0.00	Y	
K	22847	INSERT SPINE FIXATION DEVICE            	    14.09	  $524.57	      ---	  $661.53	004	1	0	0.00	    $0.00	Y	
K	22848	INSERT PELV FIXATION DEVICE             	     9.19	  $342.14	      ---	  $431.47	004	1	0	0.00	    $0.00	Y	
O	22848	INSERT PELV FIXATION DEVICE             	     1.83	   $68.13	      ---	   $85.92	004	1	0	0.00	    $0.00	Y	
O	22849	REINSERT SPINAL FIXATION                	     3.86	  $143.71	      ---	  $181.23	004	1	0	0.00	    $0.00	Y	
K	22849	REINSERT SPINAL FIXATION                	    19.30	  $718.54	      ---	  $906.14	004	1	0	0.00	    $0.00	Y	
K	22850	REMOVE SPINE FIXATION DEVICE            	    14.26	  $530.90	      ---	  $669.51	004	1	0	0.00	    $0.00	Y	
O	22850	REMOVE SPINE FIXATION DEVICE            	     2.85	  $106.11	      ---	  $133.81	004	1	0	0.00	    $0.00	Y	
O	22852	REMOVE SPINE FIXATION DEVICE            	     2.87	  $106.85	      ---	  $134.75	004	1	0	0.00	    $0.00	Y	
K	22852	REMOVE SPINE FIXATION DEVICE            	    14.35	  $534.25	      ---	  $673.73	004	1	0	0.00	    $0.00	Y	
K	22853	INSJ BIOMECHANICAL DEVICE               	     5.90	  $219.66	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	22853	INSJ BIOMECHANICAL DEVICE               	     1.18	   $43.93	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	22854	INSJ BIOMECHANICAL DEVICE               	     1.52	   $56.59	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	22854	INSJ BIOMECHANICAL DEVICE               	     7.63	  $284.06	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	22855	REMOVAL ANTERIOR INSTRMJ                	    12.92	  $481.01	      ---	  $606.59	004	1	0	0.00	    $0.00	Y	
O	22855	REMOVAL ANTERIOR INSTRMJ                	     2.58	   $96.05	      ---	  $121.13	004	1	0	0.00	    $0.00	Y	
O	22856	TOT DISC ARTHRP 1NTRSPC CRV             	     6.61	  $246.09	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	22856	TOT DISC ARTHRP 1NTRSPC CRV             	    33.07	 $1231.20	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	22857	TOT DISC ARTHRP 1NTRSPC LMBR            	    24.91	  $927.40	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	22857	TOT DISC ARTHRP 1NTRSPC LMBR            	     4.98	  $185.41	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	22858	TOT DISC ARTHRP 2ND LVL CRV             	     2.27	   $84.51	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	22858	TOT DISC ARTHRP 2ND LVL CRV             	    11.35	  $422.56	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	22859	INSJ BIOMECHANICAL DEVICE               	     7.63	  $284.06	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	22859	INSJ BIOMECHANICAL DEVICE               	     1.52	   $56.59	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	22860	TOT DISC ARTHRP 2NTRSPC LMBR            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	22860	TOT DISC ARTHRP 2NTRSPC LMBR            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	22861	REV RPLCM ARTHRP 1NTRSPC CRV            	    40.09	 $1492.55	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	22861	REV RPLCM ARTHRP 1NTRSPC CRV            	     8.02	  $298.58	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	22862	REV RPLCM RTHRP 1NTRSPC LMBR            	     6.14	  $228.59	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	22862	REV RPLCM RTHRP 1NTRSPC LMBR            	    30.71	 $1143.33	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	22864	RMVL TOT ARTHRP 1NTRSPC CRV             	    36.70	 $1366.34	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	22864	RMVL TOT ARTHRP 1NTRSPC CRV             	     7.34	  $273.27	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	22865	RMVL TOT ARTHRP 1NTRSPC LMBR            	     5.97	  $222.26	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	22865	RMVL TOT ARTHRP 1NTRSPC LMBR            	    29.85	 $1111.32	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	22867	INSJ STABLJ DEV W/DCMPRN                	    22.55	  $839.54	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	22868	INSJ STABLJ DEV W/DCMPRN                	     5.53	  $205.88	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	22868	INSJ STABLJ DEV W/DCMPRN                	     1.10	   $40.95	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	22869	INSJ STABLJ DEV W/O DCMPRN              	    12.58	  $468.35	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	22870	INSJ STABLJ DEV W/O DCMPRN              	     3.23	  $120.25	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	22870	INSJ STABLJ DEV W/O DCMPRN              	     0.64	   $23.83	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	22899	UNLISTED PROCEDURE SPINE                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	22899	UNLISTED PROCEDURE SPINE                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	22900	EXC ABDL TUM DEEP < 5 CM                	    10.85	  $403.95	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	22900	EXC ABDL TUM DEEP < 5 CM                	     2.17	   $80.79	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	22901	EXC ABDL TUM DEEP 5 CM/>                	     2.92	  $108.71	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	22901	EXC ABDL TUM DEEP 5 CM/>                	    14.59	  $543.19	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	22902	EXC ABD LES SC < 3 CM                   	     9.60	  $357.41	      ---	  $450.72	004	1	0	0.00	    $0.00	Y	
O	22902	EXC ABD LES SC < 3 CM                   	     1.92	   $71.48	      ---	   $90.14	004	1	0	0.00	    $0.00	Y	
O	22903	EXC ABD LES SC 3 CM/>                   	     1.95	   $72.60	      ---	   $91.55	004	1	0	0.00	    $0.00	Y	
K	22903	EXC ABD LES SC 3 CM/>                   	     9.73	  $362.25	      ---	  $456.82	004	1	0	0.00	    $0.00	Y	
K	22904	RADICAL RESECT ABD TUMOR<5CM            	    22.67	  $844.00	      ---	 $1064.36	004	1	0	0.00	    $0.00	Y	
O	22904	RADICAL RESECT ABD TUMOR<5CM            	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
O	22905	RAD RESECT ABD TUMOR 5 CM/>             	     5.88	  $218.91	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	22905	RAD RESECT ABD TUMOR 5 CM/>             	    29.41	 $1094.93	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	22999	UNLISTED PX ABDOMEN MUSCSKEL            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	22999	UNLISTED PX ABDOMEN MUSCSKEL            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	23000	REMOVAL OF CALCIUM DEPOSITS             	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
K	23000	REMOVAL OF CALCIUM DEPOSITS             	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
K	23020	RELEASE SHOULDER JOINT                  	    12.46	  $463.89	      ---	  $585.00	004	1	0	0.00	    $0.00	Y	
O	23020	RELEASE SHOULDER JOINT                  	     2.49	   $92.70	      ---	  $116.91	004	1	0	0.00	    $0.00	Y	
O	23030	DRAIN SHOULDER LESION                   	     1.51	   $56.22	      ---	   $70.89	004	1	0	0.00	    $0.00	Y	
K	23030	DRAIN SHOULDER LESION                   	     7.54	  $280.71	      ---	  $354.00	004	1	0	0.00	    $0.00	Y	
K	23031	DRAIN SHOULDER BURSA                    	     3.72	  $138.50	      ---	  $174.65	004	1	0	0.00	    $0.00	Y	
K	23035	DRAIN SHOULDER BONE LESION              	    20.48	  $762.47	      ---	  $961.54	004	1	0	0.00	    $0.00	Y	
O	23035	DRAIN SHOULDER BONE LESION              	     4.10	  $152.64	      ---	  $192.50	004	1	0	0.00	    $0.00	Y	
O	23040	EXPLORATORY SHOULDER SURGERY            	     2.49	   $92.70	      ---	  $116.91	004	1	0	0.00	    $0.00	Y	
K	23040	EXPLORATORY SHOULDER SURGERY            	    12.46	  $463.89	      ---	  $585.00	004	1	0	0.00	    $0.00	Y	
K	23044	EXPLORATORY SHOULDER SURGERY            	    12.46	  $463.89	      ---	  $585.00	004	1	0	0.00	    $0.00	Y	
O	23044	EXPLORATORY SHOULDER SURGERY            	     2.49	   $92.70	      ---	  $116.91	004	1	0	0.00	    $0.00	Y	
K	23065	BIOPSY SHOULDER TISSUES                 	     2.26	   $84.14	      ---	  $106.11	004	1	0	0.00	    $0.00	Y	
K	23066	BIOPSY SHOULDER TISSUES                 	     5.01	  $186.52	      ---	  $235.22	004	1	0	0.00	    $0.00	Y	
O	23066	BIOPSY SHOULDER TISSUES                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	23071	EXC SHOULDER LES SC 3 CM/>              	     1.85	   $68.88	      ---	   $86.86	004	1	0	0.00	    $0.00	Y	
K	23071	EXC SHOULDER LES SC 3 CM/>              	     9.25	  $344.38	      ---	  $434.29	004	1	0	0.00	    $0.00	Y	
K	23073	EXC SHOULDER TUM DEEP 5 CM/>            	    15.27	  $568.50	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	23073	EXC SHOULDER TUM DEEP 5 CM/>            	     3.05	  $113.55	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	23075	EXC SHOULDER LES SC < 3 CM              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	23075	EXC SHOULDER LES SC < 3 CM              	     3.25	  $121.00	      ---	  $152.59	004	1	0	0.00	    $0.00	Y	
K	23076	EXC SHOULDER TUM DEEP < 5 CM            	    13.13	  $488.83	      ---	  $616.45	004	1	0	0.00	    $0.00	Y	
O	23076	EXC SHOULDER TUM DEEP < 5 CM            	     2.63	   $97.91	      ---	  $123.48	004	1	0	0.00	    $0.00	Y	
O	23077	RESECT SHOULDER TUMOR < 5 CM            	     5.03	  $187.27	      ---	  $236.16	004	1	0	0.00	    $0.00	Y	
K	23077	RESECT SHOULDER TUMOR < 5 CM            	    25.16	  $936.71	      ---	 $1181.26	004	1	0	0.00	    $0.00	Y	
K	23078	RESECT SHOULDER TUMOR 5 CM/>            	    30.59	 $1138.87	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	23078	RESECT SHOULDER TUMOR 5 CM/>            	     6.12	  $227.85	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	23100	BIOPSY OF SHOULDER JOINT                	     2.40	   $89.35	      ---	  $112.68	004	1	0	0.00	    $0.00	Y	
K	23100	BIOPSY OF SHOULDER JOINT                	    11.99	  $446.39	      ---	  $562.93	004	1	0	0.00	    $0.00	Y	
K	23101	SHOULDER JOINT SURGERY                  	    11.60	  $431.87	      ---	  $544.62	004	1	0	0.00	    $0.00	Y	
O	23101	SHOULDER JOINT SURGERY                  	     2.32	   $86.37	      ---	  $108.92	004	1	0	0.00	    $0.00	Y	
O	23105	REMOVE SHOULDER JOINT LINING            	     3.30	  $122.86	      ---	  $154.94	004	1	0	0.00	    $0.00	Y	
K	23105	REMOVE SHOULDER JOINT LINING            	    16.60	  $618.02	      ---	  $779.37	004	1	0	0.00	    $0.00	Y	
K	23106	INCISION OF COLLARBONE JOINT            	    16.60	  $618.02	      ---	  $779.37	004	1	0	0.00	    $0.00	Y	
O	23106	INCISION OF COLLARBONE JOINT            	     3.32	  $123.60	      ---	  $155.87	004	1	0	0.00	    $0.00	Y	
O	23107	EXPLORE TREAT SHOULDER JOINT            	     2.49	   $92.70	      ---	  $116.91	004	1	0	0.00	    $0.00	Y	
K	23107	EXPLORE TREAT SHOULDER JOINT            	    12.46	  $463.89	      ---	  $585.00	004	1	0	0.00	    $0.00	Y	
K	23120	CLAVICULECTOMY PARTIAL                  	     9.63	  $358.52	      ---	  $452.13	004	1	0	0.00	    $0.00	Y	
O	23120	CLAVICULECTOMY PARTIAL                  	     1.93	   $71.85	      ---	   $90.61	004	1	0	0.00	    $0.00	Y	
O	23125	CLAVICULECTOMY TOTAL                    	     3.32	  $123.60	      ---	  $155.87	004	1	0	0.00	    $0.00	Y	
K	23125	CLAVICULECTOMY TOTAL                    	    16.62	  $618.76	      ---	  $780.31	004	1	0	0.00	    $0.00	Y	
K	23130	ACROMP/ACROMIONECTOMY PRTL              	     9.63	  $358.52	      ---	  $452.13	004	1	0	0.00	    $0.00	Y	
O	23130	ACROMP/ACROMIONECTOMY PRTL              	     1.93	   $71.85	      ---	   $90.61	004	1	0	0.00	    $0.00	Y	
O	23140	REMOVAL OF BONE LESION                  	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
K	23140	REMOVAL OF BONE LESION                  	     6.82	  $253.91	      ---	  $320.20	004	1	0	0.00	    $0.00	Y	
K	23145	REMOVAL OF BONE LESION                  	    10.19	  $379.37	      ---	  $478.42	004	1	0	0.00	    $0.00	Y	
O	23145	REMOVAL OF BONE LESION                  	     2.04	   $75.95	      ---	   $95.78	004	1	0	0.00	    $0.00	Y	
O	23146	REMOVAL OF BONE LESION                  	     2.04	   $75.95	      ---	   $95.78	004	1	0	0.00	    $0.00	Y	
K	23146	REMOVAL OF BONE LESION                  	    10.19	  $379.37	      ---	  $478.42	004	1	0	0.00	    $0.00	Y	
K	23150	REMOVAL OF HUMERUS LESION               	    10.76	  $400.59	      ---	  $505.18	004	1	0	0.00	    $0.00	Y	
O	23150	REMOVAL OF HUMERUS LESION               	     2.15	   $80.04	      ---	  $100.94	004	1	0	0.00	    $0.00	Y	
O	23155	REMOVAL OF HUMERUS LESION               	     2.83	  $105.36	      ---	  $132.87	004	1	0	0.00	    $0.00	Y	
K	23155	REMOVAL OF HUMERUS LESION               	    14.16	  $527.18	      ---	  $664.81	004	1	0	0.00	    $0.00	Y	
K	23156	REMOVAL OF HUMERUS LESION               	    14.16	  $527.18	      ---	  $664.81	004	1	0	0.00	    $0.00	Y	
O	23156	REMOVAL OF HUMERUS LESION               	     2.83	  $105.36	      ---	  $132.87	004	1	0	0.00	    $0.00	Y	
O	23170	REMOVE COLLAR BONE LESION               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	23170	REMOVE COLLAR BONE LESION               	     7.53	  $280.34	      ---	  $353.53	004	1	0	0.00	    $0.00	Y	
K	23172	REMOVE SHOULDER BLADE LESION            	     7.18	  $267.31	      ---	  $337.10	004	1	0	0.00	    $0.00	Y	
O	23172	REMOVE SHOULDER BLADE LESION            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	23174	REMOVE HUMERUS LESION                   	     3.28	  $122.11	      ---	  $154.00	004	1	0	0.00	    $0.00	Y	
K	23174	REMOVE HUMERUS LESION                   	    16.31	  $607.22	      ---	  $765.75	004	1	0	0.00	    $0.00	Y	
K	23180	REMOVE COLLAR BONE LESION               	    10.43	  $388.31	      ---	  $489.69	004	1	0	0.00	    $0.00	Y	
O	23180	REMOVE COLLAR BONE LESION               	     2.09	   $77.81	      ---	   $98.13	004	1	0	0.00	    $0.00	Y	
O	23182	REMOVE SHOULDER BLADE LESION            	     2.22	   $82.65	      ---	  $104.23	004	1	0	0.00	    $0.00	Y	
K	23182	REMOVE SHOULDER BLADE LESION            	    11.09	  $412.88	      ---	  $520.68	004	1	0	0.00	    $0.00	Y	
K	23184	REMOVE HUMERUS LESION                   	    10.89	  $405.43	      ---	  $511.29	004	1	0	0.00	    $0.00	Y	
O	23184	REMOVE HUMERUS LESION                   	     2.18	   $81.16	      ---	  $102.35	004	1	0	0.00	    $0.00	Y	
O	23190	PARTIAL REMOVAL OF SCAPULA              	     1.59	   $59.20	      ---	   $74.65	004	1	0	0.00	    $0.00	Y	
K	23190	PARTIAL REMOVAL OF SCAPULA              	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
K	23195	REMOVAL OF HEAD OF HUMERUS              	    17.21	  $640.73	      ---	  $808.01	004	1	0	0.00	    $0.00	Y	
O	23195	REMOVAL OF HEAD OF HUMERUS              	     3.44	  $128.07	      ---	  $161.51	004	1	0	0.00	    $0.00	Y	
O	23200	RESECT CLAVICLE TUMOR                   	     4.47	  $166.42	      ---	  $209.87	004	1	0	0.00	    $0.00	Y	
K	23200	RESECT CLAVICLE TUMOR                   	    22.38	  $833.21	      ---	 $1050.74	004	1	0	0.00	    $0.00	Y	
K	23210	RESECT SCAPULA TUMOR                    	    22.22	  $827.25	      ---	 $1043.23	004	1	0	0.00	    $0.00	Y	
O	23210	RESECT SCAPULA TUMOR                    	     4.44	  $165.30	      ---	  $208.46	004	1	0	0.00	    $0.00	Y	
O	23220	RESECT PROX HUMERUS TUMOR               	     5.10	  $189.87	      ---	  $239.45	004	1	0	0.00	    $0.00	Y	
K	23220	RESECT PROX HUMERUS TUMOR               	    25.48	  $948.62	      ---	 $1196.29	004	1	0	0.00	    $0.00	Y	
K	23330	REMOVE SHOULDER FOREIGN BODY            	     3.00	  $111.69	      ---	  $140.85	004	1	0	0.00	    $0.00	Y	
K	23333	REMOVE SHOULDER FB DEEP                 	    10.58	  $393.89	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	23333	REMOVE SHOULDER FB DEEP                 	     2.12	   $78.93	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	23334	SHOULDER PROSTHESIS REMOVAL             	     4.95	  $184.29	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	23334	SHOULDER PROSTHESIS REMOVAL             	    24.77	  $922.19	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	23335	SHOULDER PROSTHESIS REMOVAL             	    29.46	 $1096.80	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	23335	SHOULDER PROSTHESIS REMOVAL             	     5.89	  $219.28	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	23350	INJECTION FOR SHOULDER X-RAY            	     4.63	  $172.37	      ---	  $217.38	004	1	1	0.00	    $0.00	Y	
K	23395	MUSCLE TRANSFER SHOULDER/ARM            	    25.37	  $944.53	      ---	 $1191.12	004	1	0	0.00	    $0.00	Y	
O	23395	MUSCLE TRANSFER SHOULDER/ARM            	     5.10	  $189.87	      ---	  $239.45	004	1	0	0.00	    $0.00	Y	
O	23397	MUSCLE TRANSFERS                        	     5.15	  $191.73	      ---	  $241.79	004	1	0	0.00	    $0.00	Y	
K	23397	MUSCLE TRANSFERS                        	    25.73	  $957.93	      ---	 $1208.02	004	1	0	0.00	    $0.00	Y	
K	23400	FIXATION OF SHOULDER BLADE              	    24.18	  $900.22	      ---	 $1135.25	004	1	0	0.00	    $0.00	Y	
O	23400	FIXATION OF SHOULDER BLADE              	     4.84	  $180.19	      ---	  $227.24	004	1	0	0.00	    $0.00	Y	
O	23405	INCISION OF TENDON & MUSCLE             	     1.72	   $64.04	      ---	   $80.75	004	1	0	0.00	    $0.00	Y	
K	23405	INCISION OF TENDON & MUSCLE             	     8.61	  $320.55	      ---	  $404.24	004	1	0	0.00	    $0.00	Y	
K	23406	INCISE TENDON(S) & MUSCLE(S)            	    10.05	  $374.16	      ---	  $471.85	004	1	0	0.00	    $0.00	Y	
O	23406	INCISE TENDON(S) & MUSCLE(S)            	     2.01	   $74.83	      ---	   $94.37	004	1	0	0.00	    $0.00	Y	
O	23410	REPAIR ROTATOR CUFF ACUTE               	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
K	23410	REPAIR ROTATOR CUFF ACUTE               	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
K	23412	REPAIR ROTATOR CUFF CHRONIC             	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
O	23412	REPAIR ROTATOR CUFF CHRONIC             	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
O	23415	RELEASE OF SHOULDER LIGAMENT            	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
K	23415	RELEASE OF SHOULDER LIGAMENT            	     9.04	  $336.56	      ---	  $424.43	004	1	0	0.00	    $0.00	Y	
K	23420	REPAIR OF SHOULDER                      	    20.39	  $759.12	      ---	  $957.31	004	1	0	0.00	    $0.00	Y	
O	23420	REPAIR OF SHOULDER                      	     4.08	  $151.90	      ---	  $191.56	004	1	0	0.00	    $0.00	Y	
O	23430	REPAIR BICEPS TENDON                    	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	23430	REPAIR BICEPS TENDON                    	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	23440	REMOVE/TRANSPLANT TENDON                	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	23440	REMOVE/TRANSPLANT TENDON                	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
O	23450	REPAIR SHOULDER CAPSULE                 	     3.85	  $143.34	      ---	  $180.76	004	1	0	0.00	    $0.00	Y	
K	23450	REPAIR SHOULDER CAPSULE                 	    19.25	  $716.68	      ---	  $903.79	004	1	0	0.00	    $0.00	Y	
K	23455	REPAIR SHOULDER CAPSULE                 	    21.52	  $801.19	      ---	 $1010.36	004	1	0	0.00	    $0.00	Y	
O	23455	REPAIR SHOULDER CAPSULE                 	     4.30	  $160.09	      ---	  $201.89	004	1	0	0.00	    $0.00	Y	
O	23460	REPAIR SHOULDER CAPSULE                 	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	23460	REPAIR SHOULDER CAPSULE                 	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
K	23462	REPAIR SHOULDER CAPSULE                 	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
O	23462	REPAIR SHOULDER CAPSULE                 	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
O	23465	REPAIR SHOULDER CAPSULE                 	     3.85	  $143.34	      ---	  $180.76	004	1	0	0.00	    $0.00	Y	
K	23465	REPAIR SHOULDER CAPSULE                 	    19.25	  $716.68	      ---	  $903.79	004	1	0	0.00	    $0.00	Y	
K	23466	REPAIR SHOULDER CAPSULE                 	    23.37	  $870.07	      ---	 $1097.22	004	1	0	0.00	    $0.00	Y	
O	23466	REPAIR SHOULDER CAPSULE                 	     4.67	  $173.86	      ---	  $219.26	004	1	0	0.00	    $0.00	Y	
O	23470	RECONSTRUCT SHOULDER JOINT              	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	23470	RECONSTRUCT SHOULDER JOINT              	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
K	23472	RECONSTRUCT SHOULDER JOINT              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	23472	RECONSTRUCT SHOULDER JOINT              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	23473	REVIS RECONST SHOULDER JOINT            	     7.28	  $271.03	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	23473	REVIS RECONST SHOULDER JOINT            	    36.43	 $1356.29	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	23474	REVIS RECONST SHOULDER JOINT            	    39.31	 $1463.51	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	23474	REVIS RECONST SHOULDER JOINT            	     7.86	  $292.63	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	23480	REVISION OF COLLAR BONE                 	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	23480	REVISION OF COLLAR BONE                 	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	23485	REVISION OF COLLAR BONE                 	    14.72	  $548.03	      ---	  $691.10	004	1	0	0.00	    $0.00	Y	
O	23485	REVISION OF COLLAR BONE                 	     2.94	  $109.46	      ---	  $138.03	004	1	0	0.00	    $0.00	Y	
O	23490	REINFORCE CLAVICLE                      	     4.16	  $154.88	      ---	  $195.31	004	1	0	0.00	    $0.00	Y	
K	23490	REINFORCE CLAVICLE                      	    20.81	  $774.76	      ---	  $977.03	004	1	0	0.00	    $0.00	Y	
K	23491	REINFORCE SHOULDER BONES                	    24.61	  $916.23	      ---	 $1155.44	004	1	0	0.00	    $0.00	Y	
O	23491	REINFORCE SHOULDER BONES                	     4.92	  $183.17	      ---	  $230.99	004	1	0	0.00	    $0.00	Y	
O	23500	CLTX CLAVICULAR FX W/O MNPJ             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	23500	CLTX CLAVICULAR FX W/O MNPJ             	    92.93	   $92.93	      ---	       --	042	0	1	0.00	    $0.00	Y	
K	23505	CLTX CLAVICULAR FX W/MNPJ               	     4.06	  $151.15	      ---	  $190.62	004	1	1	0.00	    $0.00	Y	
O	23505	CLTX CLAVICULAR FX W/MNPJ               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	23515	OPTX CLAVICULAR FX W/INT FIX            	     2.04	   $75.95	      ---	   $95.78	004	1	0	0.00	    $0.00	Y	
K	23515	OPTX CLAVICULAR FX W/INT FIX            	    10.19	  $379.37	      ---	  $478.42	004	1	0	0.00	    $0.00	Y	
K	23520	CLTX STRNCLAV DISLC W/O MNPJ            	     4.80	  $178.70	      ---	  $225.36	004	1	1	0.00	    $0.00	Y	
O	23520	CLTX STRNCLAV DISLC W/O MNPJ            	     0.96	   $35.74	      ---	   $45.07	004	1	0	0.00	    $0.00	Y	
O	23525	CLTX STRNCLAV DISLC W/MNPJ              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	23525	CLTX STRNCLAV DISLC W/MNPJ              	     3.83	  $142.59	      ---	  $179.82	004	1	1	0.00	    $0.00	Y	
K	23530	OPTX STRNCLAV DISLC AQT/CHRN            	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	23530	OPTX STRNCLAV DISLC AQT/CHRN            	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	23532	OPTX STRCLV DSLC AQ/CHRN GRF            	     2.61	   $97.17	      ---	  $122.54	004	1	0	0.00	    $0.00	Y	
K	23532	OPTX STRCLV DSLC AQ/CHRN GRF            	    13.15	  $489.57	      ---	  $617.39	004	1	0	0.00	    $0.00	Y	
K	23540	CLTX ACROMCLAV DISLC WO MNPJ            	     5.16	  $192.11	      ---	  $242.26	004	1	0	0.00	    $0.00	Y	
K	23545	CLTX ACROMCLAV DISLC W/MNPJ             	     3.54	  $131.79	      ---	  $166.20	004	1	0	0.00	    $0.00	Y	
K	23550	OPTX ACROMCLV DISLC AQT/CHRN            	    12.84	  $478.03	      ---	  $602.84	004	1	0	0.00	    $0.00	Y	
O	23550	OPTX ACROMCLV DISLC AQT/CHRN            	     2.57	   $95.68	      ---	  $120.66	004	1	0	0.00	    $0.00	Y	
O	23552	OPTX ACRCLV DSLC AQ/CHRN GRF            	     2.90	  $107.97	      ---	  $136.16	004	1	0	0.00	    $0.00	Y	
K	23552	OPTX ACRCLV DSLC AQ/CHRN GRF            	    14.40	  $536.11	      ---	  $676.08	004	1	0	0.00	    $0.00	Y	
K	23570	CLTX SCAPULAR FX W/O MNPJ               	    95.79	   $95.79	      ---	       --	042	0	1	0.00	    $0.00	Y	
O	23570	CLTX SCAPULAR FX W/O MNPJ               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	23575	CLTX SCAP FX W/MNPJ +-TRACTJ            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	23575	CLTX SCAP FX W/MNPJ +-TRACTJ            	     4.36	  $162.32	      ---	  $204.70	004	1	0	0.00	    $0.00	Y	
K	23585	OPTX SCAPULAR FX W/INT FIXJ             	    13.59	  $505.96	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	23585	OPTX SCAPULAR FX W/INT FIXJ             	     2.72	  $101.27	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	23600	CLTX PROX HUMRL FX W/O MNPJ             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	23600	CLTX PROX HUMRL FX W/O MNPJ             	   137.73	  $137.73	      ---	       --	042	0	1	0.00	    $0.00	Y	
K	23605	CLTX PRX HMRL FX MNPJ+-TRACT            	     5.80	  $215.93	      ---	  $272.31	004	1	0	0.00	    $0.00	Y	
O	23605	CLTX PRX HMRL FX MNPJ+-TRACT            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	23615	OPTX PROX HUMRL FX W/INT FIX            	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	23615	OPTX PROX HUMRL FX W/INT FIX            	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	23616	OPTX PRX HMRL FX FIX RPR RPL            	    31.52	 $1173.49	      ---	 $1479.86	004	1	0	0.00	    $0.00	Y	
O	23616	OPTX PRX HMRL FX FIX RPR RPL            	     6.31	  $234.92	      ---	  $296.25	004	1	0	0.00	    $0.00	Y	
O	23620	CLTX GR HMRL TBRS FX WO MNPJ            	     1.23	   $45.79	      ---	   $57.75	004	1	0	0.00	    $0.00	Y	
K	23620	CLTX GR HMRL TBRS FX WO MNPJ            	     6.16	  $229.34	      ---	  $289.21	004	1	1	0.00	    $0.00	Y	
K	23625	CLTX GR HMRL TBRS FX W/MNPJ             	     5.66	  $210.72	      ---	  $265.74	004	1	0	0.00	    $0.00	Y	
O	23625	CLTX GR HMRL TBRS FX W/MNPJ             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	23630	OPTX GR HMRL TBRS FX INT FIX            	     2.60	   $96.80	      ---	  $122.07	004	1	0	0.00	    $0.00	Y	
K	23630	OPTX GR HMRL TBRS FX INT FIX            	    13.02	  $484.73	      ---	  $611.29	004	1	0	0.00	    $0.00	Y	
K	23650	CLTX SHO DSLC W/MNPJ WO ANES            	   140.27	  $140.27	      ---	       --	042	0	1	0.00	    $0.00	Y	
O	23650	CLTX SHO DSLC W/MNPJ WO ANES            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	23655	CLTX SHO DSLC W/MNPJ W/ANES             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	23655	CLTX SHO DSLC W/MNPJ W/ANES             	     3.94	  $146.69	      ---	  $184.98	004	1	0	0.00	    $0.00	Y	
K	23660	OPTX ACUTE SHOULDER DISLC               	    12.84	  $478.03	      ---	  $602.84	004	1	0	0.00	    $0.00	Y	
O	23660	OPTX ACUTE SHOULDER DISLC               	     2.57	   $95.68	      ---	  $120.66	004	1	0	0.00	    $0.00	Y	
O	23665	CLTX SHO DSLC FX GR HMRL TBR            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	23665	CLTX SHO DSLC FX GR HMRL TBR            	     5.23	  $194.71	      ---	  $245.55	004	1	0	0.00	    $0.00	Y	
K	23670	OPTX SHO DISLC FX                       	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	23670	OPTX SHO DISLC FX                       	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
O	23675	CLTX SHO DISLC NECK FX MNPJ             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	23675	CLTX SHO DISLC NECK FX MNPJ             	     6.39	  $237.90	      ---	  $300.01	004	1	0	0.00	    $0.00	Y	
K	23680	OPTX SHO DISLC NECK FX FIXJ             	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
O	23680	OPTX SHO DISLC NECK FX FIXJ             	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
O	23700	MNPJ ANES SHO JT FIXJ APRATS            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	23700	MNPJ ANES SHO JT FIXJ APRATS            	     2.59	   $96.43	      ---	  $121.60	004	1	0	0.00	    $0.00	Y	
K	23800	ARTHRODESIS GLENOHUMERAL JT             	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
O	23800	ARTHRODESIS GLENOHUMERAL JT             	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
O	23802	ARTHRD GLENOHUMERAL JT W/GRF            	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	23802	ARTHRD GLENOHUMERAL JT W/GRF            	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
K	23900	INTERTHORACOSCPLR AMPUTATION            	    27.18	 $1011.91	      ---	 $1276.10	004	1	0	0.00	    $0.00	Y	
O	23900	INTERTHORACOSCPLR AMPUTATION            	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
O	23920	DISARTICULATION SHOULDER                	     4.08	  $151.90	      ---	  $191.56	004	1	0	0.00	    $0.00	Y	
K	23920	DISARTICULATION SHOULDER                	    20.39	  $759.12	      ---	  $957.31	004	1	0	0.00	    $0.00	Y	
K	23921	DISARTICULATION SHO SEC CLSR            	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	23921	DISARTICULATION SHO SEC CLSR            	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
O	23929	UNLISTED PROCEDURE SHOULDER             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	23929	UNLISTED PROCEDURE SHOULDER             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	23930	I&D UPR A/E DP ABSC/HMTMA               	     4.36	  $162.32	      ---	  $204.70	004	1	0	0.00	    $0.00	Y	
O	23930	I&D UPR A/E DP ABSC/HMTMA               	     0.87	   $32.39	      ---	   $40.85	004	1	0	0.00	    $0.00	Y	
K	23931	I&D UPR A/E BURSA                       	     3.06	  $113.92	      ---	  $143.67	004	1	0	0.00	    $0.00	Y	
K	23935	INC DP OPN B1 CRTX HUM/ELBW             	    14.56	  $542.07	      ---	  $683.59	004	1	0	0.00	    $0.00	Y	
O	23935	INC DP OPN B1 CRTX HUM/ELBW             	     2.91	  $108.34	      ---	  $136.62	004	1	0	0.00	    $0.00	Y	
O	24000	ARTHRT ELBW EXPL DRG/RMVL FB            	     2.00	   $74.46	      ---	   $93.90	004	1	0	0.00	    $0.00	Y	
K	24000	ARTHRT ELBW EXPL DRG/RMVL FB            	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
K	24006	ARTHRT ELBW CAPSL EXC RLS               	    10.86	  $404.32	      ---	  $509.88	004	1	0	0.00	    $0.00	Y	
O	24006	ARTHRT ELBW CAPSL EXC RLS               	     2.17	   $80.79	      ---	  $101.88	004	1	0	0.00	    $0.00	Y	
K	24065	BIOPSY ARM/ELBOW SOFT TISSUE            	     3.27	  $121.74	      ---	  $153.53	004	1	0	0.00	    $0.00	Y	
K	24066	BIOPSY ARM/ELBOW SOFT TISSUE            	     5.91	  $220.03	      ---	  $277.47	004	1	0	0.00	    $0.00	Y	
O	24066	BIOPSY ARM/ELBOW SOFT TISSUE            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	24071	EXC ARM/ELBOW LES SC 3 CM/>             	     1.80	   $67.01	      ---	   $84.51	004	1	0	0.00	    $0.00	Y	
K	24071	EXC ARM/ELBOW LES SC 3 CM/>             	     8.99	  $334.70	      ---	  $422.08	004	1	0	0.00	    $0.00	Y	
K	24073	EX ARM/ELBOW TUM DEEP 5 CM/>            	    15.37	  $572.23	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	24073	EX ARM/ELBOW TUM DEEP 5 CM/>            	     3.07	  $114.30	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	24075	EXC ARM/ELBOW LES SC < 3 CM             	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
K	24075	EXC ARM/ELBOW LES SC < 3 CM             	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
K	24076	EX ARM/ELBOW TUM DEEP < 5 CM            	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	24076	EX ARM/ELBOW TUM DEEP < 5 CM            	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
O	24077	RAD RESCJ TUM TISS A/E <5CM             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	24077	RAD RESCJ TUM TISS A/E <5CM             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	24079	RAD RESCJ TUM TISS A/E 5 CM+            	    28.24	 $1051.38	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	24079	RAD RESCJ TUM TISS A/E 5 CM+            	     5.65	  $210.35	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	24100	ARTHRT ELBW SYNOVIAL BX ONLY            	     2.00	   $74.46	      ---	   $93.90	004	1	0	0.00	    $0.00	Y	
K	24100	ARTHRT ELBW SYNOVIAL BX ONLY            	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
K	24101	ARTHRT ELBW JT EXPL BX RMVL             	    10.77	  $400.97	      ---	  $505.65	004	1	0	0.00	    $0.00	Y	
O	24101	ARTHRT ELBW JT EXPL BX RMVL             	     2.15	   $80.04	      ---	  $100.94	004	1	0	0.00	    $0.00	Y	
O	24102	ARTHRT ELBOW W/SYNOVECTOMY              	     2.80	  $104.24	      ---	  $131.46	004	1	0	0.00	    $0.00	Y	
K	24102	ARTHRT ELBOW W/SYNOVECTOMY              	    14.00	  $521.22	      ---	  $657.30	004	1	0	0.00	    $0.00	Y	
K	24105	EXCISION OLECRANON BURSA                	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
O	24105	EXCISION OLECRANON BURSA                	     1.09	   $40.58	      ---	   $51.18	004	1	0	0.00	    $0.00	Y	
O	24110	EXC/CURTG B1 CST/B9 TUM HUM             	     2.15	   $80.04	      ---	  $100.94	004	1	0	0.00	    $0.00	Y	
K	24110	EXC/CURTG B1 CST/B9 TUM HUM             	    10.76	  $400.59	      ---	  $505.18	004	1	0	0.00	    $0.00	Y	
K	24115	EXC/CRTG B1 CST/TUM HUM AGRF            	    14.16	  $527.18	      ---	  $664.81	004	1	0	0.00	    $0.00	Y	
O	24115	EXC/CRTG B1 CST/TUM HUM AGRF            	     2.83	  $105.36	      ---	  $132.87	004	1	0	0.00	    $0.00	Y	
O	24116	EXC/CRTG B1 CST/TUM HUM ALGR            	     2.83	  $105.36	      ---	  $132.87	004	1	0	0.00	    $0.00	Y	
K	24116	EXC/CRTG B1 CST/TUM HUM ALGR            	    14.16	  $527.18	      ---	  $664.81	004	1	0	0.00	    $0.00	Y	
K	24120	EXC/CRTG B1 CST/B9 TUM RDS              	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	24120	EXC/CRTG B1 CST/B9 TUM RDS              	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
O	24125	EXC/CRTG B1 CST/TUM RDS AGRF            	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	24125	EXC/CRTG B1 CST/TUM RDS AGRF            	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	24126	EXC/CRTG B1 CST/TUM RDS ALGR            	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	24126	EXC/CRTG B1 CST/TUM RDS ALGR            	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	24130	EXCISION RADIAL HEAD                    	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
K	24130	EXCISION RADIAL HEAD                    	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
K	24134	SEQUESTRECTOMY SHFT/DSTL HUM            	    20.91	  $778.48	      ---	  $981.72	004	1	0	0.00	    $0.00	Y	
O	24134	SEQUESTRECTOMY SHFT/DSTL HUM            	     4.18	  $155.62	      ---	  $196.25	004	1	0	0.00	    $0.00	Y	
O	24136	SEQUESTRECTOMY RADIAL H/N               	     2.59	   $96.43	      ---	  $121.60	004	1	0	0.00	    $0.00	Y	
K	24136	SEQUESTRECTOMY RADIAL H/N               	    12.93	  $481.38	      ---	  $607.06	004	1	0	0.00	    $0.00	Y	
K	24138	SEQUESTRECTOMY OLECRN PROCES            	    14.15	  $526.80	      ---	  $664.34	004	1	0	0.00	    $0.00	Y	
O	24138	SEQUESTRECTOMY OLECRN PROCES            	     2.83	  $105.36	      ---	  $132.87	004	1	0	0.00	    $0.00	Y	
O	24140	PARTIAL EXC BONE HUMERUS                	     2.21	   $82.28	      ---	  $103.76	004	1	0	0.00	    $0.00	Y	
K	24140	PARTIAL EXC BONE HUMERUS                	    11.04	  $411.02	      ---	  $518.33	004	1	0	0.00	    $0.00	Y	
K	24145	PRTL EXC BONE RADIAL H/N                	     8.17	  $304.17	      ---	  $383.58	004	1	0	0.00	    $0.00	Y	
O	24145	PRTL EXC BONE RADIAL H/N                	     1.63	   $60.68	      ---	   $76.53	004	1	0	0.00	    $0.00	Y	
O	24147	PRTL EXC BONE OLECRN PROCESS            	     1.60	   $59.57	      ---	   $75.12	004	1	0	0.00	    $0.00	Y	
K	24147	PRTL EXC BONE OLECRN PROCESS            	     8.00	  $297.84	      ---	  $375.60	004	1	0	0.00	    $0.00	Y	
K	24149	RADICAL RESECTION OF ELBOW              	    21.86	  $813.85	      ---	 $1026.33	004	1	0	0.00	    $0.00	Y	
O	24149	RADICAL RESECTION OF ELBOW              	     4.37	  $162.70	      ---	  $205.17	004	1	0	0.00	    $0.00	Y	
O	24150	RAD RESCJ TUM DSTL/SHFT HUM             	     4.89	  $182.05	      ---	  $229.59	004	1	0	0.00	    $0.00	Y	
K	24150	RAD RESCJ TUM DSTL/SHFT HUM             	    24.47	  $911.02	      ---	 $1148.87	004	1	0	0.00	    $0.00	Y	
K	24152	RAD RESECTION TUM RADIAL H/N            	    16.94	  $630.68	      ---	  $795.33	004	1	0	0.00	    $0.00	Y	
O	24152	RAD RESECTION TUM RADIAL H/N            	     3.39	  $126.21	      ---	  $159.16	004	1	0	0.00	    $0.00	Y	
O	24155	RESECTION OF ELBOW JOINT                	     3.61	  $134.40	      ---	  $169.49	004	1	0	0.00	    $0.00	Y	
K	24155	RESECTION OF ELBOW JOINT                	    18.14	  $675.35	      ---	  $851.67	004	1	0	0.00	    $0.00	Y	
K	24160	RMVL PROSTHHUMRL&ULNAR CMPNT            	     7.48	  $278.48	      ---	  $351.19	004	1	0	0.00	    $0.00	Y	
O	24160	RMVL PROSTHHUMRL&ULNAR CMPNT            	     1.49	   $55.47	      ---	   $69.96	004	1	0	0.00	    $0.00	Y	
O	24164	REMOVAL PROSTH RADIAL HEAD              	     1.15	   $42.81	      ---	   $53.99	004	1	0	0.00	    $0.00	Y	
K	24164	REMOVAL PROSTH RADIAL HEAD              	     5.75	  $214.07	      ---	  $269.96	004	1	0	0.00	    $0.00	Y	
K	24200	RMVL FB UPPER ARM/ELBW SUBQ             	     2.97	  $110.57	      ---	  $139.44	004	1	0	0.00	    $0.00	Y	
K	24201	RMVL FB UPPER ARM/ELBW DEEP             	    10.30	  $383.47	      ---	  $483.59	004	1	0	0.00	    $0.00	Y	
O	24201	RMVL FB UPPER ARM/ELBW DEEP             	     2.06	   $76.69	      ---	   $96.72	004	1	0	0.00	    $0.00	Y	
K	24220	INJECTION PX FOR ELBOW ARTHG            	     5.49	  $204.39	      ---	  $257.76	004	1	0	0.00	    $0.00	Y	
K	24300	MNPJ ELBOW UNDER ANES                   	     8.11	  $301.94	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	24300	MNPJ ELBOW UNDER ANES                   	     1.62	   $60.31	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	24301	MUSC/TDN TRANSFER UPR A/E 1             	     3.29	  $122.49	      ---	  $154.47	004	1	0	0.00	    $0.00	Y	
K	24301	MUSC/TDN TRANSFER UPR A/E 1             	    16.47	  $613.18	      ---	  $773.27	004	1	0	0.00	    $0.00	Y	
K	24305	TENDON LNGTH UPR A/E EA TDN             	     7.48	  $278.48	      ---	  $351.19	004	1	0	0.00	    $0.00	Y	
O	24305	TENDON LNGTH UPR A/E EA TDN             	     1.49	   $55.47	      ---	   $69.96	004	1	0	0.00	    $0.00	Y	
O	24310	TNOT OPN ELBW TO SHO EA TDN             	     1.22	   $45.42	      ---	   $57.28	004	1	0	0.00	    $0.00	Y	
K	24310	TNOT OPN ELBW TO SHO EA TDN             	     6.08	  $226.36	      ---	  $285.46	004	1	0	0.00	    $0.00	Y	
K	24320	TENOPLASTY ELBOW TO SHO 1               	    17.99	  $669.77	      ---	  $844.63	004	1	0	0.00	    $0.00	Y	
O	24320	TENOPLASTY ELBOW TO SHO 1               	     3.60	  $134.03	      ---	  $169.02	004	1	0	0.00	    $0.00	Y	
O	24330	FLEXOR-PLASTY ELBOW                     	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
K	24330	FLEXOR-PLASTY ELBOW                     	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
K	24331	FLEXOR-PLASTY ELBW W/ADVMNT             	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	24331	FLEXOR-PLASTY ELBW W/ADVMNT             	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
O	24332	TENOLYSIS TRICEPS                       	     2.21	   $82.28	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	24332	TENOLYSIS TRICEPS                       	    11.04	  $411.02	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	24340	TENODESIS BICEPS TDN AT ELBW            	    14.00	  $521.22	      ---	  $657.30	004	1	0	0.00	    $0.00	Y	
O	24340	TENODESIS BICEPS TDN AT ELBW            	     2.80	  $104.24	      ---	  $131.46	004	1	0	0.00	    $0.00	Y	
O	24341	RPR TDN/MUSC UPR A/E EACH               	     2.41	   $89.72	      ---	  $113.15	004	1	0	0.00	    $0.00	Y	
K	24341	RPR TDN/MUSC UPR A/E EACH               	    12.08	  $449.74	      ---	  $567.16	004	1	0	0.00	    $0.00	Y	
K	24342	REPAIR OF RUPTURED TENDON               	    16.86	  $627.70	      ---	  $791.58	004	1	0	0.00	    $0.00	Y	
O	24342	REPAIR OF RUPTURED TENDON               	     3.39	  $126.21	      ---	  $159.16	004	1	0	0.00	    $0.00	Y	
O	24343	REPR ELBOW LAT LIGMNT W/TISS            	     2.93	  $109.08	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	24343	REPR ELBOW LAT LIGMNT W/TISS            	    14.63	  $544.67	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	24344	RECONSTRUCT ELBOW LAT LIGMNT            	    21.99	  $818.69	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	24344	RECONSTRUCT ELBOW LAT LIGMNT            	     4.40	  $163.81	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	24345	REPR ELBW MED LIGMNT W/TISSU            	     2.93	  $109.08	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	24345	REPR ELBW MED LIGMNT W/TISSU            	    14.63	  $544.67	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	24346	RECONSTRUCT ELBOW MED LIGMNT            	    21.99	  $818.69	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	24346	RECONSTRUCT ELBOW MED LIGMNT            	     4.40	  $163.81	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	24357	REPAIR ELBOW PERC                       	     1.70	   $63.29	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	24357	REPAIR ELBOW PERC                       	     8.49	  $316.08	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	24358	REPAIR ELBOW W/DEB OPEN                 	     9.99	  $371.93	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	24358	REPAIR ELBOW W/DEB OPEN                 	     2.00	   $74.46	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	24359	REPAIR ELBOW DEB/ATTCH OPEN             	     2.62	   $97.54	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	24359	REPAIR ELBOW DEB/ATTCH OPEN             	    12.70	  $472.82	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	24360	RECONSTRUCT ELBOW JOINT                 	    19.00	  $707.37	      ---	  $892.05	004	1	0	0.00	    $0.00	Y	
O	24360	RECONSTRUCT ELBOW JOINT                 	     3.80	  $141.47	      ---	  $178.41	004	1	0	0.00	    $0.00	Y	
O	24361	RECONSTRUCT ELBOW JOINT                 	     4.60	  $171.26	      ---	  $215.97	004	1	0	0.00	    $0.00	Y	
K	24361	RECONSTRUCT ELBOW JOINT                 	    22.99	  $855.92	      ---	 $1079.38	004	1	0	0.00	    $0.00	Y	
K	24362	RECONSTRUCT ELBOW JOINT                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	24362	RECONSTRUCT ELBOW JOINT                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	24363	REPLACE ELBOW JOINT                     	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	24363	REPLACE ELBOW JOINT                     	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	24365	RECONSTRUCT HEAD OF RADIUS              	    14.44	  $537.60	      ---	  $677.96	004	1	0	0.00	    $0.00	Y	
O	24365	RECONSTRUCT HEAD OF RADIUS              	     2.89	  $107.59	      ---	  $135.69	004	1	0	0.00	    $0.00	Y	
O	24366	RECONSTRUCT HEAD OF RADIUS              	     2.49	   $92.70	      ---	  $116.91	004	1	0	0.00	    $0.00	Y	
K	24366	RECONSTRUCT HEAD OF RADIUS              	    12.46	  $463.89	      ---	  $585.00	004	1	0	0.00	    $0.00	Y	
K	24370	REVISE RECONST ELBOW JOINT              	    34.53	 $1285.55	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	24370	REVISE RECONST ELBOW JOINT              	     6.90	  $256.89	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	24371	REVISE RECONST ELBOW JOINT              	     7.94	  $295.61	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	24371	REVISE RECONST ELBOW JOINT              	    39.72	 $1478.78	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	24400	REVISION OF HUMERUS                     	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	24400	REVISION OF HUMERUS                     	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
O	24410	REVISION OF HUMERUS                     	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
K	24410	REVISION OF HUMERUS                     	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
K	24420	REVISION OF HUMERUS                     	    19.71	  $733.80	      ---	  $925.38	004	1	0	0.00	    $0.00	Y	
O	24420	REVISION OF HUMERUS                     	     3.96	  $147.43	      ---	  $185.92	004	1	0	0.00	    $0.00	Y	
O	24430	REPAIR OF HUMERUS                       	     3.85	  $143.34	      ---	  $180.76	004	1	0	0.00	    $0.00	Y	
K	24430	REPAIR OF HUMERUS                       	    19.25	  $716.68	      ---	  $903.79	004	1	0	0.00	    $0.00	Y	
K	24435	REPAIR HUMERUS WITH GRAFT               	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
O	24435	REPAIR HUMERUS WITH GRAFT               	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
O	24470	REVISION OF ELBOW JOINT                 	     1.59	   $59.20	      ---	   $74.65	004	1	0	0.00	    $0.00	Y	
K	24470	REVISION OF ELBOW JOINT                 	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
K	24495	DECOMPRESSION OF FOREARM                	    15.59	  $580.42	      ---	  $731.95	004	1	0	0.00	    $0.00	Y	
O	24495	DECOMPRESSION OF FOREARM                	     3.12	  $116.16	      ---	  $146.48	004	1	0	0.00	    $0.00	Y	
O	24498	REINFORCE HUMERUS                       	     4.12	  $153.39	      ---	  $193.43	004	1	0	0.00	    $0.00	Y	
K	24498	REINFORCE HUMERUS                       	    20.58	  $766.19	      ---	  $966.23	004	1	0	0.00	    $0.00	Y	
K	24500	TREAT HUMERUS FRACTURE                  	   176.90	  $176.90	      ---	       --	042	0	1	0.00	    $0.00	Y	
O	24500	TREAT HUMERUS FRACTURE                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	24505	TREAT HUMERUS FRACTURE                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	24505	TREAT HUMERUS FRACTURE                  	     7.23	  $269.17	      ---	  $339.45	004	1	1	0.00	    $0.00	Y	
K	24515	TREAT HUMERUS FRACTURE                  	    12.46	  $463.89	      ---	  $585.00	004	1	0	0.00	    $0.00	Y	
O	24515	TREAT HUMERUS FRACTURE                  	     2.49	   $92.70	      ---	  $116.91	004	1	0	0.00	    $0.00	Y	
O	24516	TREAT HUMERUS FRACTURE                  	     3.02	  $112.43	      ---	  $141.79	004	1	0	0.00	    $0.00	Y	
K	24516	TREAT HUMERUS FRACTURE                  	    15.12	  $562.92	      ---	  $709.88	004	1	0	0.00	    $0.00	Y	
K	24530	TREAT HUMERUS FRACTURE                  	   198.98	  $198.98	      ---	       --	042	0	1	0.00	    $0.00	Y	
O	24530	TREAT HUMERUS FRACTURE                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	24535	TREAT HUMERUS FRACTURE                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	24535	TREAT HUMERUS FRACTURE                  	     8.08	  $300.82	      ---	  $379.36	004	1	0	0.00	    $0.00	Y	
K	24538	TREAT HUMERUS FRACTURE                  	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	24538	TREAT HUMERUS FRACTURE                  	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	24545	TREAT HUMERUS FRACTURE                  	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	24545	TREAT HUMERUS FRACTURE                  	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	24546	TREAT HUMERUS FRACTURE                  	    17.77	  $661.58	      ---	  $834.30	004	1	0	0.00	    $0.00	Y	
O	24546	TREAT HUMERUS FRACTURE                  	     3.56	  $132.54	      ---	  $167.14	004	1	0	0.00	    $0.00	Y	
O	24560	TREAT HUMERUS FRACTURE                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	24560	TREAT HUMERUS FRACTURE                  	   165.99	  $165.99	      ---	       --	042	0	1	0.00	    $0.00	Y	
K	24565	TREAT HUMERUS FRACTURE                  	     6.98	  $259.87	      ---	  $327.71	004	1	1	0.00	    $0.00	Y	
O	24565	TREAT HUMERUS FRACTURE                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	24566	TREAT HUMERUS FRACTURE                  	     1.71	   $63.66	      ---	   $80.28	004	1	0	0.00	    $0.00	Y	
K	24566	TREAT HUMERUS FRACTURE                  	     8.57	  $319.06	      ---	  $402.36	004	1	0	0.00	    $0.00	Y	
K	24575	TREAT HUMERUS FRACTURE                  	    10.19	  $379.37	      ---	  $478.42	004	1	0	0.00	    $0.00	Y	
O	24575	TREAT HUMERUS FRACTURE                  	     2.04	   $75.95	      ---	   $95.78	004	1	0	0.00	    $0.00	Y	
O	24576	TREAT HUMERUS FRACTURE                  	     1.63	   $60.68	      ---	   $76.53	004	1	0	0.00	    $0.00	Y	
K	24576	TREAT HUMERUS FRACTURE                  	     8.14	  $303.05	      ---	  $382.17	004	1	1	0.00	    $0.00	Y	
K	24577	TREAT HUMERUS FRACTURE                  	     7.23	  $269.17	      ---	  $339.45	004	1	0	0.00	    $0.00	Y	
O	24577	TREAT HUMERUS FRACTURE                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	24579	TREAT HUMERUS FRACTURE                  	     2.04	   $75.95	      ---	   $95.78	004	1	0	0.00	    $0.00	Y	
K	24579	TREAT HUMERUS FRACTURE                  	    10.19	  $379.37	      ---	  $478.42	004	1	0	0.00	    $0.00	Y	
K	24582	TREAT HUMERUS FRACTURE                  	     9.37	  $348.85	      ---	  $439.92	004	1	0	0.00	    $0.00	Y	
O	24582	TREAT HUMERUS FRACTURE                  	     1.87	   $69.62	      ---	   $87.80	004	1	0	0.00	    $0.00	Y	
O	24586	TREAT ELBOW FRACTURE                    	     4.49	  $167.16	      ---	  $210.81	004	1	0	0.00	    $0.00	Y	
K	24586	TREAT ELBOW FRACTURE                    	    22.43	  $835.07	      ---	 $1053.09	004	1	0	0.00	    $0.00	Y	
K	24587	TREAT ELBOW FRACTURE                    	    23.63	  $879.74	      ---	 $1109.43	004	1	0	0.00	    $0.00	Y	
O	24587	TREAT ELBOW FRACTURE                    	     4.73	  $176.10	      ---	  $222.07	004	1	0	0.00	    $0.00	Y	
O	24600	TREAT ELBOW DISLOCATION                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	24600	TREAT ELBOW DISLOCATION                 	   221.73	  $221.73	      ---	       --	042	0	1	0.00	    $0.00	Y	
K	24605	TREAT ELBOW DISLOCATION                 	     4.65	  $173.12	      ---	  $218.32	004	1	0	0.00	    $0.00	Y	
O	24605	TREAT ELBOW DISLOCATION                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	24615	TREAT ELBOW DISLOCATION                 	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	24615	TREAT ELBOW DISLOCATION                 	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	24620	TREAT ELBOW FRACTURE                    	     6.15	  $228.96	      ---	  $288.74	004	1	0	0.00	    $0.00	Y	
O	24620	TREAT ELBOW FRACTURE                    	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	24635	TREAT ELBOW FRACTURE                    	     3.09	  $115.04	      ---	  $145.08	004	1	0	0.00	    $0.00	Y	
K	24635	TREAT ELBOW FRACTURE                    	    15.47	  $575.95	      ---	  $726.32	004	1	0	0.00	    $0.00	Y	
K	24640	TREAT ELBOW DISLOCATION                 	     3.05	  $113.55	      ---	  $143.20	004	1	1	0.00	    $0.00	Y	
O	24640	TREAT ELBOW DISLOCATION                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
X	24640	TREAT ELBOW DISLOCATION                 	   113.55	  $113.55	      ---	       --	009	1	1	0.00	    $0.00	Y	
O	24650	TREAT RADIUS FRACTURE                   	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	24650	TREAT RADIUS FRACTURE                   	   149.31	  $149.31	      ---	       --	042	0	1	0.00	    $0.00	Y	
K	24655	TREAT RADIUS FRACTURE                   	     6.21	  $231.20	      ---	  $291.56	004	1	0	0.00	    $0.00	Y	
O	24655	TREAT RADIUS FRACTURE                   	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	24665	TREAT RADIUS FRACTURE                   	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
K	24665	TREAT RADIUS FRACTURE                   	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
K	24666	TREAT RADIUS FRACTURE                   	    12.46	  $463.89	      ---	  $585.00	004	1	0	0.00	    $0.00	Y	
O	24666	TREAT RADIUS FRACTURE                   	     2.49	   $92.70	      ---	  $116.91	004	1	0	0.00	    $0.00	Y	
O	24670	TREAT ULNAR FRACTURE                    	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	24670	TREAT ULNAR FRACTURE                    	   154.54	  $154.54	      ---	       --	042	0	1	0.00	    $0.00	Y	
K	24675	TREAT ULNAR FRACTURE                    	     6.44	  $239.76	      ---	  $302.36	004	1	1	0.00	    $0.00	Y	
O	24675	TREAT ULNAR FRACTURE                    	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	24685	TREAT ULNAR FRACTURE                    	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
K	24685	TREAT ULNAR FRACTURE                    	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
K	24800	FUSION OF ELBOW JOINT                   	    17.44	  $649.29	      ---	  $818.81	004	1	0	0.00	    $0.00	Y	
O	24800	FUSION OF ELBOW JOINT                   	     3.49	  $129.93	      ---	  $163.86	004	1	0	0.00	    $0.00	Y	
O	24802	FUSION/GRAFT OF ELBOW JOINT             	     3.62	  $134.77	      ---	  $169.96	004	1	0	0.00	    $0.00	Y	
K	24802	FUSION/GRAFT OF ELBOW JOINT             	    18.12	  $674.61	      ---	  $850.73	004	1	0	0.00	    $0.00	Y	
K	24900	AMPUTATION OF UPPER ARM                 	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	24900	AMPUTATION OF UPPER ARM                 	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	24920	AMPUTATION OF UPPER ARM                 	     2.04	   $75.95	      ---	   $95.78	004	1	0	0.00	    $0.00	Y	
K	24920	AMPUTATION OF UPPER ARM                 	    10.19	  $379.37	      ---	  $478.42	004	1	0	0.00	    $0.00	Y	
K	24925	AMPUTATION FOLLOW-UP SURGERY            	     7.02	  $261.35	      ---	  $329.59	004	1	0	0.00	    $0.00	Y	
O	24925	AMPUTATION FOLLOW-UP SURGERY            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	24930	AMPUTATION FOLLOW-UP SURGERY            	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	24930	AMPUTATION FOLLOW-UP SURGERY            	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	24931	AMPUTATE UPPER ARM & IMPLANT            	    15.06	  $560.68	      ---	  $707.07	004	1	0	0.00	    $0.00	Y	
O	24931	AMPUTATE UPPER ARM & IMPLANT            	     3.06	  $113.92	      ---	  $143.67	004	1	0	0.00	    $0.00	Y	
O	24935	REVISION OF AMPUTATION                  	     5.11	  $190.25	      ---	  $239.91	004	1	0	0.00	    $0.00	Y	
K	24935	REVISION OF AMPUTATION                  	    25.53	  $950.48	      ---	 $1198.63	004	1	0	0.00	    $0.00	Y	
K	24940	REVISION OF UPPER ARM                   	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	24940	REVISION OF UPPER ARM                   	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	24999	UNLISTED PX HUMERUS/ELBOW               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	24999	UNLISTED PX HUMERUS/ELBOW               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	25000	INCISION OF TENDON SHEATH               	     4.98	  $185.41	      ---	  $233.81	004	1	0	0.00	    $0.00	Y	
O	25000	INCISION OF TENDON SHEATH               	     1.00	   $37.23	      ---	   $46.95	004	1	0	0.00	    $0.00	Y	
O	25001	INCISE FLEXOR CARPI RADIALIS            	     1.35	   $50.26	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	25001	INCISE FLEXOR CARPI RADIALIS            	     6.75	  $251.30	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	25020	DECOMPRESS FOREARM 1 SPACE              	    13.38	  $498.14	      ---	  $628.19	004	1	0	0.00	    $0.00	Y	
O	25020	DECOMPRESS FOREARM 1 SPACE              	     2.68	   $99.78	      ---	  $125.83	004	1	0	0.00	    $0.00	Y	
O	25023	DECOMPRESS FOREARM 1 SPACE              	     2.61	   $97.17	      ---	  $122.54	004	1	0	0.00	    $0.00	Y	
K	25023	DECOMPRESS FOREARM 1 SPACE              	    13.04	  $485.48	      ---	  $612.23	004	1	0	0.00	    $0.00	Y	
K	25024	DECOMPRESS FOREARM 2 SPACES             	    15.53	  $578.18	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	25024	DECOMPRESS FOREARM 2 SPACES             	     3.11	  $115.79	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	25025	DECOMPRESS FOREARM 2 SPACES             	     5.01	  $186.52	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	25025	DECOMPRESS FOREARM 2 SPACES             	    25.03	  $931.87	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	25028	DRAINAGE OF FOREARM LESION              	    12.24	  $455.70	      ---	  $574.67	004	1	0	0.00	    $0.00	Y	
O	25028	DRAINAGE OF FOREARM LESION              	     2.45	   $91.21	      ---	  $115.03	004	1	0	0.00	    $0.00	Y	
O	25031	DRAINAGE OF FOREARM BURSA               	     2.20	   $81.91	      ---	  $103.29	004	1	0	0.00	    $0.00	Y	
K	25031	DRAINAGE OF FOREARM BURSA               	    11.01	  $409.90	      ---	  $516.92	004	1	0	0.00	    $0.00	Y	
K	25035	TREAT FOREARM BONE LESION               	     9.73	  $362.25	      ---	  $456.82	004	1	0	0.00	    $0.00	Y	
O	25035	TREAT FOREARM BONE LESION               	     1.95	   $72.60	      ---	   $91.55	004	1	0	0.00	    $0.00	Y	
K	25040	EXPLORE/TREAT WRIST JOINT               	     7.09	  $263.96	      ---	  $332.88	004	1	0	0.00	    $0.00	Y	
K	25065	BIOPSY FOREARM SOFT TISSUES             	     2.08	   $77.44	      ---	   $97.66	004	1	0	0.00	    $0.00	Y	
K	25066	BIOPSY FOREARM SOFT TISSUES             	     5.10	  $189.87	      ---	  $239.45	004	1	0	0.00	    $0.00	Y	
O	25066	BIOPSY FOREARM SOFT TISSUES             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	25071	EXC FOREARM LES SC 3 CM/>               	     1.89	   $70.36	      ---	   $88.74	004	1	0	0.00	    $0.00	Y	
K	25071	EXC FOREARM LES SC 3 CM/>               	     9.43	  $351.08	      ---	  $442.74	004	1	0	0.00	    $0.00	Y	
K	25073	EXC FOREARM TUM DEEP 3 CM/>             	    11.80	  $439.31	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	25073	EXC FOREARM TUM DEEP 3 CM/>             	     2.36	   $87.86	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	25075	EXC FOREARM LES SC < 3 CM               	     1.76	   $65.52	      ---	   $82.63	004	1	0	0.00	    $0.00	Y	
K	25075	EXC FOREARM LES SC < 3 CM               	     8.82	  $328.37	      ---	  $414.10	004	1	0	0.00	    $0.00	Y	
K	25076	EXC FOREARM TUM DEEP < 3 CM             	     4.61	  $171.63	      ---	  $216.44	004	1	0	0.00	    $0.00	Y	
O	25076	EXC FOREARM TUM DEEP < 3 CM             	     0.92	   $34.25	      ---	   $43.19	004	1	0	0.00	    $0.00	Y	
O	25077	RESECT FOREARM/WRIST TUM<3CM            	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
K	25077	RESECT FOREARM/WRIST TUM<3CM            	    20.01	  $744.97	      ---	  $939.47	004	1	0	0.00	    $0.00	Y	
K	25078	RESECT FORARM/WRIST TUM 3CM>            	    24.70	  $919.58	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	25078	RESECT FORARM/WRIST TUM 3CM>            	     4.94	  $183.92	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	25085	INCISION OF WRIST CAPSULE               	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
K	25085	INCISION OF WRIST CAPSULE               	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
K	25100	BIOPSY OF WRIST JOINT                   	     5.66	  $210.72	      ---	  $265.74	004	1	0	0.00	    $0.00	Y	
O	25100	BIOPSY OF WRIST JOINT                   	     1.13	   $42.07	      ---	   $53.05	004	1	0	0.00	    $0.00	Y	
O	25101	EXPLORE/TREAT WRIST JOINT               	     1.54	   $57.33	      ---	   $72.30	004	1	0	0.00	    $0.00	Y	
K	25101	EXPLORE/TREAT WRIST JOINT               	     7.70	  $286.67	      ---	  $361.52	004	1	0	0.00	    $0.00	Y	
K	25105	REMOVE WRIST JOINT LINING               	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	25105	REMOVE WRIST JOINT LINING               	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
O	25107	REMOVE WRIST JOINT CARTILAGE            	     1.70	   $63.29	      ---	   $79.82	004	1	0	0.00	    $0.00	Y	
K	25107	REMOVE WRIST JOINT CARTILAGE            	     8.49	  $316.08	      ---	  $398.61	004	1	0	0.00	    $0.00	Y	
K	25109	EXCISE TENDON FOREARM/WRIST             	    11.34	  $422.19	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	25109	EXCISE TENDON FOREARM/WRIST             	     2.27	   $84.51	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	25110	REMOVE WRIST TENDON LESION              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	25110	REMOVE WRIST TENDON LESION              	     5.11	  $190.25	      ---	  $239.91	004	1	0	0.00	    $0.00	Y	
K	25111	REMOVE WRIST TENDON LESION              	     5.66	  $210.72	      ---	  $265.74	004	1	0	0.00	    $0.00	Y	
O	25111	REMOVE WRIST TENDON LESION              	     1.13	   $42.07	      ---	   $53.05	004	1	0	0.00	    $0.00	Y	
O	25112	REREMOVE WRIST TENDON LESION            	     1.13	   $42.07	      ---	   $53.05	004	1	0	0.00	    $0.00	Y	
K	25112	REREMOVE WRIST TENDON LESION            	     5.66	  $210.72	      ---	  $265.74	004	1	0	0.00	    $0.00	Y	
K	25115	REMOVE WRIST/FOREARM LESION             	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	25116	REMOVE WRIST/FOREARM LESION             	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	25116	REMOVE WRIST/FOREARM LESION             	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	25118	EXCISE WRIST TENDON SHEATH              	     2.00	   $74.46	      ---	   $93.90	004	1	0	0.00	    $0.00	Y	
K	25118	EXCISE WRIST TENDON SHEATH              	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
K	25119	PARTIAL REMOVAL OF ULNA                 	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	25119	PARTIAL REMOVAL OF ULNA                 	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	25120	REMOVAL OF FOREARM LESION               	     1.71	   $63.66	      ---	   $80.28	004	1	0	0.00	    $0.00	Y	
K	25120	REMOVAL OF FOREARM LESION               	     8.54	  $317.94	      ---	  $400.95	004	1	0	0.00	    $0.00	Y	
K	25125	REMOVE/GRAFT FOREARM LESION             	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	25125	REMOVE/GRAFT FOREARM LESION             	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	25126	REMOVE/GRAFT FOREARM LESION             	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	25126	REMOVE/GRAFT FOREARM LESION             	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	25130	REMOVAL OF WRIST LESION                 	     5.66	  $210.72	      ---	  $265.74	004	1	0	0.00	    $0.00	Y	
O	25130	REMOVAL OF WRIST LESION                 	     1.13	   $42.07	      ---	   $53.05	004	1	0	0.00	    $0.00	Y	
O	25135	REMOVE & GRAFT WRIST LESION             	     1.59	   $59.20	      ---	   $74.65	004	1	0	0.00	    $0.00	Y	
K	25135	REMOVE & GRAFT WRIST LESION             	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
K	25136	REMOVE & GRAFT WRIST LESION             	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
O	25136	REMOVE & GRAFT WRIST LESION             	     1.59	   $59.20	      ---	   $74.65	004	1	0	0.00	    $0.00	Y	
O	25145	REMOVE FOREARM BONE LESION              	     3.24	  $120.63	      ---	  $152.12	004	1	0	0.00	    $0.00	Y	
K	25145	REMOVE FOREARM BONE LESION              	    16.20	  $603.13	      ---	  $760.59	004	1	0	0.00	    $0.00	Y	
K	25150	PARTIAL REMOVAL OF ULNA                 	     8.07	  $300.45	      ---	  $378.89	004	1	0	0.00	    $0.00	Y	
O	25150	PARTIAL REMOVAL OF ULNA                 	     1.61	   $59.94	      ---	   $75.59	004	1	0	0.00	    $0.00	Y	
O	25151	PARTIAL REMOVAL OF RADIUS               	     1.90	   $70.74	      ---	   $89.21	004	1	0	0.00	    $0.00	Y	
K	25151	PARTIAL REMOVAL OF RADIUS               	     9.49	  $353.31	      ---	  $445.56	004	1	0	0.00	    $0.00	Y	
K	25170	RESECT RADIUS/ULNAR TUMOR               	    24.10	  $897.24	      ---	 $1131.50	004	1	0	0.00	    $0.00	Y	
O	25170	RESECT RADIUS/ULNAR TUMOR               	     4.82	  $179.45	      ---	  $226.30	004	1	0	0.00	    $0.00	Y	
O	25210	REMOVAL OF WRIST BONE                   	     1.59	   $59.20	      ---	   $74.65	004	1	0	0.00	    $0.00	Y	
K	25210	REMOVAL OF WRIST BONE                   	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
K	25215	REMOVAL OF WRIST BONES                  	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	25215	REMOVAL OF WRIST BONES                  	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	25230	PARTIAL REMOVAL OF RADIUS               	     1.13	   $42.07	      ---	   $53.05	004	1	0	0.00	    $0.00	Y	
K	25230	PARTIAL REMOVAL OF RADIUS               	     5.66	  $210.72	      ---	  $265.74	004	1	0	0.00	    $0.00	Y	
K	25240	PARTIAL REMOVAL OF ULNA                 	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
O	25240	PARTIAL REMOVAL OF ULNA                 	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
K	25246	INJECTION FOR WRIST X-RAY               	     4.89	  $182.05	      ---	  $229.59	004	1	0	0.00	    $0.00	Y	
K	25248	REMOVE FOREARM FOREIGN BODY             	    12.51	  $465.75	      ---	  $587.34	004	1	0	0.00	    $0.00	Y	
O	25248	REMOVE FOREARM FOREIGN BODY             	     2.50	   $93.08	      ---	  $117.38	004	1	0	0.00	    $0.00	Y	
O	25250	REMOVAL OF WRIST PROSTHESIS             	     1.59	   $59.20	      ---	   $74.65	004	1	0	0.00	    $0.00	Y	
K	25250	REMOVAL OF WRIST PROSTHESIS             	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
K	25251	REMOVAL OF WRIST PROSTHESIS             	    10.44	  $388.68	      ---	  $490.16	004	1	0	0.00	    $0.00	Y	
O	25251	REMOVAL OF WRIST PROSTHESIS             	     2.09	   $77.81	      ---	   $98.13	004	1	0	0.00	    $0.00	Y	
K	25259	MANIPULATE WRIST W/ANESTHES             	     8.01	  $298.21	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	25260	REPAIR FOREARM TENDON/MUSCLE            	    10.04	  $373.79	      ---	  $471.38	004	1	0	0.00	    $0.00	Y	
O	25260	REPAIR FOREARM TENDON/MUSCLE            	     2.01	   $74.83	      ---	   $94.37	004	1	0	0.00	    $0.00	Y	
O	25263	REPAIR FOREARM TENDON/MUSCLE            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	25263	REPAIR FOREARM TENDON/MUSCLE            	    10.61	  $395.01	      ---	  $498.14	004	1	0	0.00	    $0.00	Y	
K	25265	REPAIR FOREARM TENDON/MUSCLE            	    15.06	  $560.68	      ---	  $707.07	004	1	0	0.00	    $0.00	Y	
O	25265	REPAIR FOREARM TENDON/MUSCLE            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	25270	REPAIR FOREARM TENDON/MUSCLE            	     1.75	   $65.15	      ---	   $82.16	004	1	0	0.00	    $0.00	Y	
K	25270	REPAIR FOREARM TENDON/MUSCLE            	     8.74	  $325.39	      ---	  $410.34	004	1	0	0.00	    $0.00	Y	
K	25272	REPAIR FOREARM TENDON/MUSCLE            	     9.48	  $352.94	      ---	  $445.09	004	1	0	0.00	    $0.00	Y	
O	25272	REPAIR FOREARM TENDON/MUSCLE            	     1.90	   $70.74	      ---	   $89.21	004	1	0	0.00	    $0.00	Y	
O	25274	REPAIR FOREARM TENDON/MUSCLE            	     2.15	   $80.04	      ---	  $100.94	004	1	0	0.00	    $0.00	Y	
K	25274	REPAIR FOREARM TENDON/MUSCLE            	    10.75	  $400.22	      ---	  $504.71	004	1	0	0.00	    $0.00	Y	
K	25275	REPAIR FOREARM TENDON SHEATH            	    14.11	  $525.32	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	25275	REPAIR FOREARM TENDON SHEATH            	     2.82	  $104.99	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	25280	REVISE WRIST/FOREARM TENDON             	     1.87	   $69.62	      ---	   $87.80	004	1	0	0.00	    $0.00	Y	
K	25280	REVISE WRIST/FOREARM TENDON             	     9.37	  $348.85	      ---	  $439.92	004	1	0	0.00	    $0.00	Y	
K	25290	INCISE WRIST/FOREARM TENDON             	     9.14	  $340.28	      ---	  $429.12	004	1	0	0.00	    $0.00	Y	
O	25290	INCISE WRIST/FOREARM TENDON             	     1.83	   $68.13	      ---	   $85.92	004	1	0	0.00	    $0.00	Y	
O	25295	RELEASE WRIST/FOREARM TENDON            	     1.79	   $66.64	      ---	   $84.04	004	1	0	0.00	    $0.00	Y	
K	25295	RELEASE WRIST/FOREARM TENDON            	     8.97	  $333.95	      ---	  $421.14	004	1	0	0.00	    $0.00	Y	
K	25300	FUSION OF TENDONS AT WRIST              	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	25300	FUSION OF TENDONS AT WRIST              	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
O	25301	FUSION OF TENDONS AT WRIST              	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
K	25301	FUSION OF TENDONS AT WRIST              	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
K	25310	TRANSPLANT FOREARM TENDON               	    10.76	  $400.59	      ---	  $505.18	004	1	0	0.00	    $0.00	Y	
O	25310	TRANSPLANT FOREARM TENDON               	     2.15	   $80.04	      ---	  $100.94	004	1	0	0.00	    $0.00	Y	
O	25312	TRANSPLANT FOREARM TENDON               	     2.31	   $86.00	      ---	  $108.45	004	1	0	0.00	    $0.00	Y	
K	25312	TRANSPLANT FOREARM TENDON               	    11.54	  $429.63	      ---	  $541.80	004	1	0	0.00	    $0.00	Y	
K	25315	REVISE PALSY HAND TENDON(S)             	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	25315	REVISE PALSY HAND TENDON(S)             	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
O	25316	REVISE PALSY HAND TENDON(S)             	     6.16	  $229.34	      ---	  $289.21	004	1	0	0.00	    $0.00	Y	
K	25316	REVISE PALSY HAND TENDON(S)             	    30.82	 $1147.43	      ---	 $1447.00	004	1	0	0.00	    $0.00	Y	
K	25320	REPAIR/REVISE WRIST JOINT               	    18.58	  $691.73	      ---	  $872.33	004	1	0	0.00	    $0.00	Y	
O	25320	REPAIR/REVISE WRIST JOINT               	     3.72	  $138.50	      ---	  $174.65	004	1	0	0.00	    $0.00	Y	
O	25332	REVISE WRIST JOINT                      	     4.18	  $155.62	      ---	  $196.25	004	1	0	0.00	    $0.00	Y	
K	25332	REVISE WRIST JOINT                      	    20.88	  $777.36	      ---	  $980.32	004	1	0	0.00	    $0.00	Y	
K	25335	CENTRALIZATION WRIST ON ULNA            	    22.17	  $825.39	      ---	 $1040.88	004	1	0	0.00	    $0.00	Y	
O	25335	CENTRALIZATION WRIST ON ULNA            	     4.43	  $164.93	      ---	  $207.99	004	1	0	0.00	    $0.00	Y	
O	25337	RECONSTRUCT ULNA/RADIOULNAR             	     2.13	   $79.30	      ---	  $100.00	004	1	0	0.00	    $0.00	Y	
K	25337	RECONSTRUCT ULNA/RADIOULNAR             	    10.66	  $396.87	      ---	  $500.49	004	1	0	0.00	    $0.00	Y	
K	25350	REVISION OF RADIUS                      	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	25350	REVISION OF RADIUS                      	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	25355	REVISION OF RADIUS                      	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	25355	REVISION OF RADIUS                      	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	25360	REVISION OF ULNA                        	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	25360	REVISION OF ULNA                        	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	25365	REVISE RADIUS & ULNA                    	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
K	25365	REVISE RADIUS & ULNA                    	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
K	25370	REVISE RADIUS OR ULNA                   	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	25370	REVISE RADIUS OR ULNA                   	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
O	25375	REVISE RADIUS & ULNA                    	     4.08	  $151.90	      ---	  $191.56	004	1	0	0.00	    $0.00	Y	
K	25375	REVISE RADIUS & ULNA                    	    20.39	  $759.12	      ---	  $957.31	004	1	0	0.00	    $0.00	Y	
K	25390	SHORTEN RADIUS OR ULNA                  	    12.46	  $463.89	      ---	  $585.00	004	1	0	0.00	    $0.00	Y	
O	25390	SHORTEN RADIUS OR ULNA                  	     2.49	   $92.70	      ---	  $116.91	004	1	0	0.00	    $0.00	Y	
O	25391	LENGTHEN RADIUS OR ULNA                 	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
K	25391	LENGTHEN RADIUS OR ULNA                 	    15.63	  $581.90	      ---	  $733.83	004	1	0	0.00	    $0.00	Y	
K	25392	SHORTEN RADIUS & ULNA                   	    17.44	  $649.29	      ---	  $818.81	004	1	0	0.00	    $0.00	Y	
O	25392	SHORTEN RADIUS & ULNA                   	     3.51	  $130.68	      ---	  $164.79	004	1	0	0.00	    $0.00	Y	
O	25393	LENGTHEN RADIUS & ULNA                  	     3.96	  $147.43	      ---	  $185.92	004	1	0	0.00	    $0.00	Y	
K	25393	LENGTHEN RADIUS & ULNA                  	    19.71	  $733.80	      ---	  $925.38	004	1	0	0.00	    $0.00	Y	
K	25394	REPAIR CARPAL BONE SHORTEN              	    16.45	  $612.43	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	25394	REPAIR CARPAL BONE SHORTEN              	     3.29	  $122.49	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	25400	REPAIR RADIUS OR ULNA                   	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
K	25400	REPAIR RADIUS OR ULNA                   	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
K	25405	REPAIR/GRAFT RADIUS OR ULNA             	    19.25	  $716.68	      ---	  $903.79	004	1	0	0.00	    $0.00	Y	
O	25405	REPAIR/GRAFT RADIUS OR ULNA             	     3.85	  $143.34	      ---	  $180.76	004	1	0	0.00	    $0.00	Y	
O	25415	REPAIR RADIUS & ULNA                    	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	25415	REPAIR RADIUS & ULNA                    	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
K	25420	REPAIR/GRAFT RADIUS & ULNA              	    26.05	  $969.84	      ---	 $1223.05	004	1	0	0.00	    $0.00	Y	
O	25420	REPAIR/GRAFT RADIUS & ULNA              	     5.21	  $193.97	      ---	  $244.61	004	1	0	0.00	    $0.00	Y	
O	25425	REPAIR/GRAFT RADIUS OR ULNA             	     3.37	  $125.47	      ---	  $158.22	004	1	0	0.00	    $0.00	Y	
K	25425	REPAIR/GRAFT RADIUS OR ULNA             	    16.60	  $618.02	      ---	  $779.37	004	1	0	0.00	    $0.00	Y	
K	25426	REPAIR/GRAFT RADIUS & ULNA              	    19.71	  $733.80	      ---	  $925.38	004	1	0	0.00	    $0.00	Y	
O	25426	REPAIR/GRAFT RADIUS & ULNA              	     3.96	  $147.43	      ---	  $185.92	004	1	0	0.00	    $0.00	Y	
O	25430	VASC GRAFT INTO CARPAL BONE             	     2.92	  $108.71	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	25430	VASC GRAFT INTO CARPAL BONE             	    14.61	  $543.93	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	25431	REPAIR NONUNION CARPAL BONE             	    14.35	  $534.25	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	25431	REPAIR NONUNION CARPAL BONE             	     2.87	  $106.85	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	25440	REPAIR NONU SCPHD CARPL B1              	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
K	25440	REPAIR NONU SCPHD CARPL B1              	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
K	25441	ARTHRP W/PROSTC DSTL RDS                	    22.68	  $844.38	      ---	 $1064.83	004	1	0	0.00	    $0.00	Y	
O	25441	ARTHRP W/PROSTC DSTL RDS                	     4.54	  $169.02	      ---	  $213.15	004	1	0	0.00	    $0.00	Y	
O	25442	ARTHRP W/PROSTC DSTL ULNA               	     2.07	   $77.07	      ---	   $97.19	004	1	0	0.00	    $0.00	Y	
K	25442	ARTHRP W/PROSTC DSTL ULNA               	    10.36	  $385.70	      ---	  $486.40	004	1	0	0.00	    $0.00	Y	
K	25443	ARTHRP PROSTC DSTL SCPH CRPL            	    10.87	  $404.69	      ---	  $510.35	004	1	0	0.00	    $0.00	Y	
O	25443	ARTHRP PROSTC DSTL SCPH CRPL            	     2.15	   $80.04	      ---	  $100.94	004	1	0	0.00	    $0.00	Y	
O	25444	ARTHRP W/PROSTC LUNATE                  	     2.15	   $80.04	      ---	  $100.94	004	1	0	0.00	    $0.00	Y	
K	25444	ARTHRP W/PROSTC LUNATE                  	    10.87	  $404.69	      ---	  $510.35	004	1	0	0.00	    $0.00	Y	
K	25445	ARTHRP W/PROSTC TRAPEZIUM               	    10.87	  $404.69	      ---	  $510.35	004	1	0	0.00	    $0.00	Y	
O	25445	ARTHRP W/PROSTC TRAPEZIUM               	     2.15	   $80.04	      ---	  $100.94	004	1	0	0.00	    $0.00	Y	
O	25446	ARTHRP W/PROSTC DST RDS&CRPS            	     5.37	  $199.93	      ---	  $252.12	004	1	0	0.00	    $0.00	Y	
K	25446	ARTHRP W/PROSTC DST RDS&CRPS            	    26.84	  $999.25	      ---	 $1260.14	004	1	0	0.00	    $0.00	Y	
K	25447	ARTHRP NTRCRP/CRP/MTCR NTRPS            	    17.94	  $667.91	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	25447	ARTHRP NTRCRP/CRP/MTCR NTRPS            	     3.59	  $133.66	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	25448	ARTHRP NTRCRPL/CRP/MTCRP SSP            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	25448	ARTHRP NTRCRPL/CRP/MTCRP SSP            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	25449	REVJ ARTHRP WRIST JOINT                 	    26.69	  $993.67	      ---	 $1253.10	004	1	0	0.00	    $0.00	Y	
O	25449	REVJ ARTHRP WRIST JOINT                 	     5.34	  $198.81	      ---	  $250.71	004	1	0	0.00	    $0.00	Y	
O	25450	EPIPHYSL ARRST DSTL RDS/ULNA            	     1.85	   $68.88	      ---	   $86.86	004	1	0	0.00	    $0.00	Y	
K	25450	EPIPHYSL ARRST DSTL RDS/ULNA            	     9.24	  $344.01	      ---	  $433.82	004	1	0	0.00	    $0.00	Y	
K	25455	EPIPHYSL ARRST DSTL RDS&ULNA            	     9.66	  $359.64	      ---	  $453.54	004	1	0	0.00	    $0.00	Y	
O	25455	EPIPHYSL ARRST DSTL RDS&ULNA            	     1.93	   $71.85	      ---	   $90.61	004	1	0	0.00	    $0.00	Y	
O	25490	PROPHYLACTIC TX RADIUS                  	     4.42	  $164.56	      ---	  $207.52	004	1	0	0.00	    $0.00	Y	
K	25490	PROPHYLACTIC TX RADIUS                  	    22.09	  $822.41	      ---	 $1037.13	004	1	0	0.00	    $0.00	Y	
K	25491	PROPHYLACTIC TX ULNA                    	    22.27	  $829.11	      ---	 $1045.58	004	1	0	0.00	    $0.00	Y	
O	25491	PROPHYLACTIC TX ULNA                    	     4.45	  $165.67	      ---	  $208.93	004	1	0	0.00	    $0.00	Y	
O	25492	PROPHYLACTIC TX RADIUS&ULNA             	     5.29	  $196.95	      ---	  $248.37	004	1	0	0.00	    $0.00	Y	
K	25492	PROPHYLACTIC TX RADIUS&ULNA             	    26.44	  $984.36	      ---	 $1241.36	004	1	0	0.00	    $0.00	Y	
K	25500	CLTX RDL SHFT FX W/O MNPJ               	   148.06	  $148.06	      ---	       --	042	0	1	0.00	    $0.00	Y	
O	25500	CLTX RDL SHFT FX W/O MNPJ               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	25505	CLTX RDL SHFT FX W/MNPJ                 	     6.76	  $251.67	      ---	  $317.38	004	1	0	0.00	    $0.00	Y	
K	25515	OPTX RADIAL SHAFT FRACTURE              	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	25515	OPTX RADIAL SHAFT FRACTURE              	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
O	25520	CLTX RDL SHFT FX&DISLC                  	     1.74	   $64.78	      ---	   $81.69	004	1	0	0.00	    $0.00	Y	
K	25520	CLTX RDL SHFT FX&DISLC                  	     8.70	  $323.90	      ---	  $408.47	004	1	0	0.00	    $0.00	Y	
K	25525	OPTX RDL SHFT FX&CLTX RAD/UL            	    16.92	  $629.93	      ---	  $794.39	004	1	0	0.00	    $0.00	Y	
O	25525	OPTX RDL SHFT FX&CLTX RAD/UL            	     3.39	  $126.21	      ---	  $159.16	004	1	0	0.00	    $0.00	Y	
O	25526	OPTX RDL SHFT FX&DSTL RAD/UL            	     3.60	  $134.03	      ---	  $169.02	004	1	0	0.00	    $0.00	Y	
K	25526	OPTX RDL SHFT FX&DSTL RAD/UL            	    17.99	  $669.77	      ---	  $844.63	004	1	0	0.00	    $0.00	Y	
K	25530	CLTX ULNAR SHFT FX W/O MNPJ             	   142.50	  $142.50	      ---	       --	042	0	1	0.00	    $0.00	Y	
O	25530	CLTX ULNAR SHFT FX W/O MNPJ             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	25535	CLTX ULNAR SHFT FX W/MNPJ               	     6.64	  $247.21	      ---	  $311.75	004	1	0	0.00	    $0.00	Y	
K	25545	OPTX ULNAR SHFT FX INT FIXJ             	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	25545	OPTX ULNAR SHFT FX INT FIXJ             	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
O	25560	CLTX RDL&ULN SHFT FX WO MNPJ            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	25560	CLTX RDL&ULN SHFT FX WO MNPJ            	   148.97	  $148.97	      ---	       --	042	0	1	0.00	    $0.00	Y	
K	25565	CLTX RDL&ULN SHFT FX W/MNPJ             	     7.14	  $265.82	      ---	  $335.22	004	1	0	0.00	    $0.00	Y	
O	25565	CLTX RDL&ULN SHFT FX W/MNPJ             	     1.43	   $53.24	      ---	   $67.14	004	1	0	0.00	    $0.00	Y	
O	25574	OPTX RDL&ULN SHFT FX RDS/ULN            	     2.58	   $96.05	      ---	  $121.13	004	1	0	0.00	    $0.00	Y	
K	25574	OPTX RDL&ULN SHFT FX RDS/ULN            	    12.91	  $480.64	      ---	  $606.12	004	1	0	0.00	    $0.00	Y	
K	25575	OPTX RDL&ULN SHFT FX RDS&ULN            	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	25575	OPTX RDL&ULN SHFT FX RDS&ULN            	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
O	25600	CLTX DST RDL FX/EPHYS SEP WO            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	25600	CLTX DST RDL FX/EPHYS SEP WO            	   157.38	  $157.38	      ---	       --	042	0	1	0.00	    $0.00	Y	
K	25605	CLTX DST RDL FX/EPHYS SEP W/            	     7.29	  $271.41	      ---	  $342.27	004	1	0	0.00	    $0.00	Y	
K	25606	PERQ SKEL FIXJ DSTL RDL FX              	    13.97	  $520.10	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	25606	PERQ SKEL FIXJ DSTL RDL FX              	     2.79	  $103.87	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	25607	OPTX DST RD XARTC FX/EPI SEP            	     3.11	  $115.79	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	25607	OPTX DST RD XARTC FX/EPI SEP            	    15.56	  $579.30	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	25608	OPTX DST RD XART FX/EPI SEP2            	    17.72	  $659.72	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	25608	OPTX DST RD XART FX/EPI SEP2            	     3.54	  $131.79	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	25609	OPTX DST RD XART FX/EP SEP3+            	     4.52	  $168.28	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	25609	OPTX DST RD XART FX/EP SEP3+            	    22.59	  $841.03	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	25622	CLTX CARPL SCPHD FX W/O MNPJ            	     4.20	  $156.37	      ---	  $197.19	004	1	0	0.00	    $0.00	Y	
K	25624	CLTX CARPL SCPHD FX W/MNPJ              	     6.34	  $236.04	      ---	  $297.66	004	1	0	0.00	    $0.00	Y	
K	25628	OPTX CARPL SCPHD FX INT FIXJ            	    14.89	  $554.35	      ---	  $699.09	004	1	0	0.00	    $0.00	Y	
O	25628	OPTX CARPL SCPHD FX INT FIXJ            	     2.98	  $110.95	      ---	  $139.91	004	1	0	0.00	    $0.00	Y	
O	25630	CLTX CARPL FX W/O MNPJ EA B1            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	25630	CLTX CARPL FX W/O MNPJ EA B1            	   163.65	  $163.65	      ---	       --	042	0	1	0.00	    $0.00	Y	
K	25635	CLTX CARPL FX W/MNPJ EA B1              	     6.19	  $230.45	      ---	  $290.62	004	1	0	0.00	    $0.00	Y	
K	25645	OPTX CRPL FX OTH/THN SCPH EA            	     7.12	  $265.08	      ---	  $334.28	004	1	0	0.00	    $0.00	Y	
O	25645	OPTX CRPL FX OTH/THN SCPH EA            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	25650	CLTX ULNAR STYLOID FRACTURE             	     8.35	  $310.87	      ---	  $392.03	004	1	0	0.00	    $0.00	Y	
K	25651	PERQ SKEL FIX ULNAR STYLD FX            	     8.60	  $320.18	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	25651	PERQ SKEL FIX ULNAR STYLD FX            	     1.72	   $64.04	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	25652	OPTX ULNAR STYLOID FRACTURE             	     2.55	   $94.94	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	25652	OPTX ULNAR STYLOID FRACTURE             	    12.75	  $474.68	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	25660	CLTX RDCRPL/NTRCRPL DISLC 1+            	     4.51	  $167.91	      ---	  $211.74	004	1	1	0.00	    $0.00	Y	
K	25670	OPTX RDCRPL/NTRCRPL DISLC 1+            	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	25670	OPTX RDCRPL/NTRCRPL DISLC 1+            	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
O	25671	PERQ SKEL FIX RAD/ULN DISLC             	     2.11	   $78.56	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	25671	PERQ SKEL FIX RAD/ULN DISLC             	    10.55	  $392.78	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	25675	CLTX DSTL RAD/ULN DISLC MNPJ            	     6.17	  $229.71	      ---	  $289.68	004	1	0	0.00	    $0.00	Y	
K	25676	OPTX RAD/ULN DISLC AQT/CHRNC            	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	25676	OPTX RAD/ULN DISLC AQT/CHRNC            	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
O	25680	CLTX TRNS-SCPHPRLNR FX MNPJ             	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
K	25680	CLTX TRNS-SCPHPRLNR FX MNPJ             	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
K	25685	OPTX TRNS-SCPHPRLNR FX DISLC            	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	25685	OPTX TRNS-SCPHPRLNR FX DISLC            	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	25690	CLTX LUNATE DISLC W/MNPJ                	     6.23	  $231.94	      ---	  $292.50	004	1	1	0.00	    $0.00	Y	
K	25695	OPTX LUNATE DISLOCATION                 	     9.40	  $349.96	      ---	  $441.33	004	1	0	0.00	    $0.00	Y	
O	25695	OPTX LUNATE DISLOCATION                 	     1.88	   $69.99	      ---	   $88.27	004	1	0	0.00	    $0.00	Y	
O	25800	ARTHRD WRIST COMPLETE WO GRF            	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	25800	ARTHRD WRIST COMPLETE WO GRF            	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	25805	ARTHRD WRIST W/SLIDING GRAFT            	    19.36	  $720.77	      ---	  $908.95	004	1	0	0.00	    $0.00	Y	
O	25805	ARTHRD WRIST W/SLIDING GRAFT            	     3.87	  $144.08	      ---	  $181.70	004	1	0	0.00	    $0.00	Y	
O	25810	ARTHRD WRST ILIAC/OTH AGRFT             	     3.62	  $134.77	      ---	  $169.96	004	1	0	0.00	    $0.00	Y	
K	25810	ARTHRD WRST ILIAC/OTH AGRFT             	    18.08	  $673.12	      ---	  $848.86	004	1	0	0.00	    $0.00	Y	
K	25820	ARTHRD WRIST LMTD W/O B1 GRF            	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	25820	ARTHRD WRIST LMTD W/O B1 GRF            	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
O	25825	ARTHRD WRIST WITH AUTOGRAFT             	     3.26	  $121.37	      ---	  $153.06	004	1	0	0.00	    $0.00	Y	
K	25825	ARTHRD WRIST WITH AUTOGRAFT             	    16.32	  $607.59	      ---	  $766.22	004	1	0	0.00	    $0.00	Y	
K	25830	ARTHRD DST RAD/UL JT SGM RSC            	    11.23	  $418.09	      ---	  $527.25	004	1	0	0.00	    $0.00	Y	
O	25830	ARTHRD DST RAD/UL JT SGM RSC            	     2.24	   $83.40	      ---	  $105.17	004	1	0	0.00	    $0.00	Y	
O	25900	AMPUTATION OF FOREARM                   	     2.04	   $75.95	      ---	   $95.78	004	1	0	0.00	    $0.00	Y	
K	25900	AMPUTATION OF FOREARM                   	    10.19	  $379.37	      ---	  $478.42	004	1	0	0.00	    $0.00	Y	
K	25905	AMPUTATION OF FOREARM                   	    10.56	  $393.15	      ---	  $495.79	004	1	0	0.00	    $0.00	Y	
O	25905	AMPUTATION OF FOREARM                   	     2.11	   $78.56	      ---	   $99.06	004	1	0	0.00	    $0.00	Y	
O	25907	AMPUTATION FOLLOW-UP SURGERY            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	25907	AMPUTATION FOLLOW-UP SURGERY            	     9.86	  $367.09	      ---	  $462.93	004	1	0	0.00	    $0.00	Y	
K	25909	AMPUTATION FOLLOW-UP SURGERY            	    10.35	  $385.33	      ---	  $485.93	004	1	0	0.00	    $0.00	Y	
O	25909	AMPUTATION FOLLOW-UP SURGERY            	     2.07	   $77.07	      ---	   $97.19	004	1	0	0.00	    $0.00	Y	
O	25915	AMPUTATION OF FOREARM                   	     6.34	  $236.04	      ---	  $297.66	004	1	0	0.00	    $0.00	Y	
K	25915	AMPUTATION OF FOREARM                   	    31.69	 $1179.82	      ---	 $1487.85	004	1	0	0.00	    $0.00	Y	
K	25920	AMPUTATE HAND AT WRIST                  	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	25920	AMPUTATE HAND AT WRIST                  	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
O	25922	AMPUTATE HAND AT WRIST                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	25922	AMPUTATE HAND AT WRIST                  	     7.36	  $274.01	      ---	  $345.55	004	1	0	0.00	    $0.00	Y	
K	25924	AMPUTATION FOLLOW-UP SURGERY            	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	25924	AMPUTATION FOLLOW-UP SURGERY            	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
O	25927	AMPUTATION OF HAND                      	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	25927	AMPUTATION OF HAND                      	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	25929	AMPUTATION FOLLOW-UP SURGERY            	     7.17	  $266.94	      ---	  $336.63	004	1	0	0.00	    $0.00	Y	
O	25929	AMPUTATION FOLLOW-UP SURGERY            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	25931	AMPUTATION FOLLOW-UP SURGERY            	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	25931	AMPUTATION FOLLOW-UP SURGERY            	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	25999	UNLISTED PX FOREARM/WRIST               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	25999	UNLISTED PX FOREARM/WRIST               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	26010	DRAINAGE OF FINGER ABSCESS              	     2.81	  $104.62	      ---	  $131.93	004	1	1	0.00	    $0.00	Y	
K	26011	DRAINAGE OF FINGER ABSCESS              	     3.81	  $141.85	      ---	  $178.88	004	1	1	0.00	    $0.00	Y	
O	26011	DRAINAGE OF FINGER ABSCESS              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	26020	DRAIN HAND TENDON SHEATH                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	26020	DRAIN HAND TENDON SHEATH                	     6.88	  $256.14	      ---	  $323.02	004	1	0	0.00	    $0.00	Y	
K	26025	DRAINAGE OF PALM BURSA                  	     6.99	  $260.24	      ---	  $328.18	004	1	0	0.00	    $0.00	Y	
O	26025	DRAINAGE OF PALM BURSA                  	     1.40	   $52.12	      ---	   $65.73	004	1	0	0.00	    $0.00	Y	
O	26030	DRAINAGE OF PALM BURSAS                 	     2.91	  $108.34	      ---	  $136.62	004	1	0	0.00	    $0.00	Y	
K	26030	DRAINAGE OF PALM BURSAS                 	    14.55	  $541.70	      ---	  $683.12	004	1	0	0.00	    $0.00	Y	
K	26034	TREAT HAND BONE LESION                  	     8.53	  $317.57	      ---	  $400.48	004	1	0	0.00	    $0.00	Y	
O	26034	TREAT HAND BONE LESION                  	     1.71	   $63.66	      ---	   $80.28	004	1	0	0.00	    $0.00	Y	
O	26035	DECOMPRESS FINGERS/HAND                 	     4.40	  $163.81	      ---	  $206.58	004	1	0	0.00	    $0.00	Y	
K	26035	DECOMPRESS FINGERS/HAND                 	    21.98	  $818.32	      ---	 $1031.96	004	1	0	0.00	    $0.00	Y	
K	26037	DECOMPRESS FINGERS/HAND                 	     8.34	  $310.50	      ---	  $391.56	004	1	0	0.00	    $0.00	Y	
O	26037	DECOMPRESS FINGERS/HAND                 	     1.67	   $62.17	      ---	   $78.41	004	1	0	0.00	    $0.00	Y	
O	26040	RELEASE PALM CONTRACTURE                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	26040	RELEASE PALM CONTRACTURE                	     6.09	  $226.73	      ---	  $285.93	004	1	0	0.00	    $0.00	Y	
K	26045	RELEASE PALM CONTRACTURE                	     7.77	  $289.28	      ---	  $364.80	004	1	0	0.00	    $0.00	Y	
O	26045	RELEASE PALM CONTRACTURE                	     1.55	   $57.71	      ---	   $72.77	004	1	0	0.00	    $0.00	Y	
O	26055	INCISE FINGER TENDON SHEATH             	     1.13	   $42.07	      ---	   $53.05	004	1	0	0.00	    $0.00	Y	
K	26055	INCISE FINGER TENDON SHEATH             	     5.66	  $210.72	      ---	  $265.74	004	1	0	0.00	    $0.00	Y	
K	26060	INCISION OF FINGER TENDON               	     4.24	  $157.86	      ---	  $199.07	004	1	0	0.00	    $0.00	Y	
O	26060	INCISION OF FINGER TENDON               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	26070	EXPLORE/TREAT HAND JOINT                	     1.21	   $45.05	      ---	   $56.81	004	1	0	0.00	    $0.00	Y	
K	26070	EXPLORE/TREAT HAND JOINT                	     6.03	  $224.50	      ---	  $283.11	004	1	0	0.00	    $0.00	Y	
K	26075	EXPLORE/TREAT FINGER JOINT              	     6.31	  $234.92	      ---	  $296.25	004	1	0	0.00	    $0.00	Y	
O	26075	EXPLORE/TREAT FINGER JOINT              	     1.26	   $46.91	      ---	   $59.16	004	1	0	0.00	    $0.00	Y	
O	26080	EXPLORE/TREAT FINGER JOINT              	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
K	26080	EXPLORE/TREAT FINGER JOINT              	     6.78	  $252.42	      ---	  $318.32	004	1	0	0.00	    $0.00	Y	
K	26100	BIOPSY HAND JOINT LINING                	     5.66	  $210.72	      ---	  $265.74	004	1	0	0.00	    $0.00	Y	
O	26100	BIOPSY HAND JOINT LINING                	     1.13	   $42.07	      ---	   $53.05	004	1	0	0.00	    $0.00	Y	
O	26105	BIOPSY FINGER JOINT LINING              	     1.30	   $48.40	      ---	   $61.04	004	1	0	0.00	    $0.00	Y	
K	26105	BIOPSY FINGER JOINT LINING              	     6.49	  $241.62	      ---	  $304.71	004	1	0	0.00	    $0.00	Y	
K	26110	BIOPSY FINGER JOINT LINING              	     6.13	  $228.22	      ---	  $287.80	004	1	0	0.00	    $0.00	Y	
O	26110	BIOPSY FINGER JOINT LINING              	     1.22	   $45.42	      ---	   $57.28	004	1	0	0.00	    $0.00	Y	
O	26111	EXC HAND LES SC 1.5 CM/>                	     1.84	   $68.50	      ---	   $86.39	004	1	0	0.00	    $0.00	Y	
K	26111	EXC HAND LES SC 1.5 CM/>                	     9.22	  $343.26	      ---	  $432.88	004	1	0	0.00	    $0.00	Y	
K	26113	EXC HAND TUM DEEP 1.5 CM/>              	    12.14	  $451.97	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	26113	EXC HAND TUM DEEP 1.5 CM/>              	     2.43	   $90.47	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	26115	EXC HAND LES SC < 1.5 CM                	     4.78	  $177.96	      ---	  $224.42	004	1	1	0.00	    $0.00	Y	
K	26116	EXC HAND TUM DEEP < 1.5 CM              	     7.71	  $287.04	      ---	  $361.98	004	1	0	0.00	    $0.00	Y	
O	26116	EXC HAND TUM DEEP < 1.5 CM              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	26117	RAD RESECT HAND TUMOR < 3 CM            	     3.69	  $137.38	      ---	  $173.25	004	1	0	0.00	    $0.00	Y	
K	26117	RAD RESECT HAND TUMOR < 3 CM            	    18.45	  $686.89	      ---	  $866.23	004	1	0	0.00	    $0.00	Y	
K	26118	RAD RESECT HAND TUMOR 3 CM/>            	    23.59	  $878.26	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	26118	RAD RESECT HAND TUMOR 3 CM/>            	     4.72	  $175.73	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	26121	RELEASE PALM CONTRACTURE                	     1.89	   $70.36	      ---	   $88.74	004	1	0	0.00	    $0.00	Y	
K	26121	RELEASE PALM CONTRACTURE                	     9.43	  $351.08	      ---	  $442.74	004	1	0	0.00	    $0.00	Y	
K	26123	RELEASE PALM CONTRACTURE                	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	26123	RELEASE PALM CONTRACTURE                	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	26125	RELEASE PALM CONTRACTURE                	     1.13	   $42.07	      ---	   $53.05	004	1	0	0.00	    $0.00	Y	
K	26125	RELEASE PALM CONTRACTURE                	     5.66	  $210.72	      ---	  $265.74	004	1	0	0.00	    $0.00	Y	
K	26130	REMOVE WRIST JOINT LINING               	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	26130	REMOVE WRIST JOINT LINING               	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	26135	REVISE FINGER JOINT EACH                	     1.93	   $71.85	      ---	   $90.61	004	1	0	0.00	    $0.00	Y	
K	26135	REVISE FINGER JOINT EACH                	     9.66	  $359.64	      ---	  $453.54	004	1	0	0.00	    $0.00	Y	
K	26140	REVISE FINGER JOINT EACH                	     8.86	  $329.86	      ---	  $415.98	004	1	0	0.00	    $0.00	Y	
O	26140	REVISE FINGER JOINT EACH                	     1.77	   $65.90	      ---	   $83.10	004	1	0	0.00	    $0.00	Y	
O	26145	TENDON EXCISION PALM/FINGER             	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	26145	TENDON EXCISION PALM/FINGER             	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	26160	REMOVE TENDON SHEATH LESION             	     4.41	  $164.18	      ---	  $207.05	004	1	0	0.00	    $0.00	Y	
O	26160	REMOVE TENDON SHEATH LESION             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	26170	REMOVAL OF PALM TENDON EACH             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	26170	REMOVAL OF PALM TENDON EACH             	     5.62	  $209.23	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	26180	REMOVAL OF FINGER TENDON                	     5.94	  $221.15	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	26180	REMOVAL OF FINGER TENDON                	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	26185	REMOVE FINGER BONE                      	     1.52	   $56.59	      ---	   $71.36	004	1	0	0.00	    $0.00	Y	
K	26185	REMOVE FINGER BONE                      	     7.61	  $283.32	      ---	  $357.29	004	1	0	0.00	    $0.00	Y	
K	26200	REMOVE HAND BONE LESION                 	     7.76	  $288.90	      ---	  $364.33	004	1	0	0.00	    $0.00	Y	
O	26200	REMOVE HAND BONE LESION                 	     1.55	   $57.71	      ---	   $72.77	004	1	0	0.00	    $0.00	Y	
O	26205	REMOVE/GRAFT BONE LESION                	     1.86	   $69.25	      ---	   $87.33	004	1	0	0.00	    $0.00	Y	
K	26205	REMOVE/GRAFT BONE LESION                	     9.32	  $346.98	      ---	  $437.57	004	1	0	0.00	    $0.00	Y	
K	26210	REMOVAL OF FINGER LESION                	     7.68	  $285.93	      ---	  $360.58	004	1	0	0.00	    $0.00	Y	
O	26210	REMOVAL OF FINGER LESION                	     1.54	   $57.33	      ---	   $72.30	004	1	0	0.00	    $0.00	Y	
O	26215	REMOVE/GRAFT FINGER LESION              	     1.79	   $66.64	      ---	   $84.04	004	1	0	0.00	    $0.00	Y	
K	26215	REMOVE/GRAFT FINGER LESION              	     8.94	  $332.84	      ---	  $419.73	004	1	0	0.00	    $0.00	Y	
K	26230	PARTIAL REMOVAL OF HAND BONE            	     8.00	  $297.84	      ---	  $375.60	004	1	0	0.00	    $0.00	Y	
O	26230	PARTIAL REMOVAL OF HAND BONE            	     1.60	   $59.57	      ---	   $75.12	004	1	0	0.00	    $0.00	Y	
O	26235	PARTIAL REMOVAL FINGER BONE             	     1.53	   $56.96	      ---	   $71.83	004	1	0	0.00	    $0.00	Y	
K	26235	PARTIAL REMOVAL FINGER BONE             	     7.66	  $285.18	      ---	  $359.64	004	1	0	0.00	    $0.00	Y	
K	26236	PARTIAL REMOVAL FINGER BONE             	     7.14	  $265.82	      ---	  $335.22	004	1	0	0.00	    $0.00	Y	
O	26236	PARTIAL REMOVAL FINGER BONE             	     1.43	   $53.24	      ---	   $67.14	004	1	0	0.00	    $0.00	Y	
O	26250	EXTENSIVE HAND SURGERY                  	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	26250	EXTENSIVE HAND SURGERY                  	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	26260	RESECT PROX FINGER TUMOR                	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	26260	RESECT PROX FINGER TUMOR                	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	26262	RESECT DISTAL FINGER TUMOR              	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	26262	RESECT DISTAL FINGER TUMOR              	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	26320	REMOVAL OF IMPLANT FROM HAND            	     7.93	  $295.23	      ---	  $372.31	004	1	1	0.00	    $0.00	Y	
O	26320	REMOVAL OF IMPLANT FROM HAND            	     1.59	   $59.20	      ---	   $74.65	004	1	0	0.00	    $0.00	Y	
K	26340	MANIPULATE FINGER W/ANESTH              	     6.16	  $229.34	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	26341	MANIPULAT PALM CORD POST INJ            	     1.71	   $63.66	      ---	   $80.28	004	1	1	0.00	    $0.00	Y	
K	26350	REPAIR FINGER/HAND TENDON               	    10.11	  $376.40	      ---	  $474.66	004	1	0	0.00	    $0.00	Y	
O	26350	REPAIR FINGER/HAND TENDON               	     2.02	   $75.20	      ---	   $94.84	004	1	0	0.00	    $0.00	Y	
O	26352	REPAIR/GRAFT HAND TENDON                	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
K	26352	REPAIR/GRAFT HAND TENDON                	    15.63	  $581.90	      ---	  $733.83	004	1	0	0.00	    $0.00	Y	
K	26356	REPAIR FINGER/HAND TENDON               	    11.64	  $433.36	      ---	  $546.50	004	1	0	0.00	    $0.00	Y	
O	26356	REPAIR FINGER/HAND TENDON               	     2.33	   $86.75	      ---	  $109.39	004	1	0	0.00	    $0.00	Y	
O	26357	REPAIR FINGER/HAND TENDON               	     2.37	   $88.24	      ---	  $111.27	004	1	0	0.00	    $0.00	Y	
K	26357	REPAIR FINGER/HAND TENDON               	    11.86	  $441.55	      ---	  $556.83	004	1	0	0.00	    $0.00	Y	
K	26358	REPAIR/GRAFT HAND TENDON                	    16.08	  $598.66	      ---	  $754.96	004	1	0	0.00	    $0.00	Y	
O	26358	REPAIR/GRAFT HAND TENDON                	     3.22	  $119.88	      ---	  $151.18	004	1	0	0.00	    $0.00	Y	
O	26370	REPAIR FINGER/HAND TENDON               	     2.18	   $81.16	      ---	  $102.35	004	1	0	0.00	    $0.00	Y	
K	26370	REPAIR FINGER/HAND TENDON               	    10.90	  $405.81	      ---	  $511.76	004	1	0	0.00	    $0.00	Y	
K	26372	REPAIR/GRAFT HAND TENDON                	    15.63	  $581.90	      ---	  $733.83	004	1	0	0.00	    $0.00	Y	
O	26372	REPAIR/GRAFT HAND TENDON                	     3.13	  $116.53	      ---	  $146.95	004	1	0	0.00	    $0.00	Y	
O	26373	REPAIR FINGER/HAND TENDON               	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	26373	REPAIR FINGER/HAND TENDON               	    11.36	  $422.93	      ---	  $533.35	004	1	0	0.00	    $0.00	Y	
K	26390	REVISE HAND/FINGER TENDON               	    10.66	  $396.87	      ---	  $500.49	004	1	0	0.00	    $0.00	Y	
O	26390	REVISE HAND/FINGER TENDON               	     2.13	   $79.30	      ---	  $100.00	004	1	0	0.00	    $0.00	Y	
O	26392	REPAIR/GRAFT HAND TENDON                	     2.87	  $106.85	      ---	  $134.75	004	1	0	0.00	    $0.00	Y	
K	26392	REPAIR/GRAFT HAND TENDON                	    14.50	  $539.84	      ---	  $680.78	004	1	0	0.00	    $0.00	Y	
K	26410	REPAIR HAND TENDON                      	     8.02	  $298.58	      ---	  $376.54	004	1	0	0.00	    $0.00	Y	
O	26410	REPAIR HAND TENDON                      	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	26412	REPAIR/GRAFT HAND TENDON                	     1.89	   $70.36	      ---	   $88.74	004	1	0	0.00	    $0.00	Y	
K	26412	REPAIR/GRAFT HAND TENDON                	     9.45	  $351.82	      ---	  $443.68	004	1	0	0.00	    $0.00	Y	
K	26415	EXCISION HAND/FINGER TENDON             	    19.03	  $708.49	      ---	  $893.46	004	1	0	0.00	    $0.00	Y	
O	26415	EXCISION HAND/FINGER TENDON             	     3.81	  $141.85	      ---	  $178.88	004	1	0	0.00	    $0.00	Y	
O	26416	GRAFT HAND OR FINGER TENDON             	     2.99	  $111.32	      ---	  $140.38	004	1	0	0.00	    $0.00	Y	
K	26416	GRAFT HAND OR FINGER TENDON             	    15.11	  $562.55	      ---	  $709.41	004	1	0	0.00	    $0.00	Y	
K	26418	REPAIR FINGER TENDON                    	     7.87	  $293.00	      ---	  $369.50	004	1	0	0.00	    $0.00	Y	
O	26418	REPAIR FINGER TENDON                    	     1.57	   $58.45	      ---	   $73.71	004	1	0	0.00	    $0.00	Y	
O	26420	REPAIR/GRAFT FINGER TENDON              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	26420	REPAIR/GRAFT FINGER TENDON              	    10.72	  $399.11	      ---	  $503.30	004	1	0	0.00	    $0.00	Y	
K	26426	REPAIR FINGER/HAND TENDON               	     9.08	  $338.05	      ---	  $426.31	004	1	0	0.00	    $0.00	Y	
O	26426	REPAIR FINGER/HAND TENDON               	     1.82	   $67.76	      ---	   $85.45	004	1	0	0.00	    $0.00	Y	
O	26428	REPAIR/GRAFT FINGER TENDON              	     2.49	   $92.70	      ---	  $116.91	004	1	0	0.00	    $0.00	Y	
K	26428	REPAIR/GRAFT FINGER TENDON              	    12.46	  $463.89	      ---	  $585.00	004	1	0	0.00	    $0.00	Y	
K	26432	REPAIR FINGER TENDON                    	     6.73	  $250.56	      ---	  $315.97	004	1	0	0.00	    $0.00	Y	
O	26432	REPAIR FINGER TENDON                    	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	26433	REPAIR FINGER TENDON                    	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	26433	REPAIR FINGER TENDON                    	    13.62	  $507.07	      ---	  $639.46	004	1	0	0.00	    $0.00	Y	
K	26434	REPAIR/GRAFT FINGER TENDON              	     8.16	  $303.80	      ---	  $383.11	004	1	0	0.00	    $0.00	Y	
O	26434	REPAIR/GRAFT FINGER TENDON              	     1.63	   $60.68	      ---	   $76.53	004	1	0	0.00	    $0.00	Y	
O	26437	REALIGNMENT OF TENDONS                  	     2.98	  $110.95	      ---	  $139.91	004	1	0	0.00	    $0.00	Y	
K	26437	REALIGNMENT OF TENDONS                  	    14.89	  $554.35	      ---	  $699.09	004	1	0	0.00	    $0.00	Y	
K	26440	RELEASE PALM/FINGER TENDON              	     9.14	  $340.28	      ---	  $429.12	004	1	0	0.00	    $0.00	Y	
O	26440	RELEASE PALM/FINGER TENDON              	     1.83	   $68.13	      ---	   $85.92	004	1	0	0.00	    $0.00	Y	
O	26442	RELEASE PALM & FINGER TENDON            	     2.28	   $84.88	      ---	  $107.05	004	1	0	0.00	    $0.00	Y	
K	26442	RELEASE PALM & FINGER TENDON            	    11.38	  $423.68	      ---	  $534.29	004	1	0	0.00	    $0.00	Y	
K	26445	RELEASE HAND/FINGER TENDON              	     8.70	  $323.90	      ---	  $408.47	004	1	0	0.00	    $0.00	Y	
O	26445	RELEASE HAND/FINGER TENDON              	     1.74	   $64.78	      ---	   $81.69	004	1	0	0.00	    $0.00	Y	
O	26449	RELEASE FOREARM/HAND TENDON             	     3.85	  $143.34	      ---	  $180.76	004	1	0	0.00	    $0.00	Y	
K	26449	RELEASE FOREARM/HAND TENDON             	    19.24	  $716.31	      ---	  $903.32	004	1	0	0.00	    $0.00	Y	
K	26450	INCISION OF PALM TENDON                 	     4.89	  $182.05	      ---	  $229.59	004	1	0	0.00	    $0.00	Y	
O	26450	INCISION OF PALM TENDON                 	     0.98	   $36.49	      ---	   $46.01	004	1	0	0.00	    $0.00	Y	
O	26455	INCISION OF FINGER TENDON               	     1.13	   $42.07	      ---	   $53.05	004	1	0	0.00	    $0.00	Y	
K	26455	INCISION OF FINGER TENDON               	     5.66	  $210.72	      ---	  $265.74	004	1	0	0.00	    $0.00	Y	
K	26460	INCISE HAND/FINGER TENDON               	     4.62	  $172.00	      ---	  $216.91	004	1	0	0.00	    $0.00	Y	
O	26460	INCISE HAND/FINGER TENDON               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	26471	FUSION OF FINGER TENDONS                	     1.59	   $59.20	      ---	   $74.65	004	1	0	0.00	    $0.00	Y	
K	26471	FUSION OF FINGER TENDONS                	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
K	26474	FUSION OF FINGER TENDONS                	     7.70	  $286.67	      ---	  $361.52	004	1	0	0.00	    $0.00	Y	
O	26474	FUSION OF FINGER TENDONS                	     1.54	   $57.33	      ---	   $72.30	004	1	0	0.00	    $0.00	Y	
O	26476	TENDON LENGTHENING                      	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
K	26476	TENDON LENGTHENING                      	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
K	26477	TENDON SHORTENING                       	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	26477	TENDON SHORTENING                       	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
O	26478	LENGTHENING OF HAND TENDON              	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
K	26478	LENGTHENING OF HAND TENDON              	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
K	26479	SHORTENING OF HAND TENDON               	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	26479	SHORTENING OF HAND TENDON               	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
O	26480	TRANSPLANT HAND TENDON                  	     2.06	   $76.69	      ---	   $96.72	004	1	0	0.00	    $0.00	Y	
K	26480	TRANSPLANT HAND TENDON                  	    10.30	  $383.47	      ---	  $483.59	004	1	0	0.00	    $0.00	Y	
K	26483	TRANSPLANT/GRAFT HAND TENDON            	    12.46	  $463.89	      ---	  $585.00	004	1	0	0.00	    $0.00	Y	
O	26483	TRANSPLANT/GRAFT HAND TENDON            	     2.49	   $92.70	      ---	  $116.91	004	1	0	0.00	    $0.00	Y	
O	26485	TRANSPLANT PALM TENDON                  	     2.31	   $86.00	      ---	  $108.45	004	1	0	0.00	    $0.00	Y	
K	26485	TRANSPLANT PALM TENDON                  	    11.55	  $430.01	      ---	  $542.27	004	1	0	0.00	    $0.00	Y	
K	26489	TRANSPLANT/GRAFT PALM TENDON            	    12.46	  $463.89	      ---	  $585.00	004	1	0	0.00	    $0.00	Y	
O	26489	TRANSPLANT/GRAFT PALM TENDON            	     2.49	   $92.70	      ---	  $116.91	004	1	0	0.00	    $0.00	Y	
O	26490	REVISE THUMB TENDON                     	     2.15	   $80.04	      ---	  $100.94	004	1	0	0.00	    $0.00	Y	
K	26490	REVISE THUMB TENDON                     	    10.76	  $400.59	      ---	  $505.18	004	1	0	0.00	    $0.00	Y	
K	26492	TENDON TRANSFER WITH GRAFT              	    12.46	  $463.89	      ---	  $585.00	004	1	0	0.00	    $0.00	Y	
O	26492	TENDON TRANSFER WITH GRAFT              	     2.49	   $92.70	      ---	  $116.91	004	1	0	0.00	    $0.00	Y	
O	26494	HAND TENDON/MUSCLE TRANSFER             	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	26494	HAND TENDON/MUSCLE TRANSFER             	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	26496	REVISE THUMB TENDON                     	    21.05	  $783.69	      ---	  $988.30	004	1	0	0.00	    $0.00	Y	
O	26496	REVISE THUMB TENDON                     	     4.21	  $156.74	      ---	  $197.66	004	1	0	0.00	    $0.00	Y	
O	26497	FINGER TENDON TRANSFER                  	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	26497	FINGER TENDON TRANSFER                  	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	26498	FINGER TENDON TRANSFER                  	    16.99	  $632.54	      ---	  $797.68	004	1	0	0.00	    $0.00	Y	
O	26498	FINGER TENDON TRANSFER                  	     3.40	  $126.58	      ---	  $159.63	004	1	0	0.00	    $0.00	Y	
O	26499	REVISION OF FINGER                      	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	26499	REVISION OF FINGER                      	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	26500	HAND TENDON RECONSTRUCTION              	     8.30	  $309.01	      ---	  $389.69	004	1	0	0.00	    $0.00	Y	
O	26500	HAND TENDON RECONSTRUCTION              	     1.66	   $61.80	      ---	   $77.94	004	1	0	0.00	    $0.00	Y	
O	26502	HAND TENDON RECONSTRUCTION              	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
K	26502	HAND TENDON RECONSTRUCTION              	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
K	26508	RELEASE THUMB CONTRACTURE               	     9.40	  $349.96	      ---	  $441.33	004	1	0	0.00	    $0.00	Y	
O	26508	RELEASE THUMB CONTRACTURE               	     1.88	   $69.99	      ---	   $88.27	004	1	0	0.00	    $0.00	Y	
O	26510	THUMB TENDON TRANSFER                   	     3.19	  $118.76	      ---	  $149.77	004	1	0	0.00	    $0.00	Y	
K	26510	THUMB TENDON TRANSFER                   	    15.95	  $593.82	      ---	  $748.85	004	1	0	0.00	    $0.00	Y	
K	26516	FUSION OF KNUCKLE JOINT                 	     8.93	  $332.46	      ---	  $419.26	004	1	0	0.00	    $0.00	Y	
O	26516	FUSION OF KNUCKLE JOINT                 	     1.79	   $66.64	      ---	   $84.04	004	1	0	0.00	    $0.00	Y	
O	26517	FUSION OF KNUCKLE JOINTS                	     2.38	   $88.61	      ---	  $111.74	004	1	0	0.00	    $0.00	Y	
K	26517	FUSION OF KNUCKLE JOINTS                	    11.89	  $442.66	      ---	  $558.24	004	1	0	0.00	    $0.00	Y	
K	26518	FUSION OF KNUCKLE JOINTS                	    14.16	  $527.18	      ---	  $664.81	004	1	0	0.00	    $0.00	Y	
O	26518	FUSION OF KNUCKLE JOINTS                	     2.83	  $105.36	      ---	  $132.87	004	1	0	0.00	    $0.00	Y	
O	26520	RELEASE KNUCKLE CONTRACTURE             	     1.85	   $68.88	      ---	   $86.86	004	1	0	0.00	    $0.00	Y	
K	26520	RELEASE KNUCKLE CONTRACTURE             	     9.27	  $345.12	      ---	  $435.23	004	1	0	0.00	    $0.00	Y	
K	26525	RELEASE FINGER CONTRACTURE              	     9.34	  $347.73	      ---	  $438.51	004	1	0	0.00	    $0.00	Y	
O	26525	RELEASE FINGER CONTRACTURE              	     1.87	   $69.62	      ---	   $87.80	004	1	0	0.00	    $0.00	Y	
O	26530	REVISE KNUCKLE JOINT                    	     2.18	   $81.16	      ---	  $102.35	004	1	0	0.00	    $0.00	Y	
K	26530	REVISE KNUCKLE JOINT                    	    10.88	  $405.06	      ---	  $510.82	004	1	0	0.00	    $0.00	Y	
K	26531	REVISE KNUCKLE WITH IMPLANT             	    11.40	  $424.42	      ---	  $535.23	004	1	0	0.00	    $0.00	Y	
O	26531	REVISE KNUCKLE WITH IMPLANT             	     2.28	   $84.88	      ---	  $107.05	004	1	0	0.00	    $0.00	Y	
O	26535	REVISE FINGER JOINT                     	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
K	26535	REVISE FINGER JOINT                     	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
K	26536	REVISE/IMPLANT FINGER JOINT             	    10.87	  $404.69	      ---	  $510.35	004	1	0	0.00	    $0.00	Y	
O	26536	REVISE/IMPLANT FINGER JOINT             	     2.15	   $80.04	      ---	  $100.94	004	1	0	0.00	    $0.00	Y	
O	26540	REPAIR HAND JOINT                       	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	26540	REPAIR HAND JOINT                       	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	26541	REPAIR HAND JOINT WITH GRAFT            	    13.36	  $497.39	      ---	  $627.25	004	1	0	0.00	    $0.00	Y	
O	26541	REPAIR HAND JOINT WITH GRAFT            	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
O	26542	REPAIR HAND JOINT WITH GRAFT            	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	26542	REPAIR HAND JOINT WITH GRAFT            	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	26545	RECONSTRUCT FINGER JOINT                	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	26545	RECONSTRUCT FINGER JOINT                	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
O	26546	REPAIR NONUNION HAND                    	     2.81	  $104.62	      ---	  $131.93	004	1	0	0.00	    $0.00	Y	
K	26546	REPAIR NONUNION HAND                    	    14.02	  $521.96	      ---	  $658.24	004	1	0	0.00	    $0.00	Y	
K	26548	RECONSTRUCT FINGER JOINT                	     9.95	  $370.44	      ---	  $467.15	004	1	0	0.00	    $0.00	Y	
O	26548	RECONSTRUCT FINGER JOINT                	     1.99	   $74.09	      ---	   $93.43	004	1	0	0.00	    $0.00	Y	
O	26550	POLLICIZATION DIGIT                     	     6.61	  $246.09	      ---	  $310.34	004	1	0	0.00	    $0.00	Y	
K	26550	POLLICIZATION DIGIT                     	    33.05	 $1230.45	      ---	 $1551.70	004	1	0	0.00	    $0.00	Y	
K	26551	GREAT TOE-HAND TRANSFER                 	    66.18	 $2463.88	      ---	 $3107.15	004	1	0	0.00	    $0.00	Y	
O	26551	GREAT TOE-HAND TRANSFER                 	    13.24	  $492.93	      ---	  $621.62	004	1	0	0.00	    $0.00	Y	
O	26553	SINGLE TRANSFER TOE-HAND                	    13.10	  $487.71	      ---	  $615.05	004	1	0	0.00	    $0.00	Y	
K	26553	SINGLE TRANSFER TOE-HAND                	    65.47	 $2437.45	      ---	 $3073.82	004	1	0	0.00	    $0.00	Y	
K	26554	DOUBLE TRANSFER TOE-HAND                	    76.46	 $2846.61	      ---	 $3589.80	004	1	0	0.00	    $0.00	Y	
O	26554	DOUBLE TRANSFER TOE-HAND                	    15.29	  $569.25	      ---	  $717.87	004	1	0	0.00	    $0.00	Y	
O	26555	POSITIONAL CHANGE OF FINGER             	     6.52	  $242.74	      ---	  $306.11	004	1	0	0.00	    $0.00	Y	
K	26555	POSITIONAL CHANGE OF FINGER             	    32.61	 $1214.07	      ---	 $1531.04	004	1	0	0.00	    $0.00	Y	
K	26556	TOE JOINT TRANSFER                      	    69.29	 $2579.67	      ---	 $3253.17	004	1	0	0.00	    $0.00	Y	
O	26556	TOE JOINT TRANSFER                      	    13.85	  $515.64	      ---	  $650.26	004	1	0	0.00	    $0.00	Y	
O	26560	REPAIR OF WEB FINGER                    	     2.15	   $80.04	      ---	  $100.94	004	1	0	0.00	    $0.00	Y	
K	26560	REPAIR OF WEB FINGER                    	    10.76	  $400.59	      ---	  $505.18	004	1	0	0.00	    $0.00	Y	
K	26561	REPAIR OF WEB FINGER                    	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	26561	REPAIR OF WEB FINGER                    	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
O	26562	REPAIR OF WEB FINGER                    	     4.07	  $151.53	      ---	  $191.09	004	1	0	0.00	    $0.00	Y	
K	26562	REPAIR OF WEB FINGER                    	    20.35	  $757.63	      ---	  $955.43	004	1	0	0.00	    $0.00	Y	
K	26565	CORRECT METACARPAL FLAW                 	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	26565	CORRECT METACARPAL FLAW                 	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
O	26567	CORRECT FINGER DEFORMITY                	     1.74	   $64.78	      ---	   $81.69	004	1	0	0.00	    $0.00	Y	
K	26567	CORRECT FINGER DEFORMITY                	     8.68	  $323.16	      ---	  $407.53	004	1	0	0.00	    $0.00	Y	
K	26568	LENGTHEN METACARPAL/FINGER              	    22.64	  $842.89	      ---	 $1062.95	004	1	0	0.00	    $0.00	Y	
O	26568	LENGTHEN METACARPAL/FINGER              	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
O	26580	REPAIR CLEFT HAND                       	     5.70	  $212.21	      ---	  $267.62	004	1	0	0.00	    $0.00	Y	
K	26580	REPAIR CLEFT HAND                       	    28.52	 $1061.80	      ---	 $1339.01	004	1	0	0.00	    $0.00	Y	
K	26587	RECONSTRUCT EXTRA FINGER                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	26587	RECONSTRUCT EXTRA FINGER                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	26590	REPAIR FINGER DEFORMITY                 	     5.92	  $220.40	      ---	  $277.94	004	1	0	0.00	    $0.00	Y	
K	26590	REPAIR FINGER DEFORMITY                 	    29.61	 $1102.38	      ---	 $1390.19	004	1	0	0.00	    $0.00	Y	
K	26591	REPAIR MUSCLES OF HAND                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	26591	REPAIR MUSCLES OF HAND                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	26593	RELEASE MUSCLES OF HAND                 	     3.00	  $111.69	      ---	  $140.85	004	1	0	0.00	    $0.00	Y	
K	26593	RELEASE MUSCLES OF HAND                 	    15.00	  $558.45	      ---	  $704.25	004	1	0	0.00	    $0.00	Y	
K	26596	EXCISION CONSTRICTING TISSUE            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	26596	EXCISION CONSTRICTING TISSUE            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	26600	TREAT METACARPAL FRACTURE               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	26600	TREAT METACARPAL FRACTURE               	   138.83	  $138.83	      ---	       --	042	0	1	0.00	    $0.00	Y	
K	26605	TREAT METACARPAL FRACTURE               	     4.92	  $183.17	      ---	  $230.99	004	1	1	0.00	    $0.00	Y	
O	26605	TREAT METACARPAL FRACTURE               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	26607	TREAT METACARPAL FRACTURE               	    10.92	  $406.55	      ---	  $512.69	004	1	0	0.00	    $0.00	Y	
K	26608	TREAT METACARPAL FRACTURE               	     6.27	  $233.43	      ---	  $294.38	004	1	0	0.00	    $0.00	Y	
O	26608	TREAT METACARPAL FRACTURE               	     1.26	   $46.91	      ---	   $59.16	004	1	0	0.00	    $0.00	Y	
O	26615	TREAT METACARPAL FRACTURE               	     1.59	   $59.20	      ---	   $74.65	004	1	0	0.00	    $0.00	Y	
K	26615	TREAT METACARPAL FRACTURE               	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
K	26641	TREAT THUMB DISLOCATION                 	     5.56	  $207.00	      ---	  $261.04	004	1	1	0.00	    $0.00	Y	
O	26641	TREAT THUMB DISLOCATION                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	26645	TREAT THUMB FRACTURE                    	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	26645	TREAT THUMB FRACTURE                    	     6.18	  $230.08	      ---	  $290.15	004	1	1	0.00	    $0.00	Y	
K	26650	TREAT THUMB FRACTURE                    	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
O	26650	TREAT THUMB FRACTURE                    	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
O	26665	TREAT THUMB FRACTURE                    	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	26665	TREAT THUMB FRACTURE                    	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	26670	TREAT HAND DISLOCATION                  	     5.41	  $201.41	      ---	  $254.00	004	1	1	0.00	    $0.00	Y	
K	26675	TREAT HAND DISLOCATION                  	     5.95	  $221.52	      ---	  $279.35	004	1	0	0.00	    $0.00	Y	
K	26676	PIN HAND DISLOCATION                    	     6.21	  $231.20	      ---	  $291.56	004	1	0	0.00	    $0.00	Y	
K	26685	TREAT HAND DISLOCATION                  	     6.85	  $255.03	      ---	  $321.61	004	1	0	0.00	    $0.00	Y	
O	26685	TREAT HAND DISLOCATION                  	     1.37	   $51.01	      ---	   $64.32	004	1	0	0.00	    $0.00	Y	
O	26686	TREAT HAND DISLOCATION                  	     2.80	  $104.24	      ---	  $131.46	004	1	0	0.00	    $0.00	Y	
K	26686	TREAT HAND DISLOCATION                  	    14.02	  $521.96	      ---	  $658.24	004	1	0	0.00	    $0.00	Y	
K	26700	TREAT KNUCKLE DISLOCATION               	     3.74	  $139.24	      ---	  $175.59	004	1	1	0.00	    $0.00	Y	
K	26705	TREAT KNUCKLE DISLOCATION               	     5.47	  $203.65	      ---	  $256.82	004	1	0	0.00	    $0.00	Y	
K	26706	PIN KNUCKLE DISLOCATION                 	     4.79	  $178.33	      ---	  $224.89	004	1	0	0.00	    $0.00	Y	
K	26715	TREAT KNUCKLE DISLOCATION               	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
O	26715	TREAT KNUCKLE DISLOCATION               	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
K	26720	TREAT FINGER FRACTURE EACH              	    73.68	   $73.68	      ---	       --	042	0	1	0.00	    $0.00	Y	
K	26725	TREAT FINGER FRACTURE EACH              	     3.64	  $135.52	      ---	  $170.90	004	1	1	0.00	    $0.00	Y	
K	26727	TREAT FINGER FRACTURE EACH              	     5.86	  $218.17	      ---	  $275.13	004	1	1	0.00	    $0.00	Y	
O	26727	TREAT FINGER FRACTURE EACH              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	26735	TREAT FINGER FRACTURE EACH              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	26735	TREAT FINGER FRACTURE EACH              	     6.16	  $229.34	      ---	  $289.21	004	1	0	0.00	    $0.00	Y	
K	26740	TREAT FINGER FRACTURE EACH              	     2.38	   $88.61	      ---	  $111.74	004	1	1	0.00	    $0.00	Y	
K	26742	TREAT FINGER FRACTURE EACH              	     5.78	  $215.19	      ---	  $271.37	004	1	1	0.00	    $0.00	Y	
K	26746	TREAT FINGER FRACTURE EACH              	     6.06	  $225.61	      ---	  $284.52	004	1	0	0.00	    $0.00	Y	
O	26746	TREAT FINGER FRACTURE EACH              	     1.21	   $45.05	      ---	   $56.81	004	1	0	0.00	    $0.00	Y	
K	26750	TREAT FINGER FRACTURE EACH              	    81.85	   $81.85	      ---	       --	042	0	1	0.00	    $0.00	Y	
K	26755	TREAT FINGER FRACTURE EACH              	     3.44	  $128.07	      ---	  $161.51	004	1	1	0.00	    $0.00	Y	
K	26756	PIN FINGER FRACTURE EACH                	     9.81	  $365.23	      ---	  $460.58	004	1	0	0.00	    $0.00	Y	
O	26756	PIN FINGER FRACTURE EACH                	     1.96	   $72.97	      ---	   $92.02	004	1	0	0.00	    $0.00	Y	
O	26765	TREAT FINGER FRACTURE EACH              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	26765	TREAT FINGER FRACTURE EACH              	     4.85	  $180.57	      ---	  $227.71	004	1	0	0.00	    $0.00	Y	
K	26770	TREAT FINGER DISLOCATION                	     3.35	  $124.72	      ---	  $157.28	004	1	1	0.00	    $0.00	Y	
K	26775	TREAT FINGER DISLOCATION                	     5.18	  $192.85	      ---	  $243.20	004	1	0	0.00	    $0.00	Y	
K	26776	PIN FINGER DISLOCATION                  	     5.56	  $207.00	      ---	  $261.04	004	1	0	0.00	    $0.00	Y	
K	26785	TREAT FINGER DISLOCATION                	     4.88	  $181.68	      ---	  $229.12	004	1	0	0.00	    $0.00	Y	
O	26785	TREAT FINGER DISLOCATION                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	26820	THUMB FUSION WITH GRAFT                 	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	26820	THUMB FUSION WITH GRAFT                 	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	26841	FUSION OF THUMB                         	     9.09	  $338.42	      ---	  $426.78	004	1	0	0.00	    $0.00	Y	
O	26841	FUSION OF THUMB                         	     1.82	   $67.76	      ---	   $85.45	004	1	0	0.00	    $0.00	Y	
O	26842	THUMB FUSION WITH GRAFT                 	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	26842	THUMB FUSION WITH GRAFT                 	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	26843	FUSION OF HAND JOINT                    	     9.68	  $360.39	      ---	  $454.48	004	1	0	0.00	    $0.00	Y	
O	26843	FUSION OF HAND JOINT                    	     1.94	   $72.23	      ---	   $91.08	004	1	0	0.00	    $0.00	Y	
O	26844	FUSION/GRAFT OF HAND JOINT              	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	26844	FUSION/GRAFT OF HAND JOINT              	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	26850	FUSION OF KNUCKLE                       	     8.84	  $329.11	      ---	  $415.04	004	1	0	0.00	    $0.00	Y	
O	26850	FUSION OF KNUCKLE                       	     1.77	   $65.90	      ---	   $83.10	004	1	0	0.00	    $0.00	Y	
O	26852	FUSION OF KNUCKLE WITH GRAFT            	     2.03	   $75.58	      ---	   $95.31	004	1	0	0.00	    $0.00	Y	
K	26852	FUSION OF KNUCKLE WITH GRAFT            	    10.14	  $377.51	      ---	  $476.07	004	1	0	0.00	    $0.00	Y	
K	26860	FUSION OF FINGER JOINT                  	     7.13	  $265.45	      ---	  $334.75	004	1	0	0.00	    $0.00	Y	
O	26860	FUSION OF FINGER JOINT                  	     1.43	   $53.24	      ---	   $67.14	004	1	0	0.00	    $0.00	Y	
O	26861	FUSION OF FINGER JNT ADD-ON             	     0.50	   $18.62	      ---	   $23.48	004	1	0	0.00	    $0.00	Y	
K	26861	FUSION OF FINGER JNT ADD-ON             	     2.50	   $93.08	      ---	  $117.38	004	1	0	0.00	    $0.00	Y	
K	26862	FUSION/GRAFT OF FINGER JOINT            	     9.48	  $352.94	      ---	  $445.09	004	1	0	0.00	    $0.00	Y	
O	26862	FUSION/GRAFT OF FINGER JOINT            	     1.90	   $70.74	      ---	   $89.21	004	1	0	0.00	    $0.00	Y	
O	26863	FUSE/GRAFT ADDED JOINT                  	     0.68	   $25.32	      ---	   $31.93	004	1	0	0.00	    $0.00	Y	
K	26863	FUSE/GRAFT ADDED JOINT                  	     3.40	  $126.58	      ---	  $159.63	004	1	0	0.00	    $0.00	Y	
K	26910	AMPUTATE METACARPAL BONE                	     9.13	  $339.91	      ---	  $428.65	004	1	0	0.00	    $0.00	Y	
O	26910	AMPUTATE METACARPAL BONE                	     1.83	   $68.13	      ---	   $85.92	004	1	0	0.00	    $0.00	Y	
O	26951	AMPUTATION OF FINGER/THUMB              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	26951	AMPUTATION OF FINGER/THUMB              	     7.02	  $261.35	      ---	  $329.59	004	1	0	0.00	    $0.00	Y	
K	26952	AMPUTATION OF FINGER/THUMB              	     8.35	  $310.87	      ---	  $392.03	004	1	0	0.00	    $0.00	Y	
O	26952	AMPUTATION OF FINGER/THUMB              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	26989	UNLISTED PX HANDS/FINGERS               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	26989	UNLISTED PX HANDS/FINGERS               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	26990	DRAINAGE OF PELVIS LESION               	    18.14	  $675.35	      ---	  $851.67	004	1	0	0.00	    $0.00	Y	
O	26990	DRAINAGE OF PELVIS LESION               	     3.63	  $135.14	      ---	  $170.43	004	1	0	0.00	    $0.00	Y	
K	26991	DRAINAGE OF PELVIS BURSA                	     8.05	  $299.70	      ---	  $377.95	004	1	0	0.00	    $0.00	Y	
K	26992	DRAINAGE OF BONE LESION                 	    26.07	  $970.59	      ---	 $1223.99	004	1	0	0.00	    $0.00	Y	
O	26992	DRAINAGE OF BONE LESION                 	     5.21	  $193.97	      ---	  $244.61	004	1	0	0.00	    $0.00	Y	
K	27000	INCISION OF HIP TENDON                  	     5.73	  $213.33	      ---	  $269.02	004	1	0	0.00	    $0.00	Y	
K	27001	INCISION OF HIP TENDON                  	     6.71	  $249.81	      ---	  $315.03	004	1	0	0.00	    $0.00	Y	
K	27003	INCISION OF HIP TENDON                  	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	27003	INCISION OF HIP TENDON                  	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
O	27005	INCISION OF HIP TENDON                  	     1.77	   $65.90	      ---	   $83.10	004	1	0	0.00	    $0.00	Y	
K	27005	INCISION OF HIP TENDON                  	     8.87	  $330.23	      ---	  $416.45	004	1	0	0.00	    $0.00	Y	
K	27006	INCISION OF HIP TENDONS                 	     9.07	  $337.68	      ---	  $425.84	004	1	0	0.00	    $0.00	Y	
O	27006	INCISION OF HIP TENDONS                 	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
O	27025	INCISION OF HIP/THIGH FASCIA            	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	27025	INCISION OF HIP/THIGH FASCIA            	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	27027	BUTTOCK FASCIOTOMY                      	    17.45	  $649.66	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	27027	BUTTOCK FASCIOTOMY                      	     3.49	  $129.93	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	27030	DRAINAGE OF HIP JOINT                   	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
K	27030	DRAINAGE OF HIP JOINT                   	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
K	27033	EXPLORATION OF HIP JOINT                	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
O	27033	EXPLORATION OF HIP JOINT                	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
O	27035	DENERVATION OF HIP JOINT                	     3.85	  $143.34	      ---	  $180.76	004	1	0	0.00	    $0.00	Y	
K	27035	DENERVATION OF HIP JOINT                	    19.25	  $716.68	      ---	  $903.79	004	1	0	0.00	    $0.00	Y	
K	27036	EXCISION OF HIP JOINT/MUSCLE            	    19.79	  $736.78	      ---	  $929.14	004	1	0	0.00	    $0.00	Y	
O	27036	EXCISION OF HIP JOINT/MUSCLE            	     3.95	  $147.06	      ---	  $185.45	004	1	0	0.00	    $0.00	Y	
O	27040	BIOPSY OF SOFT TISSUES                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	27040	BIOPSY OF SOFT TISSUES                  	     3.67	  $136.63	      ---	  $172.31	004	1	1	0.00	    $0.00	Y	
K	27041	BIOPSY OF SOFT TISSUES                  	     8.16	  $303.80	      ---	  $383.11	004	1	1	0.00	    $0.00	Y	
O	27041	BIOPSY OF SOFT TISSUES                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	27043	EXC HIP PELVIS LES SC 3 CM/>            	    10.36	  $385.70	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	27045	EXC HIP/PELV TUM DEEP 5 CM/>            	    16.43	  $611.69	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	27045	EXC HIP/PELV TUM DEEP 5 CM/>            	     3.29	  $122.49	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	27047	EXC HIP/PELVIS LES SC < 3 CM            	     2.76	  $102.75	      ---	  $129.58	004	1	0	0.00	    $0.00	Y	
K	27047	EXC HIP/PELVIS LES SC < 3 CM            	    13.80	  $513.77	      ---	  $647.91	004	1	1	0.00	    $0.00	Y	
K	27048	EXC HIP/PELV TUM DEEP < 5 CM            	    11.78	  $438.57	      ---	  $553.07	004	1	0	0.00	    $0.00	Y	
O	27048	EXC HIP/PELV TUM DEEP < 5 CM            	     2.36	   $87.86	      ---	  $110.80	004	1	0	0.00	    $0.00	Y	
O	27049	RESECT HIP/PELV TUM < 5 CM              	     4.50	  $167.54	      ---	  $211.28	004	1	0	0.00	    $0.00	Y	
K	27049	RESECT HIP/PELV TUM < 5 CM              	    22.49	  $837.30	      ---	 $1055.91	004	1	0	0.00	    $0.00	Y	
K	27050	BIOPSY OF SACROILIAC JOINT              	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
O	27050	BIOPSY OF SACROILIAC JOINT              	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
O	27052	BIOPSY OF HIP JOINT                     	     2.80	  $104.24	      ---	  $131.46	004	1	0	0.00	    $0.00	Y	
K	27052	BIOPSY OF HIP JOINT                     	    14.00	  $521.22	      ---	  $657.30	004	1	0	0.00	    $0.00	Y	
K	27054	REMOVAL OF HIP JOINT LINING             	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
O	27054	REMOVAL OF HIP JOINT LINING             	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
O	27057	BUTTOCK FASCIOTOMY W/DBRDMT             	     3.87	  $144.08	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	27057	BUTTOCK FASCIOTOMY W/DBRDMT             	    19.34	  $720.03	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	27059	RESECT HIP/PELV TUM 5 CM/>              	    39.97	 $1488.08	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	27059	RESECT HIP/PELV TUM 5 CM/>              	     7.99	  $297.47	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	27060	REMOVAL OF ISCHIAL BURSA                	     1.13	   $42.07	      ---	   $53.05	004	1	0	0.00	    $0.00	Y	
K	27060	REMOVAL OF ISCHIAL BURSA                	     5.66	  $210.72	      ---	  $265.74	004	1	0	0.00	    $0.00	Y	
K	27062	REMOVE FEMUR LESION/BURSA               	     5.52	  $205.51	      ---	  $259.16	004	1	0	0.00	    $0.00	Y	
O	27062	REMOVE FEMUR LESION/BURSA               	     1.10	   $40.95	      ---	   $51.65	004	1	0	0.00	    $0.00	Y	
O	27065	REMOVE HIP BONE LES SUPER               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	27065	REMOVE HIP BONE LES SUPER               	     6.35	  $236.41	      ---	  $298.13	004	1	0	0.00	    $0.00	Y	
K	27066	REMOVE HIP BONE LES DEEP                	    10.76	  $400.59	      ---	  $505.18	004	1	0	0.00	    $0.00	Y	
O	27066	REMOVE HIP BONE LES DEEP                	     2.15	   $80.04	      ---	  $100.94	004	1	0	0.00	    $0.00	Y	
O	27067	REMOVE/GRAFT HIP BONE LESION            	     5.04	  $187.64	      ---	  $236.63	004	1	0	0.00	    $0.00	Y	
K	27067	REMOVE/GRAFT HIP BONE LESION            	    25.20	  $938.20	      ---	 $1183.14	004	1	0	0.00	    $0.00	Y	
K	27070	PART REMOVE HIP BONE SUPER              	    12.54	  $466.86	      ---	  $588.75	004	1	0	0.00	    $0.00	Y	
O	27070	PART REMOVE HIP BONE SUPER              	     2.51	   $93.45	      ---	  $117.84	004	1	0	0.00	    $0.00	Y	
O	27071	PART REMOVAL HIP BONE DEEP              	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	27071	PART REMOVAL HIP BONE DEEP              	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	27075	RESECT HIP TUMOR                        	    29.28	 $1090.09	      ---	 $1374.70	004	1	0	0.00	    $0.00	Y	
O	27075	RESECT HIP TUMOR                        	     5.86	  $218.17	      ---	  $275.13	004	1	0	0.00	    $0.00	Y	
O	27076	RESECT HIP TUM INCL ACETABUL            	     7.09	  $263.96	      ---	  $332.88	004	1	0	0.00	    $0.00	Y	
K	27076	RESECT HIP TUM INCL ACETABUL            	    35.46	 $1320.18	      ---	 $1664.85	004	1	0	0.00	    $0.00	Y	
K	27077	RESECT HIP TUM W/INNOM BONE             	    37.82	 $1408.04	      ---	 $1775.65	004	1	0	0.00	    $0.00	Y	
O	27077	RESECT HIP TUM W/INNOM BONE             	     7.56	  $281.46	      ---	  $354.94	004	1	0	0.00	    $0.00	Y	
O	27078	RSECT HIP TUM INCL FEMUR                	     4.92	  $183.17	      ---	  $230.99	004	1	0	0.00	    $0.00	Y	
K	27078	RSECT HIP TUM INCL FEMUR                	    24.59	  $915.49	      ---	 $1154.50	004	1	0	0.00	    $0.00	Y	
K	27080	REMOVAL OF TAIL BONE                    	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
O	27080	REMOVAL OF TAIL BONE                    	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
K	27086	REMOVE HIP FOREIGN BODY                 	     2.90	  $107.97	      ---	  $136.16	004	1	1	0.00	    $0.00	Y	
K	27087	REMOVE HIP FOREIGN BODY                 	    14.49	  $539.46	      ---	  $680.31	004	1	0	0.00	    $0.00	Y	
O	27087	REMOVE HIP FOREIGN BODY                 	     2.90	  $107.97	      ---	  $136.16	004	1	0	0.00	    $0.00	Y	
O	27090	REMOVAL OF HIP PROSTHESIS               	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
K	27090	REMOVAL OF HIP PROSTHESIS               	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
K	27091	REMOVAL OF HIP PROSTHESIS               	    18.15	  $675.72	      ---	  $852.14	004	1	0	0.00	    $0.00	Y	
O	27091	REMOVAL OF HIP PROSTHESIS               	     3.63	  $135.14	      ---	  $170.43	004	1	0	0.00	    $0.00	Y	
K	27093	INJECTION FOR HIP X-RAY                 	     5.41	  $201.41	      ---	  $254.00	004	1	0	0.00	    $0.00	Y	
K	27095	INJECTION FOR HIP X-RAY                 	     5.55	  $206.63	      ---	  $260.57	004	1	0	0.00	    $0.00	Y	
K	27096	INJECT SACROILIAC JOINT                 	     7.89	  $293.74	      ---	  $370.44	004	1	0	0.00	    $0.00	Y	
X	27096	INJECT SACROILIAC JOINT                 	   293.74	  $293.74	      ---	       --	009	1	0	0.00	    $0.00	Y	
O	27097	REVISION OF HIP TENDON                  	     3.21	  $119.51	      ---	  $150.71	004	1	0	0.00	    $0.00	Y	
K	27097	REVISION OF HIP TENDON                  	    16.05	  $597.54	      ---	  $753.55	004	1	0	0.00	    $0.00	Y	
K	27098	TRANSFER TENDON TO PELVIS               	    16.22	  $603.87	      ---	  $761.53	004	1	0	0.00	    $0.00	Y	
O	27098	TRANSFER TENDON TO PELVIS               	     3.24	  $120.63	      ---	  $152.12	004	1	0	0.00	    $0.00	Y	
O	27100	TRANSFER OF ABDOMINAL MUSCLE            	     3.40	  $126.58	      ---	  $159.63	004	1	0	0.00	    $0.00	Y	
K	27100	TRANSFER OF ABDOMINAL MUSCLE            	    16.99	  $632.54	      ---	  $797.68	004	1	0	0.00	    $0.00	Y	
K	27105	TRANSFER OF SPINAL MUSCLE               	    18.12	  $674.61	      ---	  $850.73	004	1	0	0.00	    $0.00	Y	
O	27105	TRANSFER OF SPINAL MUSCLE               	     3.62	  $134.77	      ---	  $169.96	004	1	0	0.00	    $0.00	Y	
O	27110	TRANSFER OF ILIOPSOAS MUSCLE            	     4.08	  $151.90	      ---	  $191.56	004	1	0	0.00	    $0.00	Y	
K	27110	TRANSFER OF ILIOPSOAS MUSCLE            	    20.39	  $759.12	      ---	  $957.31	004	1	0	0.00	    $0.00	Y	
K	27111	TRANSFER OF ILIOPSOAS MUSCLE            	    18.80	  $699.92	      ---	  $882.66	004	1	0	0.00	    $0.00	Y	
O	27111	TRANSFER OF ILIOPSOAS MUSCLE            	     3.74	  $139.24	      ---	  $175.59	004	1	0	0.00	    $0.00	Y	
O	27120	RECONSTRUCTION OF HIP SOCKET            	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
K	27120	RECONSTRUCTION OF HIP SOCKET            	    27.18	 $1011.91	      ---	 $1276.10	004	1	0	0.00	    $0.00	Y	
K	27122	RECONSTRUCTION OF HIP SOCKET            	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
O	27122	RECONSTRUCTION OF HIP SOCKET            	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
O	27125	PARTIAL HIP REPLACEMENT                 	     5.60	  $208.49	      ---	  $262.92	004	1	0	0.00	    $0.00	Y	
K	27125	PARTIAL HIP REPLACEMENT                 	    28.00	 $1042.44	      ---	 $1314.60	004	1	0	0.00	    $0.00	Y	
K	27130	TOTAL HIP ARTHROPLASTY                  	    40.00	 $1489.20	      ---	 $1878.00	004	1	0	0.00	    $0.00	Y	
O	27130	TOTAL HIP ARTHROPLASTY                  	     8.00	  $297.84	      ---	  $375.60	004	1	0	0.00	    $0.00	Y	
O	27132	TOTAL HIP ARTHROPLASTY                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	27132	TOTAL HIP ARTHROPLASTY                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	27134	REVISE HIP JOINT REPLACEMENT            	    42.98	 $1600.15	      ---	 $2017.91	004	1	0	0.00	    $0.00	Y	
O	27134	REVISE HIP JOINT REPLACEMENT            	     8.60	  $320.18	      ---	  $403.77	004	1	0	0.00	    $0.00	Y	
O	27137	REVISE HIP JOINT REPLACEMENT            	     6.65	  $247.58	      ---	  $312.22	004	1	0	0.00	    $0.00	Y	
K	27137	REVISE HIP JOINT REPLACEMENT            	    33.25	 $1237.90	      ---	 $1561.09	004	1	0	0.00	    $0.00	Y	
K	27138	REVISE HIP JOINT REPLACEMENT            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	27138	REVISE HIP JOINT REPLACEMENT            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	27140	TRANSPLANT FEMUR RIDGE                  	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	27140	TRANSPLANT FEMUR RIDGE                  	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	27146	INCISION OF HIP BONE                    	    27.18	 $1011.91	      ---	 $1276.10	004	1	0	0.00	    $0.00	Y	
O	27146	INCISION OF HIP BONE                    	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
O	27147	REVISION OF HIP BONE                    	     6.38	  $237.53	      ---	  $299.54	004	1	0	0.00	    $0.00	Y	
K	27147	REVISION OF HIP BONE                    	    31.88	 $1186.89	      ---	 $1496.77	004	1	0	0.00	    $0.00	Y	
K	27151	INCISION OF HIP BONES                   	    28.44	 $1058.82	      ---	 $1335.26	004	1	0	0.00	    $0.00	Y	
O	27151	INCISION OF HIP BONES                   	     5.69	  $211.84	      ---	  $267.15	004	1	0	0.00	    $0.00	Y	
O	27156	REVISION OF HIP BONES                   	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
K	27156	REVISION OF HIP BONES                   	    33.98	 $1265.08	      ---	 $1595.36	004	1	0	0.00	    $0.00	Y	
K	27158	REVISION OF PELVIS                      	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	27158	REVISION OF PELVIS                      	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	27161	INCISION OF NECK OF FEMUR               	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	27161	INCISION OF NECK OF FEMUR               	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
K	27165	INCISION/FIXATION OF FEMUR              	    27.18	 $1011.91	      ---	 $1276.10	004	1	0	0.00	    $0.00	Y	
O	27165	INCISION/FIXATION OF FEMUR              	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
O	27170	REPAIR/GRAFT FEMUR HEAD/NECK            	     5.10	  $189.87	      ---	  $239.45	004	1	0	0.00	    $0.00	Y	
K	27170	REPAIR/GRAFT FEMUR HEAD/NECK            	    25.51	  $949.74	      ---	 $1197.69	004	1	0	0.00	    $0.00	Y	
K	27175	TREAT SLIPPED EPIPHYSIS                 	    14.13	  $526.06	      ---	  $663.40	004	1	0	0.00	    $0.00	Y	
O	27175	TREAT SLIPPED EPIPHYSIS                 	     2.83	  $105.36	      ---	  $132.87	004	1	0	0.00	    $0.00	Y	
O	27176	TREAT SLIPPED EPIPHYSIS                 	     4.40	  $163.81	      ---	  $206.58	004	1	0	0.00	    $0.00	Y	
K	27176	TREAT SLIPPED EPIPHYSIS                 	    22.00	  $819.06	      ---	 $1032.90	004	1	0	0.00	    $0.00	Y	
K	27177	TREAT SLIPPED EPIPHYSIS                 	    22.49	  $837.30	      ---	 $1055.91	004	1	0	0.00	    $0.00	Y	
O	27177	TREAT SLIPPED EPIPHYSIS                 	     4.50	  $167.54	      ---	  $211.28	004	1	0	0.00	    $0.00	Y	
O	27178	TREAT SLIPPED EPIPHYSIS                 	     4.40	  $163.81	      ---	  $206.58	004	1	0	0.00	    $0.00	Y	
K	27178	TREAT SLIPPED EPIPHYSIS                 	    22.00	  $819.06	      ---	 $1032.90	004	1	0	0.00	    $0.00	Y	
K	27179	REVISE HEAD/NECK OF FEMUR               	    18.12	  $674.61	      ---	  $850.73	004	1	0	0.00	    $0.00	Y	
O	27179	REVISE HEAD/NECK OF FEMUR               	     3.62	  $134.77	      ---	  $169.96	004	1	0	0.00	    $0.00	Y	
O	27181	TREAT SLIPPED EPIPHYSIS                 	     4.80	  $178.70	      ---	  $225.36	004	1	0	0.00	    $0.00	Y	
K	27181	TREAT SLIPPED EPIPHYSIS                 	    24.00	  $893.52	      ---	 $1126.80	004	1	0	0.00	    $0.00	Y	
K	27185	REVISION OF FEMUR EPIPHYSIS             	     8.00	  $297.84	      ---	  $375.60	004	1	0	0.00	    $0.00	Y	
O	27185	REVISION OF FEMUR EPIPHYSIS             	     1.60	   $59.57	      ---	   $75.12	004	1	0	0.00	    $0.00	Y	
O	27187	REINFORCE HIP BONES                     	     4.55	  $169.40	      ---	  $213.62	004	1	0	0.00	    $0.00	Y	
K	27187	REINFORCE HIP BONES                     	    22.75	  $846.98	      ---	 $1068.11	004	1	0	0.00	    $0.00	Y	
K	27197	CLSD TX PELVIC RING FX                  	     2.76	  $102.75	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	27198	CLSD TX PELVIC RING FX                  	     6.88	  $256.14	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	27198	CLSD TX PELVIC RING FX                  	     1.37	   $51.01	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	27200	TREAT TAIL BONE FRACTURE                	     0.78	   $29.04	      ---	   $36.62	004	1	0	0.00	    $0.00	Y	
K	27200	TREAT TAIL BONE FRACTURE                	     3.90	  $145.20	      ---	  $183.11	004	1	1	0.00	    $0.00	Y	
K	27202	TREAT TAIL BONE FRACTURE                	    26.43	  $983.99	      ---	 $1240.89	004	1	0	0.00	    $0.00	Y	
O	27202	TREAT TAIL BONE FRACTURE                	     5.29	  $196.95	      ---	  $248.37	004	1	0	0.00	    $0.00	Y	
O	27215	TREAT PELVIC FRACTURE(S)                	     3.41	  $126.95	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	27215	TREAT PELVIC FRACTURE(S)                	    17.07	  $635.52	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	27216	TREAT PELVIC RING FRACTURE              	    12.49	  $465.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	27216	TREAT PELVIC RING FRACTURE              	     2.50	   $93.08	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	27217	TREAT PELVIC RING FRACTURE              	     3.92	  $145.94	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	27217	TREAT PELVIC RING FRACTURE              	    19.57	  $728.59	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	27218	TREAT PELVIC RING FRACTURE              	    21.98	  $818.32	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	27218	TREAT PELVIC RING FRACTURE              	     4.39	  $163.44	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	27220	TREAT HIP SOCKET FRACTURE               	     2.28	   $84.88	      ---	  $107.05	004	1	0	0.00	    $0.00	Y	
K	27220	TREAT HIP SOCKET FRACTURE               	    11.39	  $424.05	      ---	  $534.76	004	1	0	0.00	    $0.00	Y	
K	27222	TREAT HIP SOCKET FRACTURE               	    10.43	  $388.31	      ---	  $489.69	004	1	0	0.00	    $0.00	Y	
O	27222	TREAT HIP SOCKET FRACTURE               	     2.09	   $77.81	      ---	   $98.13	004	1	0	0.00	    $0.00	Y	
O	27226	TREAT HIP WALL FRACTURE                 	     4.36	  $162.32	      ---	  $204.70	004	1	0	0.00	    $0.00	Y	
K	27226	TREAT HIP WALL FRACTURE                 	    21.81	  $811.99	      ---	 $1023.98	004	1	0	0.00	    $0.00	Y	
K	27227	TREAT HIP FRACTURE(S)                   	    26.25	  $977.29	      ---	 $1232.44	004	1	0	0.00	    $0.00	Y	
O	27227	TREAT HIP FRACTURE(S)                   	     5.26	  $195.83	      ---	  $246.96	004	1	0	0.00	    $0.00	Y	
O	27228	TREAT HIP FRACTURE(S)                   	     5.55	  $206.63	      ---	  $260.57	004	1	0	0.00	    $0.00	Y	
K	27228	TREAT HIP FRACTURE(S)                   	    27.77	 $1033.88	      ---	 $1303.80	004	1	0	0.00	    $0.00	Y	
K	27230	TREAT THIGH FRACTURE                    	     0.00	    $0.00	      ---	       --	004	1	1	0.00	    $0.00	Y	
O	27230	TREAT THIGH FRACTURE                    	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	27232	TREAT THIGH FRACTURE                    	     2.15	   $80.04	      ---	  $100.94	004	1	0	0.00	    $0.00	Y	
K	27232	TREAT THIGH FRACTURE                    	    10.76	  $400.59	      ---	  $505.18	004	1	0	0.00	    $0.00	Y	
K	27235	TREAT THIGH FRACTURE                    	    22.00	  $819.06	      ---	 $1032.90	004	1	0	0.00	    $0.00	Y	
O	27235	TREAT THIGH FRACTURE                    	     4.40	  $163.81	      ---	  $206.58	004	1	0	0.00	    $0.00	Y	
O	27236	TREAT THIGH FRACTURE                    	     4.85	  $180.57	      ---	  $227.71	004	1	0	0.00	    $0.00	Y	
K	27236	TREAT THIGH FRACTURE                    	    24.24	  $902.46	      ---	 $1138.07	004	1	0	0.00	    $0.00	Y	
K	27238	TREAT THIGH FRACTURE                    	   244.91	  $244.91	      ---	       --	042	0	1	0.00	    $0.00	Y	
O	27238	TREAT THIGH FRACTURE                    	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	27240	TREAT THIGH FRACTURE                    	     2.15	   $80.04	      ---	  $100.94	004	1	0	0.00	    $0.00	Y	
K	27240	TREAT THIGH FRACTURE                    	    10.76	  $400.59	      ---	  $505.18	004	1	0	0.00	    $0.00	Y	
K	27244	TREAT THIGH FRACTURE                    	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
O	27244	TREAT THIGH FRACTURE                    	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
O	27245	TREAT THIGH FRACTURE                    	     5.02	  $186.89	      ---	  $235.69	004	1	0	0.00	    $0.00	Y	
K	27245	TREAT THIGH FRACTURE                    	    25.09	  $934.10	      ---	 $1177.98	004	1	0	0.00	    $0.00	Y	
K	27246	TREAT THIGH FRACTURE                    	     9.94	  $370.07	      ---	  $466.68	004	1	0	0.00	    $0.00	Y	
O	27246	TREAT THIGH FRACTURE                    	     1.99	   $74.09	      ---	   $93.43	004	1	0	0.00	    $0.00	Y	
O	27248	TREAT THIGH FRACTURE                    	     1.85	   $68.88	      ---	   $86.86	004	1	0	0.00	    $0.00	Y	
K	27248	TREAT THIGH FRACTURE                    	     9.26	  $344.75	      ---	  $434.76	004	1	0	0.00	    $0.00	Y	
K	27250	TREAT HIP DISLOCATION                   	   220.95	  $220.95	      ---	       --	042	0	1	0.00	    $0.00	Y	
O	27250	TREAT HIP DISLOCATION                   	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	27252	TREAT HIP DISLOCATION                   	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	27252	TREAT HIP DISLOCATION                   	     8.48	  $315.71	      ---	  $398.14	004	1	0	0.00	    $0.00	Y	
K	27253	TREAT HIP DISLOCATION                   	    19.25	  $716.68	      ---	  $903.79	004	1	0	0.00	    $0.00	Y	
O	27253	TREAT HIP DISLOCATION                   	     3.85	  $143.34	      ---	  $180.76	004	1	0	0.00	    $0.00	Y	
O	27254	TREAT HIP DISLOCATION                   	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
K	27254	TREAT HIP DISLOCATION                   	    27.18	 $1011.91	      ---	 $1276.10	004	1	0	0.00	    $0.00	Y	
K	27256	TREAT HIP DISLOCATION                   	   149.77	  $149.77	      ---	       --	042	0	1	0.00	    $0.00	Y	
O	27256	TREAT HIP DISLOCATION                   	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	27257	TREAT HIP DISLOCATION                   	     0.89	   $33.13	      ---	   $41.79	004	1	0	0.00	    $0.00	Y	
K	27257	TREAT HIP DISLOCATION                   	     4.46	  $166.05	      ---	  $209.40	004	1	0	0.00	    $0.00	Y	
K	27258	TREAT HIP DISLOCATION                   	    19.25	  $716.68	      ---	  $903.79	004	1	0	0.00	    $0.00	Y	
O	27258	TREAT HIP DISLOCATION                   	     3.85	  $143.34	      ---	  $180.76	004	1	0	0.00	    $0.00	Y	
O	27259	TREAT HIP DISLOCATION                   	     6.60	  $245.72	      ---	  $309.87	004	1	0	0.00	    $0.00	Y	
K	27259	TREAT HIP DISLOCATION                   	    33.02	 $1229.33	      ---	 $1550.29	004	1	0	0.00	    $0.00	Y	
K	27265	TREAT HIP DISLOCATION                   	     9.35	  $348.10	      ---	  $438.98	004	1	0	0.00	    $0.00	Y	
O	27265	TREAT HIP DISLOCATION                   	     1.87	   $69.62	      ---	   $87.80	004	1	0	0.00	    $0.00	Y	
O	27266	TREAT HIP DISLOCATION                   	     2.48	   $92.33	      ---	  $116.44	004	1	0	0.00	    $0.00	Y	
K	27266	TREAT HIP DISLOCATION                   	    12.39	  $461.28	      ---	  $581.71	004	1	0	0.00	    $0.00	Y	
K	27267	CLTX THIGH FX                           	     8.27	  $307.89	      ---	  $388.28	004	1	0	0.00	    $0.00	Y	
O	27267	CLTX THIGH FX                           	     1.65	   $61.43	      ---	   $77.47	004	1	0	0.00	    $0.00	Y	
O	27268	CLTX THIGH FX W/MNPJ                    	     2.03	   $75.58	      ---	   $95.31	004	1	0	0.00	    $0.00	Y	
K	27268	CLTX THIGH FX W/MNPJ                    	    10.17	  $378.63	      ---	  $477.48	004	1	0	0.00	    $0.00	Y	
K	27269	OPTX THIGH FX                           	    24.11	  $897.62	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	27269	OPTX THIGH FX                           	     4.82	  $179.45	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	27275	MANIPULATION OF HIP JOINT               	     2.48	   $92.33	      ---	  $116.44	004	1	0	0.00	    $0.00	Y	
K	27278	ARTHRD SI JT PRQ WO TFXJ DEV            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	27278	ARTHRD SI JT PRQ WO TFXJ DEV            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	27279	ARTHRD SI JT PERQ/MIN NVAS              	     2.61	   $97.17	      ---	  $122.54	004	1	0	0.00	    $0.00	Y	
K	27279	ARTHRD SI JT PERQ/MIN NVAS              	    13.07	  $486.60	      ---	  $613.64	004	1	0	0.00	    $0.00	Y	
K	27280	ARTHR SI JT OPN B1GRF INSTRM            	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
O	27280	ARTHR SI JT OPN B1GRF INSTRM            	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
O	27282	ARTHRODESIS SYMPHYSIS PUBIS             	     4.09	  $152.27	      ---	  $192.03	004	1	0	0.00	    $0.00	Y	
K	27282	ARTHRODESIS SYMPHYSIS PUBIS             	    20.43	  $760.61	      ---	  $959.19	004	1	0	0.00	    $0.00	Y	
K	27284	ARTHRODESIS HIP JOINT                   	    25.95	  $966.12	      ---	 $1218.35	004	1	0	0.00	    $0.00	Y	
O	27284	ARTHRODESIS HIP JOINT                   	     5.19	  $193.22	      ---	  $243.67	004	1	0	0.00	    $0.00	Y	
O	27286	ARTHRD HIP JT SBTRCHC OSTEOT            	     5.57	  $207.37	      ---	  $261.51	004	1	0	0.00	    $0.00	Y	
K	27286	ARTHRD HIP JT SBTRCHC OSTEOT            	    27.87	 $1037.60	      ---	 $1308.50	004	1	0	0.00	    $0.00	Y	
K	27290	AMPUTATION OF LEG AT HIP                	    32.85	 $1223.01	      ---	 $1542.31	004	1	0	0.00	    $0.00	Y	
O	27290	AMPUTATION OF LEG AT HIP                	     6.57	  $244.60	      ---	  $308.46	004	1	0	0.00	    $0.00	Y	
O	27295	AMPUTATION OF LEG AT HIP                	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
K	27295	AMPUTATION OF LEG AT HIP                	    27.18	 $1011.91	      ---	 $1276.10	004	1	0	0.00	    $0.00	Y	
K	27299	UNLISTED PX PELVIS/HIP JOINT            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	27299	UNLISTED PX PELVIS/HIP JOINT            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	27301	DRAIN THIGH/KNEE LESION                 	     1.89	   $70.36	      ---	   $88.74	004	1	0	0.00	    $0.00	Y	
K	27301	DRAIN THIGH/KNEE LESION                 	     9.46	  $352.20	      ---	  $444.15	004	1	0	0.00	    $0.00	Y	
K	27303	DRAINAGE OF BONE LESION                 	    18.56	  $690.99	      ---	  $871.39	004	1	0	0.00	    $0.00	Y	
O	27303	DRAINAGE OF BONE LESION                 	     3.71	  $138.12	      ---	  $174.18	004	1	0	0.00	    $0.00	Y	
O	27305	INCISE THIGH TENDON & FASCIA            	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
K	27305	INCISE THIGH TENDON & FASCIA            	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
K	27306	INCISION OF THIGH TENDON                	     5.28	  $196.57	      ---	  $247.90	004	1	0	0.00	    $0.00	Y	
O	27306	INCISION OF THIGH TENDON                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	27307	INCISION OF THIGH TENDONS               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	27307	INCISION OF THIGH TENDONS               	     6.01	  $223.75	      ---	  $282.17	004	1	0	0.00	    $0.00	Y	
K	27310	EXPLORATION OF KNEE JOINT               	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	27310	EXPLORATION OF KNEE JOINT               	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	27323	BIOPSY THIGH SOFT TISSUES               	     3.38	  $125.84	      ---	  $158.69	004	1	1	0.00	    $0.00	Y	
K	27324	BIOPSY THIGH SOFT TISSUES               	     5.19	  $193.22	      ---	  $243.67	004	1	0	0.00	    $0.00	Y	
O	27324	BIOPSY THIGH SOFT TISSUES               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	27325	NEURECTOMY HAMSTRING                    	     2.36	   $87.86	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	27325	NEURECTOMY HAMSTRING                    	    11.79	  $438.94	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	27326	NEURECTOMY POPLITEAL                    	    10.51	  $391.29	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	27326	NEURECTOMY POPLITEAL                    	     2.10	   $78.18	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	27327	EXC THIGH/KNEE LES SC < 3 CM            	     2.07	   $77.07	      ---	   $97.19	004	1	0	0.00	    $0.00	Y	
K	27327	EXC THIGH/KNEE LES SC < 3 CM            	    10.33	  $384.59	      ---	  $484.99	004	1	1	0.00	    $0.00	Y	
K	27328	EXC THIGH/KNEE TUM DEEP <5CM            	    10.38	  $386.45	      ---	  $487.34	004	1	0	0.00	    $0.00	Y	
O	27328	EXC THIGH/KNEE TUM DEEP <5CM            	     2.08	   $77.44	      ---	   $97.66	004	1	0	0.00	    $0.00	Y	
O	27329	RESECT THIGH/KNEE TUM < 5 CM            	     4.79	  $178.33	      ---	  $224.89	004	1	0	0.00	    $0.00	Y	
K	27329	RESECT THIGH/KNEE TUM < 5 CM            	    23.97	  $892.40	      ---	 $1125.39	004	1	0	0.00	    $0.00	Y	
K	27330	BIOPSY KNEE JOINT LINING                	    12.00	  $446.76	      ---	  $563.40	004	1	0	0.00	    $0.00	Y	
O	27330	BIOPSY KNEE JOINT LINING                	     2.40	   $89.35	      ---	  $112.68	004	1	0	0.00	    $0.00	Y	
O	27331	EXPLORE/TREAT KNEE JOINT                	     2.40	   $89.35	      ---	  $112.68	004	1	0	0.00	    $0.00	Y	
K	27331	EXPLORE/TREAT KNEE JOINT                	    12.00	  $446.76	      ---	  $563.40	004	1	0	0.00	    $0.00	Y	
K	27332	REMOVAL OF KNEE CARTILAGE               	    14.07	  $523.83	      ---	  $660.59	004	1	0	0.00	    $0.00	Y	
O	27332	REMOVAL OF KNEE CARTILAGE               	     2.81	  $104.62	      ---	  $131.93	004	1	0	0.00	    $0.00	Y	
O	27333	REMOVAL OF KNEE CARTILAGE               	     2.80	  $104.24	      ---	  $131.46	004	1	0	0.00	    $0.00	Y	
K	27333	REMOVAL OF KNEE CARTILAGE               	    14.00	  $521.22	      ---	  $657.30	004	1	0	0.00	    $0.00	Y	
K	27334	REMOVE KNEE JOINT LINING                	    17.00	  $632.91	      ---	  $798.15	004	1	0	0.00	    $0.00	Y	
O	27334	REMOVE KNEE JOINT LINING                	     3.40	  $126.58	      ---	  $159.63	004	1	0	0.00	    $0.00	Y	
O	27335	REMOVE KNEE JOINT LINING                	     3.47	  $129.19	      ---	  $162.92	004	1	0	0.00	    $0.00	Y	
K	27335	REMOVE KNEE JOINT LINING                	    17.35	  $645.94	      ---	  $814.58	004	1	0	0.00	    $0.00	Y	
K	27337	EXC THIGH/KNEE LES SC 3 CM/>            	     9.27	  $345.12	      ---	  $435.23	004	1	0	0.00	    $0.00	Y	
O	27337	EXC THIGH/KNEE LES SC 3 CM/>            	     1.85	   $68.88	      ---	   $86.86	004	1	0	0.00	    $0.00	Y	
O	27339	EXC THIGH/KNEE TUM DEP 5CM/>            	     3.32	  $123.60	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	27339	EXC THIGH/KNEE TUM DEP 5CM/>            	    16.62	  $618.76	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	27340	REMOVAL OF KNEECAP BURSA                	     5.66	  $210.72	      ---	  $265.74	004	1	0	0.00	    $0.00	Y	
O	27340	REMOVAL OF KNEECAP BURSA                	     1.13	   $42.07	      ---	   $53.05	004	1	0	0.00	    $0.00	Y	
O	27345	REMOVAL OF KNEE CYST                    	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
K	27345	REMOVAL OF KNEE CYST                    	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
K	27347	REMOVE KNEE CYST                        	     7.38	  $274.76	      ---	  $346.49	004	1	0	0.00	    $0.00	Y	
O	27347	REMOVE KNEE CYST                        	     1.48	   $55.10	      ---	   $69.49	004	1	0	0.00	    $0.00	Y	
O	27350	REMOVAL OF KNEECAP                      	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	27350	REMOVAL OF KNEECAP                      	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	27355	REMOVE FEMUR LESION                     	    12.46	  $463.89	      ---	  $585.00	004	1	0	0.00	    $0.00	Y	
O	27355	REMOVE FEMUR LESION                     	     2.49	   $92.70	      ---	  $116.91	004	1	0	0.00	    $0.00	Y	
O	27356	REMOVE FEMUR LESION/GRAFT               	     2.49	   $92.70	      ---	  $116.91	004	1	0	0.00	    $0.00	Y	
K	27356	REMOVE FEMUR LESION/GRAFT               	    12.46	  $463.89	      ---	  $585.00	004	1	0	0.00	    $0.00	Y	
K	27357	REMOVE FEMUR LESION/GRAFT               	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
O	27357	REMOVE FEMUR LESION/GRAFT               	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
O	27358	REMOVE FEMUR LESION/FIXATION            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	27358	REMOVE FEMUR LESION/FIXATION            	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	27360	PARTIAL REMOVAL LEG BONE(S)             	    12.48	  $464.63	      ---	  $585.94	004	1	0	0.00	    $0.00	Y	
O	27360	PARTIAL REMOVAL LEG BONE(S)             	     2.50	   $93.08	      ---	  $117.38	004	1	0	0.00	    $0.00	Y	
O	27364	RESECT THIGH/KNEE TUM 5 CM/>            	     6.90	  $256.89	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	27364	RESECT THIGH/KNEE TUM 5 CM/>            	    34.51	 $1284.81	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	27365	RESECT FEMUR/KNEE TUMOR                 	    27.60	 $1027.55	      ---	 $1295.82	004	1	0	0.00	    $0.00	Y	
O	27365	RESECT FEMUR/KNEE TUMOR                 	     5.52	  $205.51	      ---	  $259.16	004	1	0	0.00	    $0.00	Y	
K	27369	NJX CNTRST KNE ARTHG/CT/MRI             	     3.51	  $130.68	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	27372	REMOVAL OF FOREIGN BODY                 	     6.41	  $238.64	      ---	  $300.95	004	1	0	0.00	    $0.00	Y	
O	27372	REMOVAL OF FOREIGN BODY                 	     1.28	   $47.65	      ---	   $60.10	004	1	0	0.00	    $0.00	Y	
O	27380	REPAIR OF KNEECAP TENDON                	     2.49	   $92.70	      ---	  $116.91	004	1	0	0.00	    $0.00	Y	
K	27380	REPAIR OF KNEECAP TENDON                	    12.46	  $463.89	      ---	  $585.00	004	1	0	0.00	    $0.00	Y	
K	27381	REPAIR/GRAFT KNEECAP TENDON             	    18.69	  $695.83	      ---	  $877.50	004	1	0	0.00	    $0.00	Y	
O	27381	REPAIR/GRAFT KNEECAP TENDON             	     3.74	  $139.24	      ---	  $175.59	004	1	0	0.00	    $0.00	Y	
O	27385	REPAIR OF THIGH MUSCLE                  	     2.76	  $102.75	      ---	  $129.58	004	1	0	0.00	    $0.00	Y	
K	27385	REPAIR OF THIGH MUSCLE                  	    13.82	  $514.52	      ---	  $648.85	004	1	0	0.00	    $0.00	Y	
K	27386	REPAIR/GRAFT OF THIGH MUSCLE            	    18.15	  $675.72	      ---	  $852.14	004	1	0	0.00	    $0.00	Y	
O	27386	REPAIR/GRAFT OF THIGH MUSCLE            	     3.65	  $135.89	      ---	  $171.37	004	1	0	0.00	    $0.00	Y	
O	27390	INCISION OF THIGH TENDON                	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
K	27390	INCISION OF THIGH TENDON                	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
K	27391	INCISION OF THIGH TENDONS               	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	27391	INCISION OF THIGH TENDONS               	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
O	27392	INCISION OF THIGH TENDONS               	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	27392	INCISION OF THIGH TENDONS               	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	27393	LENGTHENING OF THIGH TENDON             	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
O	27393	LENGTHENING OF THIGH TENDON             	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
O	27394	LENGTHENING OF THIGH TENDONS            	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
K	27394	LENGTHENING OF THIGH TENDONS            	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
K	27395	LENGTHENING OF THIGH TENDONS            	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	27395	LENGTHENING OF THIGH TENDONS            	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
O	27396	TRANSPLANT OF THIGH TENDON              	     3.20	  $119.14	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	27396	TRANSPLANT OF THIGH TENDON              	    16.00	  $595.68	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	27397	TRANSPLANTS OF THIGH TENDONS            	    18.12	  $674.61	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	27397	TRANSPLANTS OF THIGH TENDONS            	     3.62	  $134.77	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	27400	REVISE THIGH MUSCLES/TENDONS            	     3.26	  $121.37	      ---	  $153.06	004	1	0	0.00	    $0.00	Y	
K	27400	REVISE THIGH MUSCLES/TENDONS            	    16.28	  $606.10	      ---	  $764.35	004	1	0	0.00	    $0.00	Y	
K	27403	REPAIR OF KNEE CARTILAGE                	    14.51	  $540.21	      ---	  $681.24	004	1	0	0.00	    $0.00	Y	
O	27403	REPAIR OF KNEE CARTILAGE                	     2.90	  $107.97	      ---	  $136.16	004	1	0	0.00	    $0.00	Y	
O	27405	REPAIR OF KNEE LIGAMENT                 	     3.10	  $115.41	      ---	  $145.55	004	1	0	0.00	    $0.00	Y	
K	27405	REPAIR OF KNEE LIGAMENT                 	    15.48	  $576.32	      ---	  $726.79	004	1	0	0.00	    $0.00	Y	
K	27407	REPAIR OF KNEE LIGAMENT                 	    17.48	  $650.78	      ---	  $820.69	004	1	0	0.00	    $0.00	Y	
O	27407	REPAIR OF KNEE LIGAMENT                 	     3.50	  $130.31	      ---	  $164.33	004	1	0	0.00	    $0.00	Y	
O	27409	REPAIR OF KNEE LIGAMENTS                	     4.08	  $151.90	      ---	  $191.56	004	1	0	0.00	    $0.00	Y	
K	27409	REPAIR OF KNEE LIGAMENTS                	    20.39	  $759.12	      ---	  $957.31	004	1	0	0.00	    $0.00	Y	
K	27412	AUTOCHONDROCYTE IMPLANT KNEE            	    22.41	  $834.32	      ---	 $1052.15	004	1	0	0.00	    $0.00	Y	
O	27412	AUTOCHONDROCYTE IMPLANT KNEE            	     4.48	  $166.79	      ---	  $210.34	004	1	0	0.00	    $0.00	Y	
O	27415	OSTEOCHONDRAL KNEE ALLOGRAFT            	     3.69	  $137.38	      ---	  $173.25	004	1	0	0.00	    $0.00	Y	
K	27415	OSTEOCHONDRAL KNEE ALLOGRAFT            	    18.43	  $686.15	      ---	  $865.29	004	1	0	0.00	    $0.00	Y	
K	27416	OSTEOCHONDRAL KNEE AUTOGRAFT            	    19.92	  $741.62	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	27416	OSTEOCHONDRAL KNEE AUTOGRAFT            	     3.78	  $140.73	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	27418	REPAIR DEGENERATED KNEECAP              	     3.62	  $134.77	      ---	  $169.96	004	1	0	0.00	    $0.00	Y	
K	27418	REPAIR DEGENERATED KNEECAP              	    18.12	  $674.61	      ---	  $850.73	004	1	0	0.00	    $0.00	Y	
K	27420	REVISION OF UNSTABLE KNEECAP            	    16.41	  $610.94	      ---	  $770.45	004	1	0	0.00	    $0.00	Y	
O	27420	REVISION OF UNSTABLE KNEECAP            	     3.28	  $122.11	      ---	  $154.00	004	1	0	0.00	    $0.00	Y	
O	27422	REVISION OF UNSTABLE KNEECAP            	     3.32	  $123.60	      ---	  $155.87	004	1	0	0.00	    $0.00	Y	
K	27422	REVISION OF UNSTABLE KNEECAP            	    16.61	  $618.39	      ---	  $779.84	004	1	0	0.00	    $0.00	Y	
K	27424	REVISION/REMOVAL OF KNEECAP             	    17.00	  $632.91	      ---	  $798.15	004	1	0	0.00	    $0.00	Y	
O	27424	REVISION/REMOVAL OF KNEECAP             	     3.40	  $126.58	      ---	  $159.63	004	1	0	0.00	    $0.00	Y	
O	27425	LAT RETINACULAR RELEASE OPEN            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	27425	LAT RETINACULAR RELEASE OPEN            	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
K	27427	RECONSTRUCTION KNEE                     	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	27427	RECONSTRUCTION KNEE                     	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	27428	RECONSTRUCTION KNEE                     	     4.57	  $170.14	      ---	  $214.56	004	1	0	0.00	    $0.00	Y	
K	27428	RECONSTRUCTION KNEE                     	    22.86	  $851.08	      ---	 $1073.28	004	1	0	0.00	    $0.00	Y	
K	27429	RECONSTRUCTION KNEE                     	    25.78	  $959.79	      ---	 $1210.37	004	1	0	0.00	    $0.00	Y	
O	27429	RECONSTRUCTION KNEE                     	     5.16	  $192.11	      ---	  $242.26	004	1	0	0.00	    $0.00	Y	
O	27430	REVISION OF THIGH MUSCLES               	     3.25	  $121.00	      ---	  $152.59	004	1	0	0.00	    $0.00	Y	
K	27430	REVISION OF THIGH MUSCLES               	    16.26	  $605.36	      ---	  $763.41	004	1	0	0.00	    $0.00	Y	
K	27435	INCISION OF KNEE JOINT                  	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
O	27435	INCISION OF KNEE JOINT                  	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
O	27437	REVISE KNEECAP                          	     3.00	  $111.69	      ---	  $140.85	004	1	0	0.00	    $0.00	Y	
K	27437	REVISE KNEECAP                          	    15.00	  $558.45	      ---	  $704.25	004	1	0	0.00	    $0.00	Y	
K	27438	REVISE KNEECAP WITH IMPLANT             	    20.23	  $753.16	      ---	  $949.80	004	1	0	0.00	    $0.00	Y	
O	27438	REVISE KNEECAP WITH IMPLANT             	     4.05	  $150.78	      ---	  $190.15	004	1	0	0.00	    $0.00	Y	
O	27440	REVISION OF KNEE JOINT                  	     3.40	  $126.58	      ---	  $159.63	004	1	0	0.00	    $0.00	Y	
K	27440	REVISION OF KNEE JOINT                  	    16.99	  $632.54	      ---	  $797.68	004	1	0	0.00	    $0.00	Y	
K	27441	REVISION OF KNEE JOINT                  	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
O	27441	REVISION OF KNEE JOINT                  	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
O	27442	REVISION OF KNEE JOINT                  	     4.80	  $178.70	      ---	  $225.36	004	1	0	0.00	    $0.00	Y	
K	27442	REVISION OF KNEE JOINT                  	    24.00	  $893.52	      ---	 $1126.80	004	1	0	0.00	    $0.00	Y	
K	27443	REVISION OF KNEE JOINT                  	    20.87	  $776.99	      ---	  $979.85	004	1	0	0.00	    $0.00	Y	
O	27443	REVISION OF KNEE JOINT                  	     4.17	  $155.25	      ---	  $195.78	004	1	0	0.00	    $0.00	Y	
O	27445	REVISION OF KNEE JOINT                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	27445	REVISION OF KNEE JOINT                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	27446	REVISION OF KNEE JOINT                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	27446	REVISION OF KNEE JOINT                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	27447	TOTAL KNEE ARTHROPLASTY                 	     8.00	  $297.84	      ---	  $375.60	004	1	0	0.00	    $0.00	Y	
K	27447	TOTAL KNEE ARTHROPLASTY                 	    40.00	 $1489.20	      ---	 $1878.00	004	1	0	0.00	    $0.00	Y	
K	27448	INCISION OF THIGH                       	    19.11	  $711.47	      ---	  $897.21	004	1	0	0.00	    $0.00	Y	
O	27448	INCISION OF THIGH                       	     3.82	  $142.22	      ---	  $179.35	004	1	0	0.00	    $0.00	Y	
O	27450	INCISION OF THIGH                       	     4.30	  $160.09	      ---	  $201.89	004	1	0	0.00	    $0.00	Y	
K	27450	INCISION OF THIGH                       	    21.52	  $801.19	      ---	 $1010.36	004	1	0	0.00	    $0.00	Y	
K	27454	REALIGNMENT OF THIGH BONE               	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
O	27454	REALIGNMENT OF THIGH BONE               	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
O	27455	REALIGNMENT OF KNEE                     	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	27455	REALIGNMENT OF KNEE                     	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	27457	REALIGNMENT OF KNEE                     	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
O	27457	REALIGNMENT OF KNEE                     	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
O	27465	SHORTENING OF THIGH BONE                	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	27465	SHORTENING OF THIGH BONE                	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
K	27466	LENGTHENING OF THIGH BONE               	    27.63	 $1028.66	      ---	 $1297.23	004	1	0	0.00	    $0.00	Y	
O	27466	LENGTHENING OF THIGH BONE               	     5.53	  $205.88	      ---	  $259.63	004	1	0	0.00	    $0.00	Y	
O	27468	SHORTEN/LENGTHEN THIGHS                 	     8.00	  $297.84	      ---	  $375.60	004	1	0	0.00	    $0.00	Y	
K	27468	SHORTEN/LENGTHEN THIGHS                 	    40.00	 $1489.20	      ---	 $1878.00	004	1	0	0.00	    $0.00	Y	
K	27470	REPAIR OF THIGH                         	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
O	27470	REPAIR OF THIGH                         	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
O	27472	REPAIR/GRAFT OF THIGH                   	     5.21	  $193.97	      ---	  $244.61	004	1	0	0.00	    $0.00	Y	
K	27472	REPAIR/GRAFT OF THIGH                   	    26.05	  $969.84	      ---	 $1223.05	004	1	0	0.00	    $0.00	Y	
K	27475	SURGERY TO STOP LEG GROWTH              	    14.83	  $552.12	      ---	  $696.27	004	1	0	0.00	    $0.00	Y	
O	27475	SURGERY TO STOP LEG GROWTH              	     2.97	  $110.57	      ---	  $139.44	004	1	0	0.00	    $0.00	Y	
O	27477	SURGERY TO STOP LEG GROWTH              	     3.37	  $125.47	      ---	  $158.22	004	1	0	0.00	    $0.00	Y	
K	27477	SURGERY TO STOP LEG GROWTH              	    16.87	  $628.07	      ---	  $792.05	004	1	0	0.00	    $0.00	Y	
K	27479	SURGERY TO STOP LEG GROWTH              	    20.27	  $754.65	      ---	  $951.68	004	1	0	0.00	    $0.00	Y	
O	27479	SURGERY TO STOP LEG GROWTH              	     4.05	  $150.78	      ---	  $190.15	004	1	0	0.00	    $0.00	Y	
O	27485	SURGERY TO STOP LEG GROWTH              	     2.49	   $92.70	      ---	  $116.91	004	1	0	0.00	    $0.00	Y	
K	27485	SURGERY TO STOP LEG GROWTH              	    12.46	  $463.89	      ---	  $585.00	004	1	0	0.00	    $0.00	Y	
K	27486	REVISE/REPLACE KNEE JOINT               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	27486	REVISE/REPLACE KNEE JOINT               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	27487	REVISE/REPLACE KNEE JOINT               	     7.67	  $285.55	      ---	  $360.11	004	1	0	0.00	    $0.00	Y	
K	27487	REVISE/REPLACE KNEE JOINT               	    38.37	 $1428.52	      ---	 $1801.47	004	1	0	0.00	    $0.00	Y	
K	27488	REMOVAL OF KNEE PROSTHESIS              	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
O	27488	REMOVAL OF KNEE PROSTHESIS              	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
O	27495	REINFORCE THIGH                         	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	27495	REINFORCE THIGH                         	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	27496	DECOMPRESSION OF THIGH/KNEE             	     6.88	  $256.14	      ---	  $323.02	004	1	0	0.00	    $0.00	Y	
O	27496	DECOMPRESSION OF THIGH/KNEE             	     1.37	   $51.01	      ---	   $64.32	004	1	0	0.00	    $0.00	Y	
O	27497	DECOMPRESSION OF THIGH/KNEE             	     1.68	   $62.55	      ---	   $78.88	004	1	0	0.00	    $0.00	Y	
K	27497	DECOMPRESSION OF THIGH/KNEE             	     8.40	  $312.73	      ---	  $394.38	004	1	0	0.00	    $0.00	Y	
K	27498	DECOMPRESSION OF THIGH/KNEE             	     9.58	  $356.66	      ---	  $449.78	004	1	0	0.00	    $0.00	Y	
O	27498	DECOMPRESSION OF THIGH/KNEE             	     1.91	   $71.11	      ---	   $89.67	004	1	0	0.00	    $0.00	Y	
O	27499	DECOMPRESSION OF THIGH/KNEE             	     2.21	   $82.28	      ---	  $103.76	004	1	0	0.00	    $0.00	Y	
K	27499	DECOMPRESSION OF THIGH/KNEE             	    11.04	  $411.02	      ---	  $518.33	004	1	0	0.00	    $0.00	Y	
K	27500	TREATMENT OF THIGH FRACTURE             	   345.13	  $345.13	      ---	       --	042	0	0	0.00	    $0.00	Y	
O	27500	TREATMENT OF THIGH FRACTURE             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	27501	TREATMENT OF THIGH FRACTURE             	     1.93	   $71.85	      ---	   $90.61	004	1	0	0.00	    $0.00	Y	
K	27501	TREATMENT OF THIGH FRACTURE             	     9.63	  $358.52	      ---	  $452.13	004	1	0	0.00	    $0.00	Y	
K	27502	TREATMENT OF THIGH FRACTURE             	     9.61	  $357.78	      ---	  $451.19	004	1	0	0.00	    $0.00	Y	
O	27502	TREATMENT OF THIGH FRACTURE             	     1.92	   $71.48	      ---	   $90.14	004	1	0	0.00	    $0.00	Y	
O	27503	TREATMENT OF THIGH FRACTURE             	     2.50	   $93.08	      ---	  $117.38	004	1	0	0.00	    $0.00	Y	
K	27503	TREATMENT OF THIGH FRACTURE             	    12.54	  $466.86	      ---	  $588.75	004	1	0	0.00	    $0.00	Y	
K	27506	TREATMENT OF THIGH FRACTURE             	    21.52	  $801.19	      ---	 $1010.36	004	1	0	0.00	    $0.00	Y	
O	27506	TREATMENT OF THIGH FRACTURE             	     4.30	  $160.09	      ---	  $201.89	004	1	0	0.00	    $0.00	Y	
O	27507	TREATMENT OF THIGH FRACTURE             	     4.35	  $161.95	      ---	  $204.23	004	1	0	0.00	    $0.00	Y	
K	27507	TREATMENT OF THIGH FRACTURE             	    21.73	  $809.01	      ---	 $1020.22	004	1	0	0.00	    $0.00	Y	
K	27508	TREATMENT OF THIGH FRACTURE             	   257.26	  $257.26	      ---	       --	042	0	0	0.00	    $0.00	Y	
O	27508	TREATMENT OF THIGH FRACTURE             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	27509	TREATMENT OF THIGH FRACTURE             	     1.57	   $58.45	      ---	   $73.71	004	1	0	0.00	    $0.00	Y	
K	27509	TREATMENT OF THIGH FRACTURE             	     7.87	  $293.00	      ---	  $369.50	004	1	0	0.00	    $0.00	Y	
K	27510	TREATMENT OF THIGH FRACTURE             	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	27510	TREATMENT OF THIGH FRACTURE             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	27511	TREATMENT OF THIGH FRACTURE             	     4.30	  $160.09	      ---	  $201.89	004	1	0	0.00	    $0.00	Y	
K	27511	TREATMENT OF THIGH FRACTURE             	    21.51	  $800.82	      ---	 $1009.89	004	1	0	0.00	    $0.00	Y	
K	27513	TREATMENT OF THIGH FRACTURE             	    24.24	  $902.46	      ---	 $1138.07	004	1	0	0.00	    $0.00	Y	
O	27513	TREATMENT OF THIGH FRACTURE             	     4.85	  $180.57	      ---	  $227.71	004	1	0	0.00	    $0.00	Y	
O	27514	TREATMENT OF THIGH FRACTURE             	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	27514	TREATMENT OF THIGH FRACTURE             	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
K	27516	TREAT THIGH FX GROWTH PLATE             	    13.27	  $494.04	      ---	  $623.03	004	1	0	0.00	    $0.00	Y	
O	27516	TREAT THIGH FX GROWTH PLATE             	     2.65	   $98.66	      ---	  $124.42	004	1	0	0.00	    $0.00	Y	
O	27517	TREAT THIGH FX GROWTH PLATE             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	27517	TREAT THIGH FX GROWTH PLATE             	     8.83	  $328.74	      ---	  $414.57	004	1	0	0.00	    $0.00	Y	
K	27519	TREAT THIGH FX GROWTH PLATE             	    18.80	  $699.92	      ---	  $882.66	004	1	0	0.00	    $0.00	Y	
O	27519	TREAT THIGH FX GROWTH PLATE             	     3.74	  $139.24	      ---	  $175.59	004	1	0	0.00	    $0.00	Y	
O	27520	TREAT KNEECAP FRACTURE                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	27520	TREAT KNEECAP FRACTURE                  	   176.52	  $176.52	      ---	       --	042	0	0	0.00	    $0.00	Y	
K	27524	TREAT KNEECAP FRACTURE                  	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	27524	TREAT KNEECAP FRACTURE                  	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
O	27530	TREAT KNEE FRACTURE                     	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	27530	TREAT KNEE FRACTURE                     	   201.34	  $201.34	      ---	       --	042	0	1	0.00	    $0.00	Y	
K	27532	TREAT KNEE FRACTURE                     	     6.72	  $250.19	      ---	  $315.50	004	1	0	0.00	    $0.00	Y	
O	27532	TREAT KNEE FRACTURE                     	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	27535	TREAT KNEE FRACTURE                     	     3.19	  $118.76	      ---	  $149.77	004	1	0	0.00	    $0.00	Y	
K	27535	TREAT KNEE FRACTURE                     	    15.95	  $593.82	      ---	  $748.85	004	1	0	0.00	    $0.00	Y	
K	27536	TREAT KNEE FRACTURE                     	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
O	27536	TREAT KNEE FRACTURE                     	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
O	27538	TREAT KNEE FRACTURE(S)                  	     2.44	   $90.84	      ---	  $114.56	004	1	0	0.00	    $0.00	Y	
K	27538	TREAT KNEE FRACTURE(S)                  	    12.19	  $453.83	      ---	  $572.32	004	1	1	0.00	    $0.00	Y	
K	27540	TREAT KNEE FRACTURE                     	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
O	27540	TREAT KNEE FRACTURE                     	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
O	27550	TREAT KNEE DISLOCATION                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	27550	TREAT KNEE DISLOCATION                  	   257.37	  $257.37	      ---	       --	042	0	1	0.00	    $0.00	Y	
K	27552	TREAT KNEE DISLOCATION                  	     7.06	  $262.84	      ---	  $331.47	004	1	0	0.00	    $0.00	Y	
O	27552	TREAT KNEE DISLOCATION                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	27556	TREAT KNEE DISLOCATION                  	     3.40	  $126.58	      ---	  $159.63	004	1	0	0.00	    $0.00	Y	
K	27556	TREAT KNEE DISLOCATION                  	    16.99	  $632.54	      ---	  $797.68	004	1	0	0.00	    $0.00	Y	
K	27557	TREAT KNEE DISLOCATION                  	    16.99	  $632.54	      ---	  $797.68	004	1	0	0.00	    $0.00	Y	
O	27557	TREAT KNEE DISLOCATION                  	     3.40	  $126.58	      ---	  $159.63	004	1	0	0.00	    $0.00	Y	
O	27558	TREAT KNEE DISLOCATION                  	     4.62	  $172.00	      ---	  $216.91	004	1	0	0.00	    $0.00	Y	
K	27558	TREAT KNEE DISLOCATION                  	    23.09	  $859.64	      ---	 $1084.08	004	1	0	0.00	    $0.00	Y	
K	27560	TREAT KNEECAP DISLOCATION               	     5.42	  $201.79	      ---	  $254.47	004	1	1	0.00	    $0.00	Y	
O	27560	TREAT KNEECAP DISLOCATION               	     1.08	   $40.21	      ---	   $50.71	004	1	0	0.00	    $0.00	Y	
O	27562	TREAT KNEECAP DISLOCATION               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	27562	TREAT KNEECAP DISLOCATION               	     5.12	  $190.62	      ---	  $240.38	004	1	0	0.00	    $0.00	Y	
K	27566	TREAT KNEECAP DISLOCATION               	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	27566	TREAT KNEECAP DISLOCATION               	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	27570	FIXATION OF KNEE JOINT                  	     2.09	   $77.81	      ---	   $98.13	004	1	0	0.00	    $0.00	Y	
K	27580	FUSION OF KNEE                          	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
O	27580	FUSION OF KNEE                          	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
O	27590	AMPUTATE LEG AT THIGH                   	     3.28	  $122.11	      ---	  $154.00	004	1	0	0.00	    $0.00	Y	
K	27590	AMPUTATE LEG AT THIGH                   	    16.42	  $611.32	      ---	  $770.92	004	1	0	0.00	    $0.00	Y	
K	27591	AMPUTATE LEG AT THIGH                   	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
O	27591	AMPUTATE LEG AT THIGH                   	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
O	27592	AMPUTATE LEG AT THIGH                   	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
K	27592	AMPUTATE LEG AT THIGH                   	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
K	27594	AMPUTATION FOLLOW-UP SURGERY            	     7.09	  $263.96	      ---	  $332.88	004	1	0	0.00	    $0.00	Y	
O	27594	AMPUTATION FOLLOW-UP SURGERY            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	27596	AMPUTATION FOLLOW-UP SURGERY            	     3.80	  $141.47	      ---	  $178.41	004	1	0	0.00	    $0.00	Y	
K	27596	AMPUTATION FOLLOW-UP SURGERY            	    18.98	  $706.63	      ---	  $891.11	004	1	0	0.00	    $0.00	Y	
K	27598	AMPUTATE LOWER LEG AT KNEE              	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
O	27598	AMPUTATE LOWER LEG AT KNEE              	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
O	27599	UNLISTED PX FEMUR/KNEE                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	27599	UNLISTED PX FEMUR/KNEE                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	27600	DECOMPRESSION OF LOWER LEG              	     6.21	  $231.20	      ---	  $291.56	004	1	0	0.00	    $0.00	Y	
O	27600	DECOMPRESSION OF LOWER LEG              	     1.24	   $46.17	      ---	   $58.22	004	1	0	0.00	    $0.00	Y	
O	27601	DECOMPRESSION OF LOWER LEG              	     2.33	   $86.75	      ---	  $109.39	004	1	0	0.00	    $0.00	Y	
K	27601	DECOMPRESSION OF LOWER LEG              	    11.65	  $433.73	      ---	  $546.97	004	1	0	0.00	    $0.00	Y	
K	27602	DECOMPRESSION OF LOWER LEG              	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
O	27602	DECOMPRESSION OF LOWER LEG              	     1.59	   $59.20	      ---	   $74.65	004	1	0	0.00	    $0.00	Y	
O	27603	DRAIN LOWER LEG LESION                  	     3.22	  $119.88	      ---	  $151.18	004	1	0	0.00	    $0.00	Y	
K	27603	DRAIN LOWER LEG LESION                  	    16.10	  $599.40	      ---	  $755.90	004	1	0	0.00	    $0.00	Y	
K	27604	DRAIN LOWER LEG BURSA                   	     6.29	  $234.18	      ---	  $295.32	004	1	0	0.00	    $0.00	Y	
K	27605	INCISION OF ACHILLES TENDON             	     4.74	  $176.47	      ---	  $222.54	004	1	0	0.00	    $0.00	Y	
P	27605	INCISION OF ACHILLES TENDON             	     4.74	  $176.47	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	27606	INCISION OF ACHILLES TENDON             	     5.86	  $218.17	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	27606	INCISION OF ACHILLES TENDON             	     5.87	  $218.54	      ---	  $275.60	004	1	0	0.00	    $0.00	Y	
K	27607	TREAT LOWER LEG BONE LESION             	    10.99	  $409.16	      ---	  $515.98	004	1	0	0.00	    $0.00	Y	
P	27607	TREAT LOWER LEG BONE LESION             	    10.99	  $409.16	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	27607	TREAT LOWER LEG BONE LESION             	     2.20	   $81.91	      ---	  $103.29	004	1	0	0.00	    $0.00	Y	
O	27610	EXPLORE/TREAT ANKLE JOINT               	     2.04	   $75.95	      ---	   $95.78	004	1	0	0.00	    $0.00	Y	
P	27610	EXPLORE/TREAT ANKLE JOINT               	    10.19	  $379.37	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	27610	EXPLORE/TREAT ANKLE JOINT               	    10.19	  $379.37	      ---	  $478.42	004	1	0	0.00	    $0.00	Y	
K	27612	EXPLORATION OF ANKLE JOINT              	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
P	27612	EXPLORATION OF ANKLE JOINT              	    11.33	  $421.82	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	27612	EXPLORATION OF ANKLE JOINT              	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
P	27613	BIOPSY LOWER LEG SOFT TISSUE            	     3.57	  $132.91	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	27613	BIOPSY LOWER LEG SOFT TISSUE            	     3.58	  $133.28	      ---	  $168.08	004	1	0	0.00	    $0.00	Y	
K	27614	BIOPSY LOWER LEG SOFT TISSUE            	     7.05	  $262.47	      ---	  $331.00	004	1	0	0.00	    $0.00	Y	
P	27614	BIOPSY LOWER LEG SOFT TISSUE            	     7.05	  $262.47	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	27614	BIOPSY LOWER LEG SOFT TISSUE            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	27615	RESECT LEG/ANKLE TUM < 5 CM             	     4.65	  $173.12	      ---	  $218.32	004	1	0	0.00	    $0.00	Y	
P	27615	RESECT LEG/ANKLE TUM < 5 CM             	    23.23	  $864.85	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	27615	RESECT LEG/ANKLE TUM < 5 CM             	    23.23	  $864.85	      ---	 $1090.65	004	1	0	0.00	    $0.00	Y	
K	27616	RESECT LEG/ANKLE TUM 5 CM/>             	    28.24	 $1051.38	      ---	       --	004	0	0	0.00	    $0.00	Y	
P	27616	RESECT LEG/ANKLE TUM 5 CM/>             	    28.24	 $1051.38	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	27616	RESECT LEG/ANKLE TUM 5 CM/>             	     5.65	  $210.35	      ---	       --	004	0	0	0.00	    $0.00	Y	
P	27618	EXC LEG/ANKLE TUM < 3 CM                	    13.36	  $497.39	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	27618	EXC LEG/ANKLE TUM < 3 CM                	    13.35	  $497.02	      ---	  $626.78	004	1	1	0.00	    $0.00	Y	
K	27619	EXC LEG/ANKLE TUM DEEP <5 CM            	     9.91	  $368.95	      ---	  $465.27	004	1	0	0.00	    $0.00	Y	
P	27619	EXC LEG/ANKLE TUM DEEP <5 CM            	     9.91	  $368.95	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	27619	EXC LEG/ANKLE TUM DEEP <5 CM            	     1.98	   $73.72	      ---	   $92.96	004	1	0	0.00	    $0.00	Y	
O	27620	EXPLORE/TREAT ANKLE JOINT               	     2.04	   $75.95	      ---	   $95.78	004	1	0	0.00	    $0.00	Y	
P	27620	EXPLORE/TREAT ANKLE JOINT               	    10.19	  $379.37	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	27620	EXPLORE/TREAT ANKLE JOINT               	    10.19	  $379.37	      ---	  $478.42	004	1	0	0.00	    $0.00	Y	
K	27625	REMOVE ANKLE JOINT LINING               	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
P	27625	REMOVE ANKLE JOINT LINING               	    13.59	  $505.96	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	27625	REMOVE ANKLE JOINT LINING               	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
O	27626	REMOVE ANKLE JOINT LINING               	     2.94	  $109.46	      ---	  $138.03	004	1	0	0.00	    $0.00	Y	
P	27626	REMOVE ANKLE JOINT LINING               	    14.72	  $548.03	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	27626	REMOVE ANKLE JOINT LINING               	    14.72	  $548.03	      ---	  $691.10	004	1	0	0.00	    $0.00	Y	
K	27630	REMOVAL OF TENDON LESION                	     6.96	  $259.12	      ---	  $326.77	004	1	0	0.00	    $0.00	Y	
P	27630	REMOVAL OF TENDON LESION                	     6.96	  $259.12	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	27630	REMOVAL OF TENDON LESION                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	27632	EXC LEG/ANKLE LES SC 3 CM/>             	     1.83	   $68.13	      ---	   $85.92	004	1	0	0.00	    $0.00	Y	
P	27632	EXC LEG/ANKLE LES SC 3 CM/>             	     9.17	  $341.40	      ---	       --	015	1	0	0.00	    $0.00	Y	
K	27632	EXC LEG/ANKLE LES SC 3 CM/>             	     9.17	  $341.40	      ---	  $430.53	004	1	0	0.00	    $0.00	Y	
K	27634	EXC LEG/ANKLE TUM DEP 5 CM/>            	    14.90	  $554.73	      ---	       --	004	0	0	0.00	    $0.00	Y	
P	27634	EXC LEG/ANKLE TUM DEP 5 CM/>            	    14.90	  $554.73	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	27634	EXC LEG/ANKLE TUM DEP 5 CM/>            	     2.98	  $110.95	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	27635	REMOVE LOWER LEG BONE LESION            	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	27635	REMOVE LOWER LEG BONE LESION            	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	27637	REMOVE/GRAFT LEG BONE LESION            	    14.72	  $548.03	      ---	  $691.10	004	1	0	0.00	    $0.00	Y	
O	27637	REMOVE/GRAFT LEG BONE LESION            	     2.94	  $109.46	      ---	  $138.03	004	1	0	0.00	    $0.00	Y	
O	27638	REMOVE/GRAFT LEG BONE LESION            	     2.49	   $92.70	      ---	  $116.91	004	1	0	0.00	    $0.00	Y	
K	27638	REMOVE/GRAFT LEG BONE LESION            	    12.46	  $463.89	      ---	  $585.00	004	1	0	0.00	    $0.00	Y	
K	27640	PARTIAL REMOVAL OF TIBIA                	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	27640	PARTIAL REMOVAL OF TIBIA                	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
O	27641	PARTIAL REMOVAL OF FIBULA               	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	27641	PARTIAL REMOVAL OF FIBULA               	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	27645	RESECT TIBIA TUMOR                      	    27.18	 $1011.91	      ---	 $1276.10	004	1	0	0.00	    $0.00	Y	
O	27645	RESECT TIBIA TUMOR                      	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
O	27646	RESECT FIBULA TUMOR                     	     5.01	  $186.52	      ---	  $235.22	004	1	0	0.00	    $0.00	Y	
K	27646	RESECT FIBULA TUMOR                     	    25.02	  $931.49	      ---	 $1174.69	004	1	0	0.00	    $0.00	Y	
K	27647	RESECT TALUS/CALCANEUS TUM              	    19.61	  $730.08	      ---	  $920.69	004	1	0	0.00	    $0.00	Y	
O	27647	RESECT TALUS/CALCANEUS TUM              	     3.92	  $145.94	      ---	  $184.04	004	1	0	0.00	    $0.00	Y	
P	27647	RESECT TALUS/CALCANEUS TUM              	    19.61	  $730.08	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	27648	INJECTION FOR ANKLE X-RAY               	     4.30	  $160.09	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	27648	INJECTION FOR ANKLE X-RAY               	     4.30	  $160.09	      ---	  $201.89	004	1	0	0.00	    $0.00	Y	
K	27650	REPAIR ACHILLES TENDON                  	    12.46	  $463.89	      ---	  $585.00	004	1	0	0.00	    $0.00	Y	
P	27650	REPAIR ACHILLES TENDON                  	    12.46	  $463.89	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	27650	REPAIR ACHILLES TENDON                  	     2.49	   $92.70	      ---	  $116.91	004	1	0	0.00	    $0.00	Y	
O	27652	REPAIR/GRAFT ACHILLES TENDON            	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
P	27652	REPAIR/GRAFT ACHILLES TENDON            	    15.85	  $590.10	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	27652	REPAIR/GRAFT ACHILLES TENDON            	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
K	27654	REPAIR OF ACHILLES TENDON               	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
P	27654	REPAIR OF ACHILLES TENDON               	    15.85	  $590.10	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	27654	REPAIR OF ACHILLES TENDON               	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
O	27656	REPAIR LEG FASCIA DEFECT                	     1.54	   $57.33	      ---	   $72.30	004	1	0	0.00	    $0.00	Y	
K	27656	REPAIR LEG FASCIA DEFECT                	     7.70	  $286.67	      ---	  $361.52	004	1	0	0.00	    $0.00	Y	
K	27658	REPAIR OF LEG TENDON EACH               	     7.75	  $288.53	      ---	  $363.86	004	1	0	0.00	    $0.00	Y	
O	27658	REPAIR OF LEG TENDON EACH               	     1.55	   $57.71	      ---	   $72.77	004	1	0	0.00	    $0.00	Y	
P	27658	REPAIR OF LEG TENDON EACH               	     7.75	  $288.53	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	27659	REPAIR OF LEG TENDON EACH               	     9.06	  $337.30	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	27659	REPAIR OF LEG TENDON EACH               	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
K	27659	REPAIR OF LEG TENDON EACH               	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
K	27664	REPAIR OF LEG TENDON EACH               	     6.54	  $243.48	      ---	  $307.05	004	1	0	0.00	    $0.00	Y	
O	27664	REPAIR OF LEG TENDON EACH               	     1.31	   $48.77	      ---	   $61.50	004	1	0	0.00	    $0.00	Y	
P	27664	REPAIR OF LEG TENDON EACH               	     6.54	  $243.48	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	27665	REPAIR OF LEG TENDON EACH               	     8.50	  $316.46	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	27665	REPAIR OF LEG TENDON EACH               	     1.70	   $63.29	      ---	   $79.82	004	1	0	0.00	    $0.00	Y	
K	27665	REPAIR OF LEG TENDON EACH               	     8.49	  $316.08	      ---	  $398.61	004	1	0	0.00	    $0.00	Y	
K	27675	REPAIR LOWER LEG TENDONS                	     7.48	  $278.48	      ---	  $351.19	004	1	0	0.00	    $0.00	Y	
O	27675	REPAIR LOWER LEG TENDONS                	     1.49	   $55.47	      ---	   $69.96	004	1	0	0.00	    $0.00	Y	
P	27675	REPAIR LOWER LEG TENDONS                	     7.47	  $278.11	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	27676	REPAIR LOWER LEG TENDONS                	     7.82	  $291.14	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	27676	REPAIR LOWER LEG TENDONS                	     1.56	   $58.08	      ---	   $73.24	004	1	0	0.00	    $0.00	Y	
K	27676	REPAIR LOWER LEG TENDONS                	     7.82	  $291.14	      ---	  $367.15	004	1	0	0.00	    $0.00	Y	
K	27680	RELEASE OF LOWER LEG TENDON             	     5.92	  $220.40	      ---	  $277.94	004	1	0	0.00	    $0.00	Y	
O	27680	RELEASE OF LOWER LEG TENDON             	     1.18	   $43.93	      ---	   $55.40	004	1	0	0.00	    $0.00	Y	
P	27680	RELEASE OF LOWER LEG TENDON             	     5.93	  $220.77	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	27681	RELEASE OF LOWER LEG TENDONS            	     6.80	  $253.16	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	27681	RELEASE OF LOWER LEG TENDONS            	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
K	27681	RELEASE OF LOWER LEG TENDONS            	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
K	27685	REVISION OF LOWER LEG TENDON            	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
O	27685	REVISION OF LOWER LEG TENDON            	     1.59	   $59.20	      ---	   $74.65	004	1	0	0.00	    $0.00	Y	
P	27685	REVISION OF LOWER LEG TENDON            	     7.93	  $295.23	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	27686	REVISE LOWER LEG TENDONS                	     7.93	  $295.23	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	27686	REVISE LOWER LEG TENDONS                	     1.59	   $59.20	      ---	   $74.65	004	1	0	0.00	    $0.00	Y	
K	27686	REVISE LOWER LEG TENDONS                	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
K	27687	REVISION OF CALF TENDON                 	     8.83	  $328.74	      ---	  $414.57	004	1	0	0.00	    $0.00	Y	
O	27687	REVISION OF CALF TENDON                 	     1.77	   $65.90	      ---	   $83.10	004	1	0	0.00	    $0.00	Y	
P	27687	REVISION OF CALF TENDON                 	     8.83	  $328.74	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	27690	REVISE LOWER LEG TENDON                 	     9.06	  $337.30	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	27690	REVISE LOWER LEG TENDON                 	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
K	27690	REVISE LOWER LEG TENDON                 	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
K	27691	REVISE LOWER LEG TENDON                 	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	27691	REVISE LOWER LEG TENDON                 	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
P	27691	REVISE LOWER LEG TENDON                 	    11.33	  $421.82	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	27692	REVISE ADDITIONAL LEG TENDON            	     2.26	   $84.14	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	27692	REVISE ADDITIONAL LEG TENDON            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	27692	REVISE ADDITIONAL LEG TENDON            	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	27695	REPAIR OF ANKLE LIGAMENT                	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	27695	REPAIR OF ANKLE LIGAMENT                	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
P	27695	REPAIR OF ANKLE LIGAMENT                	    11.33	  $421.82	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	27696	REPAIR OF ANKLE LIGAMENTS               	    14.97	  $557.33	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	27696	REPAIR OF ANKLE LIGAMENTS               	     2.99	  $111.32	      ---	  $140.38	004	1	0	0.00	    $0.00	Y	
K	27696	REPAIR OF ANKLE LIGAMENTS               	    14.97	  $557.33	      ---	  $702.84	004	1	0	0.00	    $0.00	Y	
K	27698	REPAIR OF ANKLE LIGAMENT                	    15.70	  $584.51	      ---	  $737.12	004	1	0	0.00	    $0.00	Y	
O	27698	REPAIR OF ANKLE LIGAMENT                	     3.14	  $116.90	      ---	  $147.42	004	1	0	0.00	    $0.00	Y	
P	27698	REPAIR OF ANKLE LIGAMENT                	    15.70	  $584.51	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	27700	REVISION OF ANKLE JOINT                 	     0.00	    $0.00	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	27700	REVISION OF ANKLE JOINT                 	     2.98	  $110.95	      ---	  $139.91	004	1	0	0.00	    $0.00	Y	
K	27700	REVISION OF ANKLE JOINT                 	    14.91	  $555.10	      ---	  $700.02	004	1	0	0.00	    $0.00	Y	
K	27702	RECONSTRUCT ANKLE JOINT                 	    24.92	  $927.77	      ---	 $1169.99	004	1	0	0.00	    $0.00	Y	
O	27702	RECONSTRUCT ANKLE JOINT                 	     4.98	  $185.41	      ---	  $233.81	004	1	0	0.00	    $0.00	Y	
P	27702	RECONSTRUCT ANKLE JOINT                 	     0.00	    $0.00	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	27703	RECONSTRUCTION ANKLE JOINT              	     0.00	    $0.00	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	27703	RECONSTRUCTION ANKLE JOINT              	     4.92	  $183.17	      ---	  $230.99	004	1	0	0.00	    $0.00	Y	
K	27703	RECONSTRUCTION ANKLE JOINT              	    24.58	  $915.11	      ---	 $1154.03	004	1	0	0.00	    $0.00	Y	
K	27704	REMOVAL OF ANKLE IMPLANT                	    13.88	  $516.75	      ---	  $651.67	004	1	0	0.00	    $0.00	Y	
O	27704	REMOVAL OF ANKLE IMPLANT                	     2.77	  $103.13	      ---	  $130.05	004	1	0	0.00	    $0.00	Y	
P	27704	REMOVAL OF ANKLE IMPLANT                	     0.00	    $0.00	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	27705	OSTEOTOMY TIBIA                         	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	27705	OSTEOTOMY TIBIA                         	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	27707	OSTEOTOMY FIBULA                        	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
O	27707	OSTEOTOMY FIBULA                        	     1.59	   $59.20	      ---	   $74.65	004	1	0	0.00	    $0.00	Y	
O	27709	OSTEOTOMY TIBIA & FIBULA                	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
K	27709	OSTEOTOMY TIBIA & FIBULA                	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
K	27712	OSTEOT MLT RELIGNMT IMED ROD            	    20.39	  $759.12	      ---	  $957.31	004	1	0	0.00	    $0.00	Y	
O	27712	OSTEOT MLT RELIGNMT IMED ROD            	     4.08	  $151.90	      ---	  $191.56	004	1	0	0.00	    $0.00	Y	
O	27715	OSTPL TIBFIB LNGTH/SHRT                 	     4.84	  $180.19	      ---	  $227.24	004	1	0	0.00	    $0.00	Y	
K	27715	OSTPL TIBFIB LNGTH/SHRT                 	    24.21	  $901.34	      ---	 $1136.66	004	1	0	0.00	    $0.00	Y	
K	27720	REPAIR OF TIBIA                         	    20.39	  $759.12	      ---	  $957.31	004	1	0	0.00	    $0.00	Y	
O	27720	REPAIR OF TIBIA                         	     4.08	  $151.90	      ---	  $191.56	004	1	0	0.00	    $0.00	Y	
O	27722	REPAIR/GRAFT OF TIBIA                   	     4.12	  $153.39	      ---	  $193.43	004	1	0	0.00	    $0.00	Y	
K	27722	REPAIR/GRAFT OF TIBIA                   	    20.58	  $766.19	      ---	  $966.23	004	1	0	0.00	    $0.00	Y	
K	27724	REPAIR/GRAFT OF TIBIA                   	    24.92	  $927.77	      ---	 $1169.99	004	1	0	0.00	    $0.00	Y	
O	27724	REPAIR/GRAFT OF TIBIA                   	     4.98	  $185.41	      ---	  $233.81	004	1	0	0.00	    $0.00	Y	
O	27725	REPAIR OF LOWER LEG                     	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	27725	REPAIR OF LOWER LEG                     	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	27726	REPAIR FIBULA NONUNION                  	    17.99	  $669.77	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	27726	REPAIR FIBULA NONUNION                  	     3.60	  $134.03	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	27727	REPAIR OF LOWER LEG                     	     4.66	  $173.49	      ---	  $218.79	004	1	0	0.00	    $0.00	Y	
K	27727	REPAIR OF LOWER LEG                     	    23.32	  $868.20	      ---	 $1094.87	004	1	0	0.00	    $0.00	Y	
K	27730	REPAIR OF TIBIA EPIPHYSIS               	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	27730	REPAIR OF TIBIA EPIPHYSIS               	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
O	27732	REPAIR OF FIBULA EPIPHYSIS              	     1.75	   $65.15	      ---	   $82.16	004	1	0	0.00	    $0.00	Y	
K	27732	REPAIR OF FIBULA EPIPHYSIS              	     8.76	  $326.13	      ---	  $411.28	004	1	0	0.00	    $0.00	Y	
K	27734	REPAIR LOWER LEG EPIPHYSES              	    14.65	  $545.42	      ---	  $687.82	004	1	0	0.00	    $0.00	Y	
O	27734	REPAIR LOWER LEG EPIPHYSES              	     2.93	  $109.08	      ---	  $137.56	004	1	0	0.00	    $0.00	Y	
O	27740	REPAIR OF LEG EPIPHYSES                 	     4.08	  $151.90	      ---	  $191.56	004	1	0	0.00	    $0.00	Y	
K	27740	REPAIR OF LEG EPIPHYSES                 	    20.39	  $759.12	      ---	  $957.31	004	1	0	0.00	    $0.00	Y	
K	27742	REPAIR OF LEG EPIPHYSES                 	    22.30	  $830.23	      ---	 $1046.99	004	1	0	0.00	    $0.00	Y	
O	27742	REPAIR OF LEG EPIPHYSES                 	     4.46	  $166.05	      ---	  $209.40	004	1	0	0.00	    $0.00	Y	
O	27745	REINFORCE TIBIA                         	     3.78	  $140.73	      ---	  $177.47	004	1	0	0.00	    $0.00	Y	
K	27745	REINFORCE TIBIA                         	    18.92	  $704.39	      ---	  $888.29	004	1	0	0.00	    $0.00	Y	
K	27750	TREATMENT OF TIBIA FRACTURE             	   184.99	  $184.99	      ---	       --	042	0	1	0.00	    $0.00	Y	
O	27750	TREATMENT OF TIBIA FRACTURE             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	27752	TREATMENT OF TIBIA FRACTURE             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	27752	TREATMENT OF TIBIA FRACTURE             	     7.32	  $272.52	      ---	  $343.67	004	1	0	0.00	    $0.00	Y	
K	27756	TREATMENT OF TIBIA FRACTURE             	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	27756	TREATMENT OF TIBIA FRACTURE             	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
O	27758	TREATMENT OF TIBIA FRACTURE             	     2.94	  $109.46	      ---	  $138.03	004	1	0	0.00	    $0.00	Y	
K	27758	TREATMENT OF TIBIA FRACTURE             	    14.72	  $548.03	      ---	  $691.10	004	1	0	0.00	    $0.00	Y	
K	27759	TREATMENT OF TIBIA FRACTURE             	    19.40	  $722.26	      ---	  $910.83	004	1	0	0.00	    $0.00	Y	
O	27759	TREATMENT OF TIBIA FRACTURE             	     3.88	  $144.45	      ---	  $182.17	004	1	0	0.00	    $0.00	Y	
O	27760	CLTX MEDIAL ANKLE FX                    	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
P	27760	CLTX MEDIAL ANKLE FX                    	   176.93	  $176.93	      ---	       --	042	0	0	0.00	    $0.00	Y	
K	27760	CLTX MEDIAL ANKLE FX                    	   176.93	  $176.93	      ---	       --	042	0	1	0.00	    $0.00	Y	
K	27762	CLTX MED ANKLE FX W/MNPJ                	     6.77	  $252.05	      ---	  $317.85	004	1	0	0.00	    $0.00	Y	
P	27762	CLTX MED ANKLE FX W/MNPJ                	     6.77	  $252.05	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	27762	CLTX MED ANKLE FX W/MNPJ                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	27766	OPTX MEDIAL ANKLE FX                    	     2.04	   $75.95	      ---	   $95.78	004	1	0	0.00	    $0.00	Y	
P	27766	OPTX MEDIAL ANKLE FX                    	    10.19	  $379.37	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	27766	OPTX MEDIAL ANKLE FX                    	    10.19	  $379.37	      ---	  $478.42	004	1	0	0.00	    $0.00	Y	
K	27767	CLTX POST ANKLE FX                      	     5.13	  $190.99	      ---	  $240.85	004	1	0	0.00	    $0.00	Y	
P	27767	CLTX POST ANKLE FX                      	     5.13	  $190.99	      ---	       --	015	1	0	0.00	    $0.00	Y	
O	27767	CLTX POST ANKLE FX                      	     1.03	   $38.35	      ---	   $48.36	004	1	0	0.00	    $0.00	Y	
O	27768	CLTX POST ANKLE FX W/MNPJ               	     1.57	   $58.45	      ---	   $73.71	004	1	0	0.00	    $0.00	Y	
P	27768	CLTX POST ANKLE FX W/MNPJ               	     7.84	  $291.88	      ---	       --	015	1	0	0.00	    $0.00	Y	
K	27768	CLTX POST ANKLE FX W/MNPJ               	     7.84	  $291.88	      ---	  $368.09	004	1	0	0.00	    $0.00	Y	
K	27769	OPTX POST ANKLE FX                      	    13.48	  $501.86	      ---	       --	004	0	0	0.00	    $0.00	Y	
P	27769	OPTX POST ANKLE FX                      	    13.48	  $501.86	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	27769	OPTX POST ANKLE FX                      	     2.70	  $100.52	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	27780	TREATMENT OF FIBULA FRACTURE            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	27780	TREATMENT OF FIBULA FRACTURE            	   130.37	  $130.37	      ---	       --	042	0	1	0.00	    $0.00	Y	
K	27781	TREATMENT OF FIBULA FRACTURE            	    11.27	  $419.58	      ---	  $529.13	004	1	0	0.00	    $0.00	Y	
O	27781	TREATMENT OF FIBULA FRACTURE            	     2.25	   $83.77	      ---	  $105.64	004	1	0	0.00	    $0.00	Y	
O	27784	TREATMENT OF FIBULA FRACTURE            	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
K	27784	TREATMENT OF FIBULA FRACTURE            	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
K	27786	TREATMENT OF ANKLE FRACTURE             	   173.92	  $173.92	      ---	       --	042	0	1	0.00	    $0.00	Y	
O	27786	TREATMENT OF ANKLE FRACTURE             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
P	27786	TREATMENT OF ANKLE FRACTURE             	   173.92	  $173.92	      ---	       --	042	0	0	0.00	    $0.00	Y	
P	27788	TREATMENT OF ANKLE FRACTURE             	     5.93	  $220.77	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	27788	TREATMENT OF ANKLE FRACTURE             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	27788	TREATMENT OF ANKLE FRACTURE             	     5.93	  $220.77	      ---	  $278.41	004	1	0	0.00	    $0.00	Y	
K	27792	TREATMENT OF ANKLE FRACTURE             	    10.19	  $379.37	      ---	  $478.42	004	1	0	0.00	    $0.00	Y	
O	27792	TREATMENT OF ANKLE FRACTURE             	     2.04	   $75.95	      ---	   $95.78	004	1	0	0.00	    $0.00	Y	
P	27792	TREATMENT OF ANKLE FRACTURE             	    10.19	  $379.37	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	27802	TREAT LOWER LEG FRACTURES               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	27808	TREATMENT OF ANKLE FRACTURE             	     1.89	   $70.36	      ---	   $88.74	004	1	0	0.00	    $0.00	Y	
P	27808	TREATMENT OF ANKLE FRACTURE             	     9.46	  $352.20	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	27808	TREATMENT OF ANKLE FRACTURE             	     9.45	  $351.82	      ---	  $443.68	004	1	1	0.00	    $0.00	Y	
K	27810	TREATMENT OF ANKLE FRACTURE             	     6.73	  $250.56	      ---	  $315.97	004	1	0	0.00	    $0.00	Y	
P	27810	TREATMENT OF ANKLE FRACTURE             	     6.72	  $250.19	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	27810	TREATMENT OF ANKLE FRACTURE             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	27814	TREATMENT OF ANKLE FRACTURE             	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
P	27814	TREATMENT OF ANKLE FRACTURE             	    13.59	  $505.96	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	27814	TREATMENT OF ANKLE FRACTURE             	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	27816	TREATMENT OF ANKLE FRACTURE             	   182.97	  $182.97	      ---	       --	042	0	1	0.00	    $0.00	Y	
P	27816	TREATMENT OF ANKLE FRACTURE             	   182.97	  $182.97	      ---	       --	042	0	0	0.00	    $0.00	Y	
O	27816	TREATMENT OF ANKLE FRACTURE             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	27818	TREATMENT OF ANKLE FRACTURE             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
P	27818	TREATMENT OF ANKLE FRACTURE             	     6.99	  $260.24	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	27818	TREATMENT OF ANKLE FRACTURE             	     7.00	  $260.61	      ---	  $328.65	004	1	0	0.00	    $0.00	Y	
K	27822	TREATMENT OF ANKLE FRACTURE             	    21.10	  $785.55	      ---	  $990.65	004	1	0	0.00	    $0.00	Y	
P	27822	TREATMENT OF ANKLE FRACTURE             	    21.10	  $785.55	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	27822	TREATMENT OF ANKLE FRACTURE             	     4.22	  $157.11	      ---	  $198.13	004	1	0	0.00	    $0.00	Y	
O	27823	TREATMENT OF ANKLE FRACTURE             	     4.51	  $167.91	      ---	  $211.74	004	1	0	0.00	    $0.00	Y	
P	27823	TREATMENT OF ANKLE FRACTURE             	    22.57	  $840.28	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	27823	TREATMENT OF ANKLE FRACTURE             	    22.57	  $840.28	      ---	 $1059.66	004	1	0	0.00	    $0.00	Y	
K	27824	TREAT LOWER LEG FRACTURE                	     5.10	  $189.87	      ---	  $239.45	004	1	0	0.00	    $0.00	Y	
P	27824	TREAT LOWER LEG FRACTURE                	     5.10	  $189.87	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	27824	TREAT LOWER LEG FRACTURE                	     1.02	   $37.97	      ---	   $47.89	004	1	0	0.00	    $0.00	Y	
O	27825	TREAT LOWER LEG FRACTURE                	     1.78	   $66.27	      ---	   $83.57	004	1	0	0.00	    $0.00	Y	
P	27825	TREAT LOWER LEG FRACTURE                	     8.87	  $330.23	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	27825	TREAT LOWER LEG FRACTURE                	     8.87	  $330.23	      ---	  $416.45	004	1	0	0.00	    $0.00	Y	
K	27826	TREAT LOWER LEG FRACTURE                	    19.96	  $743.11	      ---	  $937.12	004	1	0	0.00	    $0.00	Y	
P	27826	TREAT LOWER LEG FRACTURE                	    19.96	  $743.11	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	27826	TREAT LOWER LEG FRACTURE                	     3.99	  $148.55	      ---	  $187.33	004	1	0	0.00	    $0.00	Y	
O	27827	TREAT LOWER LEG FRACTURE                	     4.86	  $180.94	      ---	  $228.18	004	1	0	0.00	    $0.00	Y	
P	27827	TREAT LOWER LEG FRACTURE                	    24.29	  $904.32	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	27827	TREAT LOWER LEG FRACTURE                	    24.28	  $903.94	      ---	 $1139.95	004	1	0	0.00	    $0.00	Y	
K	27828	TREAT LOWER LEG FRACTURE                	    25.93	  $965.37	      ---	 $1217.41	004	1	0	0.00	    $0.00	Y	
P	27828	TREAT LOWER LEG FRACTURE                	    25.93	  $965.37	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	27828	TREAT LOWER LEG FRACTURE                	     5.18	  $192.85	      ---	  $243.20	004	1	0	0.00	    $0.00	Y	
O	27829	TREAT LOWER LEG JOINT                   	     2.93	  $109.08	      ---	  $137.56	004	1	0	0.00	    $0.00	Y	
P	27829	TREAT LOWER LEG JOINT                   	    14.68	  $546.54	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	27829	TREAT LOWER LEG JOINT                   	    14.68	  $546.54	      ---	  $689.23	004	1	0	0.00	    $0.00	Y	
K	27830	TREAT LOWER LEG DISLOCATION             	     9.96	  $370.81	      ---	  $467.62	004	1	1	0.00	    $0.00	Y	
O	27830	TREAT LOWER LEG DISLOCATION             	     1.99	   $74.09	      ---	   $93.43	004	1	0	0.00	    $0.00	Y	
O	27831	TREAT LOWER LEG DISLOCATION             	     1.69	   $62.92	      ---	   $79.35	004	1	0	0.00	    $0.00	Y	
K	27831	TREAT LOWER LEG DISLOCATION             	     8.47	  $315.34	      ---	  $397.67	004	1	0	0.00	    $0.00	Y	
K	27832	TREAT LOWER LEG DISLOCATION             	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	27832	TREAT LOWER LEG DISLOCATION             	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
O	27840	TREAT ANKLE DISLOCATION                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
P	27840	TREAT ANKLE DISLOCATION                 	   170.32	  $170.32	      ---	       --	042	0	0	0.00	    $0.00	Y	
K	27840	TREAT ANKLE DISLOCATION                 	   170.32	  $170.32	      ---	       --	042	0	1	0.00	    $0.00	Y	
K	27842	TREAT ANKLE DISLOCATION                 	     5.14	  $191.36	      ---	  $241.32	004	1	0	0.00	    $0.00	Y	
P	27842	TREAT ANKLE DISLOCATION                 	     5.14	  $191.36	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	27842	TREAT ANKLE DISLOCATION                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	27846	TREAT ANKLE DISLOCATION                 	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
P	27846	TREAT ANKLE DISLOCATION                 	    13.59	  $505.96	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	27846	TREAT ANKLE DISLOCATION                 	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	27848	TREAT ANKLE DISLOCATION                 	    18.20	  $677.59	      ---	  $854.49	004	1	0	0.00	    $0.00	Y	
P	27848	TREAT ANKLE DISLOCATION                 	    18.20	  $677.59	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	27848	TREAT ANKLE DISLOCATION                 	     3.64	  $135.52	      ---	  $170.90	004	1	0	0.00	    $0.00	Y	
P	27860	FIXATION OF ANKLE JOINT                 	     2.52	   $93.82	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	27860	FIXATION OF ANKLE JOINT                 	     2.52	   $93.82	      ---	  $118.31	004	1	0	0.00	    $0.00	Y	
K	27870	FUSION OF ANKLE JOINT OPEN              	    19.25	  $716.68	      ---	  $903.79	004	1	0	0.00	    $0.00	Y	
P	27870	FUSION OF ANKLE JOINT OPEN              	    19.26	  $717.05	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	27870	FUSION OF ANKLE JOINT OPEN              	     3.85	  $143.34	      ---	  $180.76	004	1	0	0.00	    $0.00	Y	
O	27871	FUSION OF TIBIOFIBULAR JOINT            	     3.34	  $124.35	      ---	  $156.81	004	1	0	0.00	    $0.00	Y	
K	27871	FUSION OF TIBIOFIBULAR JOINT            	    16.69	  $621.37	      ---	  $783.60	004	1	0	0.00	    $0.00	Y	
K	27880	AMPUTATION OF LOWER LEG                 	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	27880	AMPUTATION OF LOWER LEG                 	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
O	27881	AMPUTATION OF LOWER LEG                 	     3.06	  $113.92	      ---	  $143.67	004	1	0	0.00	    $0.00	Y	
K	27881	AMPUTATION OF LOWER LEG                 	    15.06	  $560.68	      ---	  $707.07	004	1	0	0.00	    $0.00	Y	
K	27882	AMPUTATION OF LOWER LEG                 	    11.89	  $442.66	      ---	  $558.24	004	1	0	0.00	    $0.00	Y	
O	27882	AMPUTATION OF LOWER LEG                 	     2.38	   $88.61	      ---	  $111.74	004	1	0	0.00	    $0.00	Y	
O	27884	AMPUTATION FOLLOW-UP SURGERY            	     3.14	  $116.90	      ---	  $147.42	004	1	0	0.00	    $0.00	Y	
K	27884	AMPUTATION FOLLOW-UP SURGERY            	    15.68	  $583.77	      ---	  $736.18	004	1	0	0.00	    $0.00	Y	
K	27886	AMPUTATION FOLLOW-UP SURGERY            	    16.68	  $621.00	      ---	  $783.13	004	1	0	0.00	    $0.00	Y	
O	27886	AMPUTATION FOLLOW-UP SURGERY            	     3.34	  $124.35	      ---	  $156.81	004	1	0	0.00	    $0.00	Y	
O	27888	AMPUTATION OF FOOT AT ANKLE             	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	27888	AMPUTATION OF FOOT AT ANKLE             	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	27889	ANKLE DISARTICULATION                   	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	27889	ANKLE DISARTICULATION                   	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
O	27892	DECOMPRESSION OF LEG                    	     1.39	   $51.75	      ---	   $65.26	004	1	0	0.00	    $0.00	Y	
K	27892	DECOMPRESSION OF LEG                    	     6.96	  $259.12	      ---	  $326.77	004	1	0	0.00	    $0.00	Y	
K	27893	DECOMPRESSION OF LEG                    	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
O	27893	DECOMPRESSION OF LEG                    	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
O	27894	DECOMPRESSION OF LEG                    	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
K	27894	DECOMPRESSION OF LEG                    	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
K	27899	UNLISTED PX LEG/ANKLE                   	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	27899	UNLISTED PX LEG/ANKLE                   	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
P	27899	UNLISTED PX LEG/ANKLE                   	     0.00	    $0.00	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28001	DRAINAGE OF BURSA OF FOOT               	     3.31	  $123.23	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	28001	DRAINAGE OF BURSA OF FOOT               	     3.31	  $123.23	      ---	  $155.40	004	1	1	0.00	    $0.00	Y	
K	28002	TREATMENT OF FOOT INFECTION             	     5.54	  $206.25	      ---	  $260.10	004	1	0	0.00	    $0.00	Y	
P	28002	TREATMENT OF FOOT INFECTION             	     5.54	  $206.25	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28003	TREATMENT OF FOOT INFECTION             	    14.97	  $557.33	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	28003	TREATMENT OF FOOT INFECTION             	    14.97	  $557.33	      ---	  $702.84	004	1	0	0.00	    $0.00	Y	
K	28005	TREAT FOOT BONE LESION                  	    15.32	  $570.36	      ---	  $719.27	004	1	0	0.00	    $0.00	Y	
P	28005	TREAT FOOT BONE LESION                  	    15.32	  $570.36	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28005	TREAT FOOT BONE LESION                  	     3.06	  $113.92	      ---	  $143.67	004	1	0	0.00	    $0.00	Y	
P	28008	INCISION OF FOOT FASCIA                 	     4.94	  $183.92	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	28008	INCISION OF FOOT FASCIA                 	     4.94	  $183.92	      ---	  $231.93	004	1	0	0.00	    $0.00	Y	
K	28010	INCISION OF TOE TENDON                  	     3.98	  $148.18	      ---	  $186.86	004	1	1	0.00	    $0.00	Y	
P	28010	INCISION OF TOE TENDON                  	     3.97	  $147.80	      ---	       --	015	0	1	0.00	    $0.00	Y	
P	28011	INCISION OF TOE TENDONS                 	     5.19	  $193.22	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	28011	INCISION OF TOE TENDONS                 	     5.19	  $193.22	      ---	  $243.67	004	1	1	0.00	    $0.00	Y	
K	28020	EXPLORATION OF FOOT JOINT               	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
P	28020	EXPLORATION OF FOOT JOINT               	     6.80	  $253.16	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28020	EXPLORATION OF FOOT JOINT               	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
P	28022	EXPLORATION OF FOOT JOINT               	     5.10	  $189.87	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	28022	EXPLORATION OF FOOT JOINT               	     5.11	  $190.25	      ---	  $239.91	004	1	0	0.00	    $0.00	Y	
K	28024	EXPLORATION OF TOE JOINT                	     5.02	  $186.89	      ---	  $235.69	004	1	0	0.00	    $0.00	Y	
P	28024	EXPLORATION OF TOE JOINT                	     5.01	  $186.52	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28035	DECOMPRESSION OF TIBIA NERVE            	     9.96	  $370.81	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28035	DECOMPRESSION OF TIBIA NERVE            	     1.99	   $74.09	      ---	   $93.43	004	1	0	0.00	    $0.00	Y	
K	28035	DECOMPRESSION OF TIBIA NERVE            	     9.97	  $371.18	      ---	  $468.09	004	1	0	0.00	    $0.00	Y	
K	28039	EXC FOOT/TOE TUM SC 1.5 CM/>            	    10.90	  $405.81	      ---	  $511.76	004	1	0	0.00	    $0.00	Y	
O	28039	EXC FOOT/TOE TUM SC 1.5 CM/>            	     2.18	   $81.16	      ---	  $102.35	004	1	0	0.00	    $0.00	Y	
P	28039	EXC FOOT/TOE TUM SC 1.5 CM/>            	    10.90	  $405.81	      ---	       --	015	1	0	0.00	    $0.00	Y	
P	28041	EXC FOOT/TOE TUM DEP 1.5CM/>            	     9.98	  $371.56	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28041	EXC FOOT/TOE TUM DEP 1.5CM/>            	     2.00	   $74.46	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	28041	EXC FOOT/TOE TUM DEP 1.5CM/>            	     9.98	  $371.56	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	28043	EXC FOOT/TOE TUM SC < 1.5 CM            	     8.11	  $301.94	      ---	  $380.76	004	1	0	0.00	    $0.00	Y	
P	28043	EXC FOOT/TOE TUM SC < 1.5 CM            	     8.11	  $301.94	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28045	EXC FOOT/TOE TUM DEEP <1.5CM            	     0.00	    $0.00	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28045	EXC FOOT/TOE TUM DEEP <1.5CM            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	28045	EXC FOOT/TOE TUM DEEP <1.5CM            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	28046	RESECT FOOT/TOE TUMOR < 3 CM            	    17.72	  $659.72	      ---	  $831.95	004	1	0	0.00	    $0.00	Y	
O	28046	RESECT FOOT/TOE TUMOR < 3 CM            	     3.54	  $131.79	      ---	  $166.20	004	1	0	0.00	    $0.00	Y	
P	28046	RESECT FOOT/TOE TUMOR < 3 CM            	     0.00	    $0.00	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28047	RESECT FOOT/TOE TUMOR 3 CM/>            	    20.81	  $774.76	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28047	RESECT FOOT/TOE TUMOR 3 CM/>            	     4.16	  $154.88	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	28047	RESECT FOOT/TOE TUMOR 3 CM/>            	    20.81	  $774.76	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	28050	BIOPSY OF FOOT JOINT LINING             	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
O	28050	BIOPSY OF FOOT JOINT LINING             	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
P	28050	BIOPSY OF FOOT JOINT LINING             	     6.80	  $253.16	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28052	BIOPSY OF FOOT JOINT LINING             	     4.52	  $168.28	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28052	BIOPSY OF FOOT JOINT LINING             	     0.90	   $33.51	      ---	   $42.26	004	1	0	0.00	    $0.00	Y	
K	28052	BIOPSY OF FOOT JOINT LINING             	     4.52	  $168.28	      ---	  $212.21	004	1	0	0.00	    $0.00	Y	
K	28054	BIOPSY OF TOE JOINT LINING              	     4.30	  $160.09	      ---	  $201.89	004	1	0	0.00	    $0.00	Y	
O	28054	BIOPSY OF TOE JOINT LINING              	     0.86	   $32.02	      ---	   $40.38	004	1	0	0.00	    $0.00	Y	
P	28054	BIOPSY OF TOE JOINT LINING              	     4.30	  $160.09	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28055	NEURECTOMY FOOT                         	     9.00	  $335.07	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28055	NEURECTOMY FOOT                         	     1.80	   $67.01	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	28055	NEURECTOMY FOOT                         	     9.00	  $335.07	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	28060	PARTIAL REMOVAL FOOT FASCIA             	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
O	28060	PARTIAL REMOVAL FOOT FASCIA             	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
P	28060	PARTIAL REMOVAL FOOT FASCIA             	     6.80	  $253.16	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28062	REMOVAL OF FOOT FASCIA                  	    12.98	  $483.25	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28062	REMOVAL OF FOOT FASCIA                  	     2.60	   $96.80	      ---	  $122.07	004	1	0	0.00	    $0.00	Y	
K	28062	REMOVAL OF FOOT FASCIA                  	    12.98	  $483.25	      ---	  $609.41	004	1	0	0.00	    $0.00	Y	
K	28070	REMOVAL OF FOOT JOINT LINING            	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
O	28070	REMOVAL OF FOOT JOINT LINING            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
P	28070	REMOVAL OF FOOT JOINT LINING            	     6.80	  $253.16	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28072	REMOVAL OF FOOT JOINT LINING            	     5.39	  $200.67	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28072	REMOVAL OF FOOT JOINT LINING            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	28072	REMOVAL OF FOOT JOINT LINING            	     5.39	  $200.67	      ---	  $253.06	004	1	0	0.00	    $0.00	Y	
K	28080	REMOVAL OF FOOT LESION                  	     4.41	  $164.18	      ---	  $207.05	004	1	0	0.00	    $0.00	Y	
O	28080	REMOVAL OF FOOT LESION                  	     0.88	   $32.76	      ---	   $41.32	004	1	0	0.00	    $0.00	Y	
P	28080	REMOVAL OF FOOT LESION                  	     4.41	  $164.18	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28086	EXCISE FOOT TENDON SHEATH               	     7.93	  $295.23	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28086	EXCISE FOOT TENDON SHEATH               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	28086	EXCISE FOOT TENDON SHEATH               	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
K	28088	EXCISE FOOT TENDON SHEATH               	     6.23	  $231.94	      ---	  $292.50	004	1	0	0.00	    $0.00	Y	
O	28088	EXCISE FOOT TENDON SHEATH               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
P	28088	EXCISE FOOT TENDON SHEATH               	     6.23	  $231.94	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28090	REMOVAL OF FOOT LESION                  	     4.94	  $183.92	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28090	REMOVAL OF FOOT LESION                  	     0.99	   $36.86	      ---	   $46.48	004	1	0	0.00	    $0.00	Y	
K	28090	REMOVAL OF FOOT LESION                  	     4.94	  $183.92	      ---	  $231.93	004	1	0	0.00	    $0.00	Y	
K	28092	REMOVAL OF TOE LESIONS                  	     4.90	  $182.43	      ---	  $230.06	004	1	0	0.00	    $0.00	Y	
P	28092	REMOVAL OF TOE LESIONS                  	     4.90	  $182.43	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28100	REMOVAL OF ANKLE/HEEL LESION            	     6.81	  $253.54	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28100	REMOVAL OF ANKLE/HEEL LESION            	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
K	28100	REMOVAL OF ANKLE/HEEL LESION            	     6.81	  $253.54	      ---	  $319.73	004	1	0	0.00	    $0.00	Y	
K	28102	REMOVE/GRAFT FOOT LESION                	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
O	28102	REMOVE/GRAFT FOOT LESION                	     1.59	   $59.20	      ---	   $74.65	004	1	0	0.00	    $0.00	Y	
O	28103	REMOVE/GRAFT FOOT LESION                	     1.89	   $70.36	      ---	   $88.74	004	1	0	0.00	    $0.00	Y	
K	28103	REMOVE/GRAFT FOOT LESION                	     9.44	  $351.45	      ---	  $443.21	004	1	0	0.00	    $0.00	Y	
K	28104	REMOVAL OF FOOT LESION                  	     5.53	  $205.88	      ---	  $259.63	004	1	0	0.00	    $0.00	Y	
O	28104	REMOVAL OF FOOT LESION                  	     1.11	   $41.33	      ---	   $52.11	004	1	0	0.00	    $0.00	Y	
P	28104	REMOVAL OF FOOT LESION                  	     5.53	  $205.88	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28106	REMOVE/GRAFT FOOT LESION                	     1.27	   $47.28	      ---	   $59.63	004	1	0	0.00	    $0.00	Y	
K	28106	REMOVE/GRAFT FOOT LESION                	     6.37	  $237.16	      ---	  $299.07	004	1	0	0.00	    $0.00	Y	
K	28107	REMOVE/GRAFT FOOT LESION                	    10.62	  $395.38	      ---	  $498.61	004	1	0	0.00	    $0.00	Y	
O	28107	REMOVE/GRAFT FOOT LESION                	     2.12	   $78.93	      ---	   $99.53	004	1	0	0.00	    $0.00	Y	
O	28108	REMOVAL OF TOE LESIONS                  	     0.91	   $33.88	      ---	   $42.72	004	1	0	0.00	    $0.00	Y	
P	28108	REMOVAL OF TOE LESIONS                  	     4.57	  $170.14	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	28108	REMOVAL OF TOE LESIONS                  	     4.57	  $170.14	      ---	  $214.56	004	1	0	0.00	    $0.00	Y	
K	28110	PART REMOVAL OF METATARSAL              	     5.04	  $187.64	      ---	  $236.63	004	1	0	0.00	    $0.00	Y	
P	28110	PART REMOVAL OF METATARSAL              	     5.04	  $187.64	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28110	PART REMOVAL OF METATARSAL              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	28111	PART REMOVAL OF METATARSAL              	     1.77	   $65.90	      ---	   $83.10	004	1	0	0.00	    $0.00	Y	
P	28111	PART REMOVAL OF METATARSAL              	     8.83	  $328.74	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	28111	PART REMOVAL OF METATARSAL              	     8.83	  $328.74	      ---	  $414.57	004	1	0	0.00	    $0.00	Y	
K	28112	PART REMOVAL OF METATARSAL              	     5.34	  $198.81	      ---	  $250.71	004	1	0	0.00	    $0.00	Y	
P	28112	PART REMOVAL OF METATARSAL              	     5.34	  $198.81	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28112	PART REMOVAL OF METATARSAL              	     1.07	   $39.84	      ---	   $50.24	004	1	0	0.00	    $0.00	Y	
O	28113	PART REMOVAL OF METATARSAL              	     1.09	   $40.58	      ---	   $51.18	004	1	0	0.00	    $0.00	Y	
P	28113	PART REMOVAL OF METATARSAL              	     5.46	  $203.28	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	28113	PART REMOVAL OF METATARSAL              	     5.46	  $203.28	      ---	  $256.35	004	1	0	0.00	    $0.00	Y	
K	28114	REMOVAL OF METATARSAL HEADS             	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
P	28114	REMOVAL OF METATARSAL HEADS             	    13.59	  $505.96	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28114	REMOVAL OF METATARSAL HEADS             	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
O	28116	REVISION OF FOOT                        	     1.59	   $59.20	      ---	   $74.65	004	1	0	0.00	    $0.00	Y	
P	28116	REVISION OF FOOT                        	     7.93	  $295.23	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	28116	REVISION OF FOOT                        	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
K	28118	REMOVAL OF HEEL BONE                    	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
P	28118	REMOVAL OF HEEL BONE                    	     7.93	  $295.23	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28118	REMOVAL OF HEEL BONE                    	     1.59	   $59.20	      ---	   $74.65	004	1	0	0.00	    $0.00	Y	
O	28119	REMOVAL OF HEEL SPUR                    	     1.59	   $59.20	      ---	   $74.65	004	1	0	0.00	    $0.00	Y	
P	28119	REMOVAL OF HEEL SPUR                    	     7.93	  $295.23	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	28119	REMOVAL OF HEEL SPUR                    	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
K	28120	PART REMOVAL OF ANKLE/HEEL              	     7.44	  $276.99	      ---	  $349.31	004	1	0	0.00	    $0.00	Y	
P	28120	PART REMOVAL OF ANKLE/HEEL              	     7.44	  $276.99	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28120	PART REMOVAL OF ANKLE/HEEL              	     1.49	   $55.47	      ---	   $69.96	004	1	0	0.00	    $0.00	Y	
O	28122	PARTIAL REMOVAL OF FOOT BONE            	     1.49	   $55.47	      ---	   $69.96	004	1	0	0.00	    $0.00	Y	
P	28122	PARTIAL REMOVAL OF FOOT BONE            	     7.43	  $276.62	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	28122	PARTIAL REMOVAL OF FOOT BONE            	     7.43	  $276.62	      ---	  $348.84	004	1	0	0.00	    $0.00	Y	
K	28124	PARTIAL REMOVAL OF TOE                  	     5.61	  $208.86	      ---	  $263.39	004	1	0	0.00	    $0.00	Y	
P	28124	PARTIAL REMOVAL OF TOE                  	     5.61	  $208.86	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28124	PARTIAL REMOVAL OF TOE                  	     1.12	   $41.70	      ---	   $52.58	004	1	0	0.00	    $0.00	Y	
O	28126	PARTIAL REMOVAL OF TOE                  	     0.90	   $33.51	      ---	   $42.26	004	1	0	0.00	    $0.00	Y	
P	28126	PARTIAL REMOVAL OF TOE                  	     4.52	  $168.28	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	28126	PARTIAL REMOVAL OF TOE                  	     4.52	  $168.28	      ---	  $212.21	004	1	0	0.00	    $0.00	Y	
K	28130	REMOVAL OF ANKLE BONE                   	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
P	28130	REMOVAL OF ANKLE BONE                   	    11.33	  $421.82	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28130	REMOVAL OF ANKLE BONE                   	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	28140	REMOVAL OF METATARSAL                   	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
P	28140	REMOVAL OF METATARSAL                   	     6.80	  $253.16	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	28140	REMOVAL OF METATARSAL                   	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
K	28150	REMOVAL OF TOE                          	     5.03	  $187.27	      ---	  $236.16	004	1	0	0.00	    $0.00	Y	
P	28150	REMOVAL OF TOE                          	     5.02	  $186.89	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28150	REMOVAL OF TOE                          	     1.01	   $37.60	      ---	   $47.42	004	1	0	0.00	    $0.00	Y	
O	28153	PARTIAL REMOVAL OF TOE                  	     1.72	   $64.04	      ---	   $80.75	004	1	0	0.00	    $0.00	Y	
P	28153	PARTIAL REMOVAL OF TOE                  	     0.00	    $0.00	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	28153	PARTIAL REMOVAL OF TOE                  	     8.61	  $320.55	      ---	  $404.24	004	1	0	0.00	    $0.00	Y	
K	28160	PARTIAL REMOVAL OF TOE                  	     4.71	  $175.35	      ---	  $221.13	004	1	0	0.00	    $0.00	Y	
P	28160	PARTIAL REMOVAL OF TOE                  	     4.71	  $175.35	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28160	PARTIAL REMOVAL OF TOE                  	     0.94	   $35.00	      ---	   $44.13	004	1	0	0.00	    $0.00	Y	
O	28171	RESECT TARSAL TUMOR                     	     3.02	  $112.43	      ---	  $141.79	004	1	0	0.00	    $0.00	Y	
P	28171	RESECT TARSAL TUMOR                     	     0.00	    $0.00	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	28171	RESECT TARSAL TUMOR                     	    15.11	  $562.55	      ---	  $709.41	004	1	0	0.00	    $0.00	Y	
K	28173	RESECT METATARSAL TUMOR                 	    15.37	  $572.23	      ---	  $721.62	004	1	0	0.00	    $0.00	Y	
P	28173	RESECT METATARSAL TUMOR                 	     0.00	    $0.00	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28173	RESECT METATARSAL TUMOR                 	     3.08	  $114.67	      ---	  $144.61	004	1	0	0.00	    $0.00	Y	
O	28175	RESECT PHALANX OF TOE TUMOR             	     2.32	   $86.37	      ---	  $108.92	004	1	0	0.00	    $0.00	Y	
P	28175	RESECT PHALANX OF TOE TUMOR             	    11.58	  $431.12	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	28175	RESECT PHALANX OF TOE TUMOR             	    11.58	  $431.12	      ---	  $543.68	004	1	0	0.00	    $0.00	Y	
K	28190	REMOVAL OF FOOT FOREIGN BODY            	     3.33	  $123.98	      ---	  $156.34	004	1	1	0.00	    $0.00	Y	
P	28190	REMOVAL OF FOOT FOREIGN BODY            	     3.33	  $123.98	      ---	       --	015	0	1	0.00	    $0.00	Y	
P	28192	REMOVAL OF FOOT FOREIGN BODY            	     9.85	  $366.72	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28192	REMOVAL OF FOOT FOREIGN BODY            	     1.97	   $73.34	      ---	   $92.49	004	1	0	0.00	    $0.00	Y	
K	28192	REMOVAL OF FOOT FOREIGN BODY            	     9.85	  $366.72	      ---	  $462.46	004	1	0	0.00	    $0.00	Y	
K	28193	REMOVAL OF FOOT FOREIGN BODY            	     5.87	  $218.54	      ---	  $275.60	004	1	0	0.00	    $0.00	Y	
O	28193	REMOVAL OF FOOT FOREIGN BODY            	     1.17	   $43.56	      ---	   $54.93	004	1	0	0.00	    $0.00	Y	
P	28193	REMOVAL OF FOOT FOREIGN BODY            	     5.86	  $218.17	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28200	REPAIR OF FOOT TENDON                   	     6.80	  $253.16	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28200	REPAIR OF FOOT TENDON                   	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
K	28200	REPAIR OF FOOT TENDON                   	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
K	28202	REPAIR/GRAFT OF FOOT TENDON             	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	28202	REPAIR/GRAFT OF FOOT TENDON             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
P	28202	REPAIR/GRAFT OF FOOT TENDON             	     9.06	  $337.30	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28208	REPAIR OF FOOT TENDON                   	     4.92	  $183.17	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28208	REPAIR OF FOOT TENDON                   	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	28208	REPAIR OF FOOT TENDON                   	     4.92	  $183.17	      ---	  $230.99	004	1	0	0.00	    $0.00	Y	
K	28210	REPAIR/GRAFT OF FOOT TENDON             	     6.75	  $251.30	      ---	  $316.91	004	1	0	0.00	    $0.00	Y	
O	28210	REPAIR/GRAFT OF FOOT TENDON             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
P	28210	REPAIR/GRAFT OF FOOT TENDON             	     6.75	  $251.30	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28220	RELEASE OF FOOT TENDON                  	     5.66	  $210.72	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28220	RELEASE OF FOOT TENDON                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	28220	RELEASE OF FOOT TENDON                  	     5.66	  $210.72	      ---	  $265.74	004	1	0	0.00	    $0.00	Y	
K	28222	RELEASE OF FOOT TENDONS                 	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
O	28222	RELEASE OF FOOT TENDONS                 	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
P	28222	RELEASE OF FOOT TENDONS                 	     6.80	  $253.16	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28225	RELEASE OF FOOT TENDON                  	     4.41	  $164.18	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28225	RELEASE OF FOOT TENDON                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	28225	RELEASE OF FOOT TENDON                  	     4.41	  $164.18	      ---	  $207.05	004	1	0	0.00	    $0.00	Y	
K	28226	RELEASE OF FOOT TENDONS                 	     4.92	  $183.17	      ---	  $230.99	004	1	0	0.00	    $0.00	Y	
O	28226	RELEASE OF FOOT TENDONS                 	     0.98	   $36.49	      ---	   $46.01	004	1	0	0.00	    $0.00	Y	
P	28226	RELEASE OF FOOT TENDONS                 	     4.92	  $183.17	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28230	INCISION OF FOOT TENDON(S)              	     4.84	  $180.19	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28230	INCISION OF FOOT TENDON(S)              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	28230	INCISION OF FOOT TENDON(S)              	     4.84	  $180.19	      ---	  $227.24	004	1	0	0.00	    $0.00	Y	
K	28232	INCISION OF TOE TENDON                  	     4.51	  $167.91	      ---	  $211.74	004	1	0	0.00	    $0.00	Y	
O	28232	INCISION OF TOE TENDON                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
P	28232	INCISION OF TOE TENDON                  	     4.51	  $167.91	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28234	INCISION OF FOOT TENDON                 	     4.57	  $170.14	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28234	INCISION OF FOOT TENDON                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	28234	INCISION OF FOOT TENDON                 	     4.57	  $170.14	      ---	  $214.56	004	1	0	0.00	    $0.00	Y	
K	28238	REVISION OF FOOT TENDON                 	     8.83	  $328.74	      ---	  $414.57	004	1	0	0.00	    $0.00	Y	
O	28238	REVISION OF FOOT TENDON                 	     1.77	   $65.90	      ---	   $83.10	004	1	0	0.00	    $0.00	Y	
P	28238	REVISION OF FOOT TENDON                 	     8.83	  $328.74	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28240	RELEASE OF BIG TOE                      	     4.83	  $179.82	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28240	RELEASE OF BIG TOE                      	     0.97	   $36.11	      ---	   $45.54	004	1	0	0.00	    $0.00	Y	
K	28240	RELEASE OF BIG TOE                      	     4.83	  $179.82	      ---	  $226.77	004	1	0	0.00	    $0.00	Y	
K	28250	REVISION OF FOOT FASCIA                 	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
O	28250	REVISION OF FOOT FASCIA                 	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
P	28250	REVISION OF FOOT FASCIA                 	     6.80	  $253.16	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28260	RELEASE OF MIDFOOT JOINT                	     9.96	  $370.81	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28260	RELEASE OF MIDFOOT JOINT                	     2.04	   $75.95	      ---	   $95.78	004	1	0	0.00	    $0.00	Y	
K	28260	RELEASE OF MIDFOOT JOINT                	     9.97	  $371.18	      ---	  $468.09	004	1	0	0.00	    $0.00	Y	
K	28261	REVISION OF FOOT TENDON                 	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	28261	REVISION OF FOOT TENDON                 	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
P	28261	REVISION OF FOOT TENDON                 	    11.33	  $421.82	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28262	REVISION OF FOOT AND ANKLE              	    17.44	  $649.29	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28262	REVISION OF FOOT AND ANKLE              	     3.51	  $130.68	      ---	  $164.79	004	1	0	0.00	    $0.00	Y	
K	28262	REVISION OF FOOT AND ANKLE              	    17.44	  $649.29	      ---	  $818.81	004	1	0	0.00	    $0.00	Y	
K	28264	RELEASE OF MIDFOOT JOINT                	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	28264	RELEASE OF MIDFOOT JOINT                	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
P	28264	RELEASE OF MIDFOOT JOINT                	    13.59	  $505.96	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28270	RELEASE OF FOOT CONTRACTURE             	     5.30	  $197.32	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28270	RELEASE OF FOOT CONTRACTURE             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	28270	RELEASE OF FOOT CONTRACTURE             	     5.30	  $197.32	      ---	  $248.84	004	1	0	0.00	    $0.00	Y	
K	28272	RELEASE OF TOE JOINT EACH               	     4.45	  $165.67	      ---	  $208.93	004	1	0	0.00	    $0.00	Y	
P	28272	RELEASE OF TOE JOINT EACH               	     4.44	  $165.30	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28280	FUSION OF TOES                          	     5.54	  $206.25	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28280	FUSION OF TOES                          	     1.11	   $41.33	      ---	   $52.11	004	1	0	0.00	    $0.00	Y	
K	28280	FUSION OF TOES                          	     5.53	  $205.88	      ---	  $259.63	004	1	0	0.00	    $0.00	Y	
K	28285	REPAIR OF HAMMERTOE                     	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
O	28285	REPAIR OF HAMMERTOE                     	     1.09	   $40.58	      ---	   $51.18	004	1	0	0.00	    $0.00	Y	
P	28285	REPAIR OF HAMMERTOE                     	     5.44	  $202.53	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28286	REPAIR OF HAMMERTOE                     	     5.18	  $192.85	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28286	REPAIR OF HAMMERTOE                     	     1.04	   $38.72	      ---	   $48.83	004	1	0	0.00	    $0.00	Y	
K	28286	REPAIR OF HAMMERTOE                     	     5.18	  $192.85	      ---	  $243.20	004	1	0	0.00	    $0.00	Y	
K	28288	PARTIAL REMOVAL OF FOOT BONE            	     5.40	  $201.04	      ---	  $253.53	004	1	0	0.00	    $0.00	Y	
P	28288	PARTIAL REMOVAL OF FOOT BONE            	     5.40	  $201.04	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28289	CORRJ HALUX RIGDUS W/O IMPLT            	     8.58	  $319.43	      ---	       --	015	1	0	0.00	    $0.00	Y	
O	28289	CORRJ HALUX RIGDUS W/O IMPLT            	     1.72	   $64.04	      ---	   $80.75	004	1	0	0.00	    $0.00	Y	
K	28289	CORRJ HALUX RIGDUS W/O IMPLT            	     8.58	  $319.43	      ---	  $402.83	004	1	0	0.00	    $0.00	Y	
K	28291	CORRJ HALUX RIGDUS W/IMPLT              	    17.76	  $661.20	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	28291	CORRJ HALUX RIGDUS W/IMPLT              	     3.55	  $132.17	      ---	       --	004	0	0	0.00	    $0.00	Y	
P	28291	CORRJ HALUX RIGDUS W/IMPLT              	    17.76	  $661.20	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28292	COR HLX VLGS RSC PRX PHLX BS            	     7.93	  $295.23	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28292	COR HLX VLGS RSC PRX PHLX BS            	     1.59	   $59.20	      ---	   $74.65	004	1	0	0.00	    $0.00	Y	
K	28292	COR HLX VLGS RSC PRX PHLX BS            	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
K	28295	COR HLX VLGS PRX MTAR OSTEOT            	    23.01	  $856.66	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	28295	COR HLX VLGS PRX MTAR OSTEOT            	     4.60	  $171.26	      ---	       --	004	0	0	0.00	    $0.00	Y	
P	28295	COR HLX VLGS PRX MTAR OSTEOT            	    23.01	  $856.66	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28296	COR HLX VLGS DSTL MTAR OSTEO            	    10.76	  $400.59	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28296	COR HLX VLGS DSTL MTAR OSTEO            	     2.15	   $80.04	      ---	  $100.94	004	1	0	0.00	    $0.00	Y	
K	28296	COR HLX VLGS DSTL MTAR OSTEO            	    10.76	  $400.59	      ---	  $505.18	004	1	0	0.00	    $0.00	Y	
K	28297	COR HLX VLGS JT ARTHRD                  	    10.76	  $400.59	      ---	  $505.18	004	1	0	0.00	    $0.00	Y	
O	28297	COR HLX VLGS JT ARTHRD                  	     2.15	   $80.04	      ---	  $100.94	004	1	0	0.00	    $0.00	Y	
P	28297	COR HLX VLGS JT ARTHRD                  	    10.76	  $400.59	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28298	COR HLX VLGS PRX PHLX OSTEOT            	     7.93	  $295.23	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28298	COR HLX VLGS PRX PHLX OSTEOT            	     1.59	   $59.20	      ---	   $74.65	004	1	0	0.00	    $0.00	Y	
K	28298	COR HLX VLGS PRX PHLX OSTEOT            	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
K	28299	COR HLX VLGS DOUBLE OSTEOT              	    14.84	  $552.49	      ---	  $696.74	004	1	0	0.00	    $0.00	Y	
O	28299	COR HLX VLGS DOUBLE OSTEOT              	     2.97	  $110.57	      ---	  $139.44	004	1	0	0.00	    $0.00	Y	
P	28299	COR HLX VLGS DOUBLE OSTEOT              	    14.84	  $552.49	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28300	INCISION OF HEEL BONE                   	    10.76	  $400.59	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28300	INCISION OF HEEL BONE                   	     2.15	   $80.04	      ---	  $100.94	004	1	0	0.00	    $0.00	Y	
K	28300	INCISION OF HEEL BONE                   	    10.76	  $400.59	      ---	  $505.18	004	1	0	0.00	    $0.00	Y	
K	28302	INCISION OF ANKLE BONE                  	    10.17	  $378.63	      ---	  $477.48	004	1	0	0.00	    $0.00	Y	
O	28302	INCISION OF ANKLE BONE                  	     2.03	   $75.58	      ---	   $95.31	004	1	0	0.00	    $0.00	Y	
P	28302	INCISION OF ANKLE BONE                  	    10.17	  $378.63	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28304	INCISION OF MIDFOOT BONES               	     9.06	  $337.30	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28304	INCISION OF MIDFOOT BONES               	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
K	28304	INCISION OF MIDFOOT BONES               	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
K	28305	INCISE/GRAFT MIDFOOT BONES              	    11.46	  $426.66	      ---	  $538.05	004	1	0	0.00	    $0.00	Y	
O	28305	INCISE/GRAFT MIDFOOT BONES              	     2.29	   $85.26	      ---	  $107.52	004	1	0	0.00	    $0.00	Y	
O	28306	INCISION OF METATARSAL                  	     1.59	   $59.20	      ---	   $74.65	004	1	0	0.00	    $0.00	Y	
P	28306	INCISION OF METATARSAL                  	     7.93	  $295.23	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	28306	INCISION OF METATARSAL                  	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
K	28307	INCISION OF METATARSAL                  	    12.48	  $464.63	      ---	  $585.94	004	1	0	0.00	    $0.00	Y	
P	28307	INCISION OF METATARSAL                  	     0.00	    $0.00	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28307	INCISION OF METATARSAL                  	     2.49	   $92.70	      ---	  $116.91	004	1	0	0.00	    $0.00	Y	
O	28308	INCISION OF METATARSAL                  	     1.27	   $47.28	      ---	   $59.63	004	1	0	0.00	    $0.00	Y	
P	28308	INCISION OF METATARSAL                  	     6.34	  $236.04	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	28308	INCISION OF METATARSAL                  	     6.34	  $236.04	      ---	  $297.66	004	1	0	0.00	    $0.00	Y	
K	28309	INCISION OF METATARSALS                 	    19.77	  $736.04	      ---	  $928.20	004	1	0	0.00	    $0.00	Y	
P	28309	INCISION OF METATARSALS                 	     0.00	    $0.00	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28309	INCISION OF METATARSALS                 	     3.95	  $147.06	      ---	  $185.45	004	1	0	0.00	    $0.00	Y	
O	28310	REVISION OF BIG TOE                     	     1.16	   $43.19	      ---	   $54.46	004	1	0	0.00	    $0.00	Y	
P	28310	REVISION OF BIG TOE                     	     5.77	  $214.82	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	28310	REVISION OF BIG TOE                     	     5.78	  $215.19	      ---	  $271.37	004	1	0	0.00	    $0.00	Y	
K	28312	REVISION OF TOE                         	     5.26	  $195.83	      ---	  $246.96	004	1	0	0.00	    $0.00	Y	
P	28312	REVISION OF TOE                         	     5.27	  $196.20	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28312	REVISION OF TOE                         	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	28313	REPAIR DEFORMITY OF TOE                 	     2.14	   $79.67	      ---	  $100.47	004	1	0	0.00	    $0.00	Y	
P	28313	REPAIR DEFORMITY OF TOE                 	    10.71	  $398.73	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	28313	REPAIR DEFORMITY OF TOE                 	    10.71	  $398.73	      ---	  $502.83	004	1	0	0.00	    $0.00	Y	
K	28315	REMOVAL OF SESAMOID BONE                	     5.12	  $190.62	      ---	  $240.38	004	1	0	0.00	    $0.00	Y	
P	28315	REMOVAL OF SESAMOID BONE                	     5.12	  $190.62	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28315	REMOVAL OF SESAMOID BONE                	     1.02	   $37.97	      ---	   $47.89	004	1	0	0.00	    $0.00	Y	
O	28320	REPAIR OF FOOT BONES                    	     3.18	  $118.39	      ---	  $149.30	004	1	0	0.00	    $0.00	Y	
P	28320	REPAIR OF FOOT BONES                    	     0.00	    $0.00	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	28320	REPAIR OF FOOT BONES                    	    15.88	  $591.21	      ---	  $745.57	004	1	0	0.00	    $0.00	Y	
K	28322	REPAIR OF METATARSALS                   	     7.30	  $271.78	      ---	  $342.74	004	1	0	0.00	    $0.00	Y	
P	28322	REPAIR OF METATARSALS                   	     7.29	  $271.41	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28322	REPAIR OF METATARSALS                   	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	28340	RESECT ENLARGED TOE TISSUE              	     2.56	   $95.31	      ---	  $120.19	004	1	0	0.00	    $0.00	Y	
P	28340	RESECT ENLARGED TOE TISSUE              	    12.79	  $476.17	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	28340	RESECT ENLARGED TOE TISSUE              	    12.79	  $476.17	      ---	  $600.49	004	1	0	0.00	    $0.00	Y	
K	28341	RESECT ENLARGED TOE                     	    14.40	  $536.11	      ---	  $676.08	004	1	0	0.00	    $0.00	Y	
P	28341	RESECT ENLARGED TOE                     	     0.00	    $0.00	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28341	RESECT ENLARGED TOE                     	     2.88	  $107.22	      ---	  $135.22	004	1	0	0.00	    $0.00	Y	
O	28344	REPAIR EXTRA TOE(S)                     	     1.72	   $64.04	      ---	   $80.75	004	1	0	0.00	    $0.00	Y	
P	28344	REPAIR EXTRA TOE(S)                     	     8.61	  $320.55	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	28344	REPAIR EXTRA TOE(S)                     	     8.60	  $320.18	      ---	  $403.77	004	1	0	0.00	    $0.00	Y	
K	28345	REPAIR WEBBED TOE(S)                    	    11.12	  $414.00	      ---	  $522.08	004	1	0	0.00	    $0.00	Y	
P	28345	REPAIR WEBBED TOE(S)                    	    11.12	  $414.00	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28345	REPAIR WEBBED TOE(S)                    	     2.22	   $82.65	      ---	  $104.23	004	1	0	0.00	    $0.00	Y	
O	28360	RECONSTRUCT CLEFT FOOT                  	     4.79	  $178.33	      ---	  $224.89	004	1	0	0.00	    $0.00	Y	
P	28360	RECONSTRUCT CLEFT FOOT                  	     0.00	    $0.00	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	28360	RECONSTRUCT CLEFT FOOT                  	    23.97	  $892.40	      ---	 $1125.39	004	1	0	0.00	    $0.00	Y	
K	28400	TREATMENT OF HEEL FRACTURE              	   161.90	  $161.90	      ---	       --	042	0	1	0.00	    $0.00	Y	
P	28400	TREATMENT OF HEEL FRACTURE              	     0.00	    $0.00	      ---	       --	015	0	1	0.00	    $0.00	Y	
O	28400	TREATMENT OF HEEL FRACTURE              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	28405	TREATMENT OF HEEL FRACTURE              	     2.25	   $83.77	      ---	  $105.64	004	1	0	0.00	    $0.00	Y	
P	28405	TREATMENT OF HEEL FRACTURE              	     0.00	    $0.00	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	28405	TREATMENT OF HEEL FRACTURE              	    11.24	  $418.47	      ---	  $527.72	004	1	0	0.00	    $0.00	Y	
K	28406	TREATMENT OF HEEL FRACTURE              	    12.21	  $454.58	      ---	  $573.26	004	1	0	0.00	    $0.00	Y	
P	28406	TREATMENT OF HEEL FRACTURE              	    12.21	  $454.58	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28406	TREATMENT OF HEEL FRACTURE              	     2.44	   $90.84	      ---	  $114.56	004	1	0	0.00	    $0.00	Y	
O	28415	TREAT HEEL FRACTURE                     	     4.94	  $183.92	      ---	  $231.93	004	1	0	0.00	    $0.00	Y	
P	28415	TREAT HEEL FRACTURE                     	    24.70	  $919.58	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	28415	TREAT HEEL FRACTURE                     	    24.71	  $919.95	      ---	 $1160.13	004	1	0	0.00	    $0.00	Y	
K	28420	TREAT/GRAFT HEEL FRACTURE               	    25.10	  $934.47	      ---	 $1178.45	004	1	0	0.00	    $0.00	Y	
O	28420	TREAT/GRAFT HEEL FRACTURE               	     5.02	  $186.89	      ---	  $235.69	004	1	0	0.00	    $0.00	Y	
P	28430	TREATMENT OF ANKLE FRACTURE             	     7.70	  $286.67	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	28430	TREATMENT OF ANKLE FRACTURE             	     7.71	  $287.04	      ---	  $361.98	004	1	1	0.00	    $0.00	Y	
K	28435	TREATMENT OF ANKLE FRACTURE             	     4.86	  $180.94	      ---	  $228.18	004	1	0	0.00	    $0.00	Y	
P	28435	TREATMENT OF ANKLE FRACTURE             	     4.86	  $180.94	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28436	TREATMENT OF ANKLE FRACTURE             	     0.00	    $0.00	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	28436	TREATMENT OF ANKLE FRACTURE             	    10.61	  $395.01	      ---	  $498.14	004	1	0	0.00	    $0.00	Y	
K	28445	TREAT ANKLE FRACTURE                    	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
P	28445	TREAT ANKLE FRACTURE                    	    11.33	  $421.82	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28445	TREAT ANKLE FRACTURE                    	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	28446	OSTEOCHONDRAL TALUS AUTOGRFT            	     4.66	  $173.49	      ---	       --	004	0	0	0.00	    $0.00	Y	
P	28446	OSTEOCHONDRAL TALUS AUTOGRFT            	    23.30	  $867.46	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	28446	OSTEOCHONDRAL TALUS AUTOGRFT            	    23.30	  $867.46	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	28450	TREAT MIDFOOT FRACTURE EACH             	   144.42	  $144.42	      ---	       --	042	0	1	0.00	    $0.00	Y	
P	28450	TREAT MIDFOOT FRACTURE EACH             	     0.00	    $0.00	      ---	       --	015	0	1	0.00	    $0.00	Y	
O	28450	TREAT MIDFOOT FRACTURE EACH             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
P	28455	TREAT MIDFOOT FRACTURE EACH             	     3.91	  $145.57	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	28455	TREAT MIDFOOT FRACTURE EACH             	     3.91	  $145.57	      ---	  $183.57	004	1	0	0.00	    $0.00	Y	
K	28456	TREAT MIDFOOT FRACTURE                  	     3.61	  $134.40	      ---	  $169.49	004	1	0	0.00	    $0.00	Y	
P	28456	TREAT MIDFOOT FRACTURE                  	     3.61	  $134.40	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28465	TREAT MIDFOOT FRACTURE EACH             	    13.19	  $491.06	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	28465	TREAT MIDFOOT FRACTURE EACH             	    13.19	  $491.06	      ---	  $619.27	004	1	0	0.00	    $0.00	Y	
K	28470	TREAT METATARSAL FRACTURE               	   138.66	  $138.66	      ---	       --	042	0	1	0.00	    $0.00	Y	
P	28470	TREAT METATARSAL FRACTURE               	     0.00	    $0.00	      ---	       --	015	1	1	0.00	    $0.00	Y	
P	28475	TREAT METATARSAL FRACTURE               	     4.16	  $154.88	      ---	       --	015	1	1	0.00	    $0.00	Y	
K	28475	TREAT METATARSAL FRACTURE               	     4.16	  $154.88	      ---	  $195.31	004	1	1	0.00	    $0.00	Y	
K	28476	TREAT METATARSAL FRACTURE               	     4.22	  $157.11	      ---	  $198.13	004	1	0	0.00	    $0.00	Y	
P	28476	TREAT METATARSAL FRACTURE               	     4.22	  $157.11	      ---	       --	015	1	0	0.00	    $0.00	Y	
P	28485	TREAT METATARSAL FRACTURE               	    12.61	  $469.47	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28485	TREAT METATARSAL FRACTURE               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	28485	TREAT METATARSAL FRACTURE               	    12.61	  $469.47	      ---	  $592.04	004	1	0	0.00	    $0.00	Y	
K	28490	TREAT BIG TOE FRACTURE                  	    57.06	   $57.06	      ---	       --	042	0	1	0.00	    $0.00	Y	
P	28490	TREAT BIG TOE FRACTURE                  	     0.00	    $0.00	      ---	       --	015	1	1	0.00	    $0.00	Y	
P	28495	TREAT BIG TOE FRACTURE                  	     1.77	   $65.90	      ---	       --	015	1	1	0.00	    $0.00	Y	
K	28495	TREAT BIG TOE FRACTURE                  	     1.77	   $65.90	      ---	   $83.10	004	1	1	0.00	    $0.00	Y	
K	28496	TREAT BIG TOE FRACTURE                  	     4.27	  $158.97	      ---	  $200.48	004	1	0	0.00	    $0.00	Y	
P	28496	TREAT BIG TOE FRACTURE                  	     4.27	  $158.97	      ---	       --	015	1	0	0.00	    $0.00	Y	
P	28505	TREAT BIG TOE FRACTURE                  	    10.34	  $384.96	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28505	TREAT BIG TOE FRACTURE                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	28505	TREAT BIG TOE FRACTURE                  	    10.35	  $385.33	      ---	  $485.93	004	1	0	0.00	    $0.00	Y	
K	28510	TREATMENT OF TOE FRACTURE               	    52.47	   $52.47	      ---	       --	042	0	1	0.00	    $0.00	Y	
P	28510	TREATMENT OF TOE FRACTURE               	     0.00	    $0.00	      ---	       --	015	0	1	0.00	    $0.00	Y	
P	28515	TREATMENT OF TOE FRACTURE               	     1.67	   $62.17	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	28515	TREATMENT OF TOE FRACTURE               	     1.66	   $61.80	      ---	   $77.94	004	1	1	0.00	    $0.00	Y	
K	28525	TREAT TOE FRACTURE                      	     9.41	  $350.33	      ---	  $441.80	004	1	0	0.00	    $0.00	Y	
P	28525	TREAT TOE FRACTURE                      	     9.41	  $350.33	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28525	TREAT TOE FRACTURE                      	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
P	28530	TREAT SESAMOID BONE FRACTURE            	     0.00	    $0.00	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	28530	TREAT SESAMOID BONE FRACTURE            	     4.44	  $165.30	      ---	  $208.46	004	1	1	0.00	    $0.00	Y	
K	28531	TREAT SESAMOID BONE FRACTURE            	     7.44	  $276.99	      ---	  $349.31	004	1	0	0.00	    $0.00	Y	
O	28531	TREAT SESAMOID BONE FRACTURE            	     1.48	   $55.10	      ---	   $69.49	004	1	0	0.00	    $0.00	Y	
P	28540	TREAT FOOT DISLOCATION                  	     2.97	  $110.57	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	28540	TREAT FOOT DISLOCATION                  	     2.96	  $110.20	      ---	  $138.97	004	1	1	0.00	    $0.00	Y	
K	28545	TREAT FOOT DISLOCATION                  	     2.87	  $106.85	      ---	  $134.75	004	1	0	0.00	    $0.00	Y	
P	28545	TREAT FOOT DISLOCATION                  	     2.87	  $106.85	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28546	TREAT FOOT DISLOCATION                  	     3.80	  $141.47	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	28546	TREAT FOOT DISLOCATION                  	     3.80	  $141.47	      ---	  $178.41	004	1	0	0.00	    $0.00	Y	
K	28555	REPAIR FOOT DISLOCATION                 	     7.67	  $285.55	      ---	  $360.11	004	1	0	0.00	    $0.00	Y	
P	28555	REPAIR FOOT DISLOCATION                 	     7.67	  $285.55	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28555	REPAIR FOOT DISLOCATION                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
P	28570	TREAT FOOT DISLOCATION                  	     3.18	  $118.39	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	28570	TREAT FOOT DISLOCATION                  	     3.18	  $118.39	      ---	  $149.30	004	1	1	0.00	    $0.00	Y	
K	28575	TREAT FOOT DISLOCATION                  	     3.34	  $124.35	      ---	  $156.81	004	1	0	0.00	    $0.00	Y	
P	28575	TREAT FOOT DISLOCATION                  	     3.34	  $124.35	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28576	TREAT FOOT DISLOCATION                  	     0.94	   $35.00	      ---	   $44.13	004	1	0	0.00	    $0.00	Y	
K	28576	TREAT FOOT DISLOCATION                  	     4.71	  $175.35	      ---	  $221.13	004	1	0	0.00	    $0.00	Y	
K	28585	REPAIR FOOT DISLOCATION                 	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	28585	REPAIR FOOT DISLOCATION                 	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
P	28585	REPAIR FOOT DISLOCATION                 	    11.33	  $421.82	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28600	TREAT FOOT DISLOCATION                  	     3.52	  $131.05	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	28600	TREAT FOOT DISLOCATION                  	     3.52	  $131.05	      ---	  $165.26	004	1	1	0.00	    $0.00	Y	
K	28605	TREAT FOOT DISLOCATION                  	     4.15	  $154.50	      ---	  $194.84	004	1	0	0.00	    $0.00	Y	
P	28605	TREAT FOOT DISLOCATION                  	     4.15	  $154.50	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28606	TREAT FOOT DISLOCATION                  	     8.74	  $325.39	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	28606	TREAT FOOT DISLOCATION                  	     8.75	  $325.76	      ---	  $410.81	004	1	0	0.00	    $0.00	Y	
K	28615	REPAIR FOOT DISLOCATION                 	    15.23	  $567.01	      ---	  $715.05	004	1	0	0.00	    $0.00	Y	
P	28615	REPAIR FOOT DISLOCATION                 	    15.23	  $567.01	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28615	REPAIR FOOT DISLOCATION                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
P	28630	TREAT TOE DISLOCATION                   	     1.65	   $61.43	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	28630	TREAT TOE DISLOCATION                   	     1.64	   $61.06	      ---	   $77.00	004	1	1	0.00	    $0.00	Y	
K	28635	TREAT TOE DISLOCATION                   	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
P	28635	TREAT TOE DISLOCATION                   	     2.27	   $84.51	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28636	TREAT TOE DISLOCATION                   	     0.79	   $29.41	      ---	   $37.09	004	1	0	0.00	    $0.00	Y	
K	28636	TREAT TOE DISLOCATION                   	     3.99	  $148.55	      ---	  $187.33	004	1	0	0.00	    $0.00	Y	
K	28645	REPAIR TOE DISLOCATION                  	     5.67	  $211.09	      ---	  $266.21	004	1	0	0.00	    $0.00	Y	
O	28645	REPAIR TOE DISLOCATION                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
P	28645	REPAIR TOE DISLOCATION                  	     5.66	  $210.72	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28660	TREAT TOE DISLOCATION                   	     2.42	   $90.10	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	28660	TREAT TOE DISLOCATION                   	     2.41	   $89.72	      ---	  $113.15	004	1	1	0.00	    $0.00	Y	
K	28665	TREAT TOE DISLOCATION                   	     2.41	   $89.72	      ---	  $113.15	004	1	0	0.00	    $0.00	Y	
P	28665	TREAT TOE DISLOCATION                   	     2.41	   $89.72	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28666	TREAT TOE DISLOCATION                   	     1.05	   $39.09	      ---	   $49.30	004	1	0	0.00	    $0.00	Y	
K	28666	TREAT TOE DISLOCATION                   	     5.28	  $196.57	      ---	  $247.90	004	1	0	0.00	    $0.00	Y	
K	28675	REPAIR OF TOE DISLOCATION               	     6.74	  $250.93	      ---	  $316.44	004	1	0	0.00	    $0.00	Y	
O	28675	REPAIR OF TOE DISLOCATION               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
P	28675	REPAIR OF TOE DISLOCATION               	     6.73	  $250.56	      ---	       --	015	1	0	0.00	    $0.00	Y	
P	28705	ARTHRODESIS PANTALAR                    	    20.67	  $769.54	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28705	ARTHRODESIS PANTALAR                    	     4.13	  $153.76	      ---	  $193.90	004	1	0	0.00	    $0.00	Y	
K	28705	ARTHRODESIS PANTALAR                    	    20.67	  $769.54	      ---	  $970.46	004	1	0	0.00	    $0.00	Y	
K	28715	ARTHRODESIS TRIPLE                      	    16.06	  $597.91	      ---	  $754.02	004	1	0	0.00	    $0.00	Y	
O	28715	ARTHRODESIS TRIPLE                      	     3.22	  $119.88	      ---	  $151.18	004	1	0	0.00	    $0.00	Y	
P	28715	ARTHRODESIS TRIPLE                      	    16.06	  $597.91	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28725	ARTHRODESIS SUBTALAR                    	    11.33	  $421.82	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28725	ARTHRODESIS SUBTALAR                    	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	28725	ARTHRODESIS SUBTALAR                    	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	28730	FUSION OF FOOT BONES                    	    12.46	  $463.89	      ---	  $585.00	004	1	0	0.00	    $0.00	Y	
O	28730	FUSION OF FOOT BONES                    	     2.49	   $92.70	      ---	  $116.91	004	1	0	0.00	    $0.00	Y	
P	28730	FUSION OF FOOT BONES                    	    12.46	  $463.89	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28735	FUSION OF FOOT BONES                    	    15.85	  $590.10	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28735	FUSION OF FOOT BONES                    	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
K	28735	FUSION OF FOOT BONES                    	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
K	28737	REVISION OF FOOT BONES                  	    10.19	  $379.37	      ---	  $478.42	004	1	0	0.00	    $0.00	Y	
O	28737	REVISION OF FOOT BONES                  	     2.04	   $75.95	      ---	   $95.78	004	1	0	0.00	    $0.00	Y	
P	28737	REVISION OF FOOT BONES                  	    10.19	  $379.37	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28740	FUSION OF FOOT BONES                    	    10.19	  $379.37	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28740	FUSION OF FOOT BONES                    	     2.04	   $75.95	      ---	   $95.78	004	1	0	0.00	    $0.00	Y	
K	28740	FUSION OF FOOT BONES                    	    10.19	  $379.37	      ---	  $478.42	004	1	0	0.00	    $0.00	Y	
K	28750	FUSION OF BIG TOE JOINT                 	     8.04	  $299.33	      ---	  $377.48	004	1	0	0.00	    $0.00	Y	
O	28750	FUSION OF BIG TOE JOINT                 	     1.61	   $59.94	      ---	   $75.59	004	1	0	0.00	    $0.00	Y	
P	28750	FUSION OF BIG TOE JOINT                 	     8.04	  $299.33	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28755	FUSION OF BIG TOE JOINT                 	     5.52	  $205.51	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28755	FUSION OF BIG TOE JOINT                 	     1.10	   $40.95	      ---	   $51.65	004	1	0	0.00	    $0.00	Y	
K	28755	FUSION OF BIG TOE JOINT                 	     5.52	  $205.51	      ---	  $259.16	004	1	0	0.00	    $0.00	Y	
K	28760	FUSION OF BIG TOE JOINT                 	     7.02	  $261.35	      ---	  $329.59	004	1	0	0.00	    $0.00	Y	
O	28760	FUSION OF BIG TOE JOINT                 	     1.41	   $52.49	      ---	   $66.20	004	1	0	0.00	    $0.00	Y	
P	28760	FUSION OF BIG TOE JOINT                 	     7.02	  $261.35	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28800	AMPUTATION OF MIDFOOT                   	    11.33	  $421.82	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28800	AMPUTATION OF MIDFOOT                   	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	28800	AMPUTATION OF MIDFOOT                   	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	28805	AMPUTATION THRU METATARSAL              	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	28805	AMPUTATION THRU METATARSAL              	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
P	28805	AMPUTATION THRU METATARSAL              	    11.33	  $421.82	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28810	AMPUTATION TOE & METATARSAL             	     6.80	  $253.16	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28810	AMPUTATION TOE & METATARSAL             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	28810	AMPUTATION TOE & METATARSAL             	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
K	28820	AMPUTATION OF TOE                       	     6.13	  $228.22	      ---	  $287.80	004	1	0	0.00	    $0.00	Y	
O	28820	AMPUTATION OF TOE                       	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
P	28820	AMPUTATION OF TOE                       	     6.13	  $228.22	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	28825	PARTIAL AMPUTATION OF TOE               	     5.44	  $202.53	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28825	PARTIAL AMPUTATION OF TOE               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	28825	PARTIAL AMPUTATION OF TOE               	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
K	28890	HI ENRGY ESWT PLANTAR FASCIA            	     7.97	  $296.72	      ---	  $374.19	004	1	0	0.00	    $0.00	Y	
P	28890	HI ENRGY ESWT PLANTAR FASCIA            	     7.97	  $296.72	      ---	       --	015	1	0	0.00	    $0.00	Y	
P	28899	UNLISTED PX FOOT/TOES                   	     0.00	    $0.00	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	28899	UNLISTED PX FOOT/TOES                   	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	28899	UNLISTED PX FOOT/TOES                   	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	29000	APPLICATION OF BODY CAST                	     5.82	  $216.68	      ---	  $273.25	004	1	0	0.00	    $0.00	Y	
O	29000	APPLICATION OF BODY CAST                	     1.16	   $43.19	      ---	   $54.46	004	1	0	0.00	    $0.00	Y	
X	29000	APPLICATION OF BODY CAST                	   324.97	  $324.97	      ---	       --	009	1	0	0.00	    $0.00	Y	
X	29010	APPLICATION OF BODY CAST                	   254.50	  $254.50	      ---	       --	009	1	0	0.00	    $0.00	Y	
K	29010	APPLICATION OF BODY CAST                	     5.73	  $213.33	      ---	  $269.02	004	1	0	0.00	    $0.00	Y	
K	29015	APPLICATION OF BODY CAST                	     5.41	  $201.41	      ---	  $254.00	004	1	0	0.00	    $0.00	Y	
X	29015	APPLICATION OF BODY CAST                	   272.38	  $272.38	      ---	       --	009	1	0	0.00	    $0.00	Y	
X	29035	APPLICATION OF BODY CAST                	   244.97	  $244.97	      ---	       --	009	1	0	0.00	    $0.00	Y	
K	29035	APPLICATION OF BODY CAST                	     6.58	  $244.97	      ---	  $308.93	004	1	0	0.00	    $0.00	Y	
K	29040	APPLICATION OF BODY CAST                	     5.16	  $192.11	      ---	  $242.26	004	1	0	0.00	    $0.00	Y	
X	29040	APPLICATION OF BODY CAST                	   272.80	  $272.80	      ---	       --	009	1	0	0.00	    $0.00	Y	
X	29044	APPLICATION OF BODY CAST                	   304.91	  $304.91	      ---	       --	009	1	0	0.00	    $0.00	Y	
K	29044	APPLICATION OF BODY CAST                	     8.19	  $304.91	      ---	  $384.52	004	1	0	0.00	    $0.00	Y	
K	29046	APPLICATION OF BODY CAST                	     8.33	  $310.13	      ---	  $391.09	004	1	0	0.00	    $0.00	Y	
X	29046	APPLICATION OF BODY CAST                	   310.13	  $310.13	      ---	       --	009	1	0	0.00	    $0.00	Y	
X	29049	APPLICATION OF FIGURE EIGHT             	   121.00	  $121.00	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	29049	APPLICATION OF FIGURE EIGHT             	     3.25	  $121.00	      ---	  $152.59	004	1	1	0.00	    $0.00	Y	
K	29055	APPLICATION OF SHOULDER CAST            	     5.42	  $201.79	      ---	  $254.47	004	1	1	0.00	    $0.00	Y	
X	29055	APPLICATION OF SHOULDER CAST            	   207.24	  $207.24	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	29058	APPLICATION OF SHOULDER CAST            	   138.12	  $138.12	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	29058	APPLICATION OF SHOULDER CAST            	     3.71	  $138.12	      ---	  $174.18	004	1	1	0.00	    $0.00	Y	
K	29065	APPLICATION OF LONG ARM CAST            	     2.49	   $92.70	      ---	  $116.91	004	1	1	0.00	    $0.00	Y	
X	29065	APPLICATION OF LONG ARM CAST            	    92.70	   $92.70	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	29075	APPLICATION OF FOREARM CAST             	    82.65	   $82.65	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	29075	APPLICATION OF FOREARM CAST             	     2.22	   $82.65	      ---	  $104.23	004	1	1	0.00	    $0.00	Y	
K	29085	APPLY HAND/WRIST CAST                   	     2.24	   $83.40	      ---	  $105.17	004	1	1	0.00	    $0.00	Y	
X	29085	APPLY HAND/WRIST CAST                   	    88.77	   $88.77	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	29086	APPLY FINGER CAST                       	    71.48	   $71.48	      ---	       --	009	0	1	0.00	    $0.00	Y	
K	29086	APPLY FINGER CAST                       	     1.25	   $46.54	      ---	       --	004	0	1	0.00	    $0.00	Y	
K	29105	APPLY LONG ARM SPLINT                   	     1.78	   $66.27	      ---	   $83.57	004	1	1	0.00	    $0.00	Y	
X	29105	APPLY LONG ARM SPLINT                   	    76.09	   $76.09	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	29125	APPLY FOREARM SPLINT                    	    61.65	   $61.65	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	29125	APPLY FOREARM SPLINT                    	     1.42	   $52.87	      ---	   $66.67	004	1	1	0.00	    $0.00	Y	
K	29126	APPLY FOREARM SPLINT                    	     1.73	   $64.41	      ---	   $81.22	004	1	1	0.00	    $0.00	Y	
X	29126	APPLY FOREARM SPLINT                    	    71.89	   $71.89	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	29130	APPLICATION OF FINGER SPLINT            	    37.97	   $37.97	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	29130	APPLICATION OF FINGER SPLINT            	     0.60	   $22.34	      ---	   $28.17	004	1	1	0.00	    $0.00	Y	
K	29131	APPLICATION OF FINGER SPLINT            	     0.90	   $33.51	      ---	   $42.26	004	1	1	0.00	    $0.00	Y	
X	29131	APPLICATION OF FINGER SPLINT            	    49.08	   $49.08	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	29200	STRAPPING THORAX                        	    35.00	   $35.00	      ---	       --	009	1	0	0.00	    $0.00	Y	
K	29200	STRAPPING THORAX                        	     0.94	   $35.00	      ---	   $44.13	004	1	0	0.00	    $0.00	Y	
K	29240	STRAPPING OF SHOULDER                   	     0.96	   $35.74	      ---	   $45.07	004	1	0	0.00	    $0.00	Y	
X	29240	STRAPPING OF SHOULDER                   	    35.74	   $35.74	      ---	       --	009	1	0	0.00	    $0.00	Y	
X	29260	STRAPPING OF ELBOW OR WRIST             	    28.29	   $28.29	      ---	       --	009	1	0	0.00	    $0.00	Y	
K	29260	STRAPPING OF ELBOW OR WRIST             	     0.76	   $28.29	      ---	   $35.68	004	1	0	0.00	    $0.00	Y	
K	29280	STRAPPING OF HAND OR FINGER             	     1.40	   $52.12	      ---	   $65.73	004	1	1	0.00	    $0.00	Y	
X	29280	STRAPPING OF HAND OR FINGER             	    52.12	   $52.12	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	29305	APPLICATION OF HIP CAST                 	   247.58	  $247.58	      ---	       --	009	1	0	0.00	    $0.00	Y	
K	29305	APPLICATION OF HIP CAST                 	     6.65	  $247.58	      ---	  $312.22	004	1	0	0.00	    $0.00	Y	
K	29325	APPLICATION OF HIP CASTS                	     5.51	  $205.14	      ---	  $258.69	004	1	0	0.00	    $0.00	Y	
X	29325	APPLICATION OF HIP CASTS                	   252.82	  $252.82	      ---	       --	009	1	0	0.00	    $0.00	Y	
X	29345	APPLICATION OF LONG LEG CAST            	   124.12	  $124.12	      ---	       --	009	1	1	0.00	    $0.00	Y	
P	29345	APPLICATION OF LONG LEG CAST            	     3.26	  $121.37	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	29345	APPLICATION OF LONG LEG CAST            	     3.26	  $121.37	      ---	  $153.06	004	1	1	0.00	    $0.00	Y	
K	29355	APPLICATION OF LONG LEG CAST            	     3.44	  $128.07	      ---	  $161.51	004	1	1	0.00	    $0.00	Y	
P	29355	APPLICATION OF LONG LEG CAST            	     3.44	  $128.07	      ---	       --	015	0	1	0.00	    $0.00	Y	
X	29355	APPLICATION OF LONG LEG CAST            	   130.00	  $130.00	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	29358	APPLY LONG LEG CAST BRACE               	   148.09	  $148.09	      ---	       --	009	1	1	0.00	    $0.00	Y	
P	29358	APPLY LONG LEG CAST BRACE               	     0.00	    $0.00	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	29358	APPLY LONG LEG CAST BRACE               	     3.70	  $137.75	      ---	  $173.72	004	1	1	0.00	    $0.00	Y	
K	29365	APPLICATION OF LONG LEG CAST            	     2.77	  $103.13	      ---	  $130.05	004	1	1	0.00	    $0.00	Y	
P	29365	APPLICATION OF LONG LEG CAST            	     2.77	  $103.13	      ---	       --	015	0	1	0.00	    $0.00	Y	
X	29365	APPLICATION OF LONG LEG CAST            	   113.90	  $113.90	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	29405	APPLY SHORT LEG CAST                    	    85.26	   $85.26	      ---	       --	009	1	1	0.00	    $0.00	Y	
P	29405	APPLY SHORT LEG CAST                    	     2.29	   $85.26	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	29405	APPLY SHORT LEG CAST                    	     2.29	   $85.26	      ---	  $107.52	004	1	1	0.00	    $0.00	Y	
K	29425	APPLY SHORT LEG CAST                    	     2.25	   $83.77	      ---	  $105.64	004	1	1	0.00	    $0.00	Y	
P	29425	APPLY SHORT LEG CAST                    	     2.24	   $83.40	      ---	       --	015	0	1	0.00	    $0.00	Y	
X	29425	APPLY SHORT LEG CAST                    	    83.77	   $83.77	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	29435	APPLY SHORT LEG CAST                    	   130.68	  $130.68	      ---	       --	009	1	0	0.00	    $0.00	Y	
P	29435	APPLY SHORT LEG CAST                    	     3.51	  $130.68	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	29435	APPLY SHORT LEG CAST                    	     3.51	  $130.68	      ---	  $164.79	004	1	0	0.00	    $0.00	Y	
K	29440	ADDITION OF WALKER TO CAST              	     1.36	   $50.63	      ---	   $63.85	004	1	1	0.00	    $0.00	Y	
P	29440	ADDITION OF WALKER TO CAST              	     1.36	   $50.63	      ---	       --	015	0	1	0.00	    $0.00	Y	
X	29440	ADDITION OF WALKER TO CAST              	    50.63	   $50.63	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	29445	APPLY RIGID LEG CAST                    	   136.63	  $136.63	      ---	       --	009	1	0	0.00	    $0.00	Y	
P	29445	APPLY RIGID LEG CAST                    	     3.66	  $136.26	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	29445	APPLY RIGID LEG CAST                    	     3.67	  $136.63	      ---	  $172.31	004	1	0	0.00	    $0.00	Y	
K	29450	APPLICATION OF LEG CAST                 	     1.84	   $68.50	      ---	   $86.39	004	1	1	0.00	    $0.00	Y	
P	29450	APPLICATION OF LEG CAST                 	     1.85	   $68.88	      ---	       --	015	0	1	0.00	    $0.00	Y	
X	29450	APPLICATION OF LEG CAST                 	   131.57	  $131.57	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	29505	APPLICATION LONG LEG SPLINT             	    82.14	   $82.14	      ---	       --	009	1	1	0.00	    $0.00	Y	
P	29505	APPLICATION LONG LEG SPLINT             	     1.85	   $68.88	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	29505	APPLICATION LONG LEG SPLINT             	     1.85	   $68.88	      ---	   $86.86	004	1	1	0.00	    $0.00	Y	
K	29515	APPLICATION LOWER LEG SPLINT            	     1.52	   $56.59	      ---	   $71.36	004	1	1	0.00	    $0.00	Y	
P	29515	APPLICATION LOWER LEG SPLINT            	     1.52	   $56.59	      ---	       --	015	0	1	0.00	    $0.00	Y	
X	29515	APPLICATION LOWER LEG SPLINT            	    65.90	   $65.90	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	29520	STRAPPING OF HIP                        	    32.31	   $32.31	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	29520	STRAPPING OF HIP                        	     0.81	   $30.16	      ---	   $38.03	004	1	1	0.00	    $0.00	Y	
K	29530	STRAPPING OF KNEE                       	     0.80	   $29.78	      ---	   $37.56	004	1	1	0.00	    $0.00	Y	
X	29530	STRAPPING OF KNEE                       	    29.78	   $29.78	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	29540	STRAPPING OF ANKLE AND/OR FT            	    25.61	   $25.61	      ---	       --	009	1	1	0.00	    $0.00	Y	
P	29540	STRAPPING OF ANKLE AND/OR FT            	     0.47	   $17.50	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	29540	STRAPPING OF ANKLE AND/OR FT            	     0.47	   $17.50	      ---	   $22.07	004	1	1	0.00	    $0.00	Y	
K	29550	STRAPPING OF TOES                       	     0.45	   $16.75	      ---	   $21.13	004	1	1	0.00	    $0.00	Y	
P	29550	STRAPPING OF TOES                       	     0.45	   $16.75	      ---	       --	015	0	1	0.00	    $0.00	Y	
X	29550	STRAPPING OF TOES                       	    17.51	   $17.51	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	29580	STRAPPING UNNA BOOT                     	    58.48	   $58.48	      ---	       --	009	1	1	0.00	    $0.00	Y	
P	29580	STRAPPING UNNA BOOT                     	     0.73	   $27.18	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	29580	STRAPPING UNNA BOOT                     	     0.73	   $27.18	      ---	   $34.27	004	1	1	0.00	    $0.00	Y	
K	29581	APPLY MULTLAY COMPRS LWR LEG            	     2.09	   $77.81	      ---	   $98.13	004	1	1	0.00	    $0.00	Y	
P	29581	APPLY MULTLAY COMPRS LWR LEG            	     2.09	   $77.81	      ---	       --	015	1	1	0.00	    $0.00	Y	
X	29581	APPLY MULTLAY COMPRS LWR LEG            	    84.24	   $84.24	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	29584	APPL MULTLAY COMPRS ARM/HAND            	    77.63	   $77.63	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	29584	APPL MULTLAY COMPRS ARM/HAND            	     0.34	   $12.66	      ---	   $15.96	004	1	1	0.00	    $0.00	Y	
K	29700	REMOVAL/REVISION OF CAST                	     0.61	   $22.71	      ---	   $28.64	004	1	1	0.00	    $0.00	Y	
X	29700	REMOVAL/REVISION OF CAST                	    57.37	   $57.37	      ---	       --	009	1	1	0.00	    $0.00	Y	
P	29700	REMOVAL/REVISION OF CAST                	     0.62	   $23.08	      ---	       --	015	0	1	0.00	    $0.00	Y	
P	29705	REMOVAL/REVISION OF CAST                	     0.78	   $29.04	      ---	       --	015	0	1	0.00	    $0.00	Y	
X	29705	REMOVAL/REVISION OF CAST                	    57.06	   $57.06	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	29705	REMOVAL/REVISION OF CAST                	     0.78	   $29.04	      ---	   $36.62	004	1	1	0.00	    $0.00	Y	
K	29710	REMOVAL/REVISION OF CAST                	     1.33	   $49.52	      ---	   $62.44	004	1	1	0.00	    $0.00	Y	
X	29710	REMOVAL/REVISION OF CAST                	   111.11	  $111.11	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	29720	REPAIR OF BODY CAST                     	    90.10	   $90.10	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	29720	REPAIR OF BODY CAST                     	     2.42	   $90.10	      ---	  $113.62	004	1	1	0.00	    $0.00	Y	
K	29730	WINDOWING OF CAST                       	     0.76	   $28.29	      ---	   $35.68	004	1	1	0.00	    $0.00	Y	
X	29730	WINDOWING OF CAST                       	    58.04	   $58.04	      ---	       --	009	1	1	0.00	    $0.00	Y	
P	29730	WINDOWING OF CAST                       	     0.76	   $28.29	      ---	       --	015	0	1	0.00	    $0.00	Y	
P	29740	WEDGING OF CAST                         	     1.96	   $72.97	      ---	       --	015	0	1	0.00	    $0.00	Y	
X	29740	WEDGING OF CAST                         	    89.51	   $89.51	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	29740	WEDGING OF CAST                         	     1.96	   $72.97	      ---	   $92.02	004	1	1	0.00	    $0.00	Y	
K	29750	WEDGING OF CLUBFOOT CAST                	     1.67	   $62.17	      ---	   $78.41	004	1	1	0.00	    $0.00	Y	
X	29750	WEDGING OF CLUBFOOT CAST                	    96.83	   $96.83	      ---	       --	009	1	1	0.00	    $0.00	Y	
P	29750	WEDGING OF CLUBFOOT CAST                	     1.67	   $62.17	      ---	       --	015	0	1	0.00	    $0.00	Y	
P	29799	UNLISTED PX CASTING/STRPG               	     0.00	    $0.00	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	29799	UNLISTED PX CASTING/STRPG               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	29800	JAW ARTHROSCOPY/SURGERY                 	    10.29	  $383.10	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	29804	JAW ARTHROSCOPY/SURGERY                 	    12.38	  $460.91	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	29805	SHO ARTHRS DX +- SYNOVIAL BX            	     8.09	  $301.19	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	29806	SHO ARTHRS SRG CAPSULORRAPHY            	    22.73	  $846.24	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	29806	SHO ARTHRS SRG CAPSULORRAPHY            	     4.55	  $169.40	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	29807	SHO ARTHRS SRG RPR SLAP LES             	     4.42	  $164.56	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	29807	SHO ARTHRS SRG RPR SLAP LES             	    22.11	  $823.16	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	29819	SHO ARTHRS SRG RMVL LOOSE/FB            	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
K	29820	SHO ARTHRS SRG PRTL SYNVCT              	    10.29	  $383.10	      ---	  $483.12	004	1	0	0.00	    $0.00	Y	
K	29821	SHO ARTHRS SRG COMPL SYNVCT             	    11.25	  $418.84	      ---	  $528.19	004	1	0	0.00	    $0.00	Y	
K	29822	SHO ARTHRS SRG LMTD DBRDMT              	    10.94	  $407.30	      ---	  $513.63	004	1	0	0.00	    $0.00	Y	
K	29823	SHO ARTHRS SRG XTNSV DBRDMT             	    11.93	  $444.15	      ---	  $560.11	004	1	0	0.00	    $0.00	Y	
K	29824	SHO ARTHRS SRG DSTL CLAVICLC            	    13.90	  $517.50	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	29824	SHO ARTHRS SRG DSTL CLAVICLC            	     2.78	  $103.50	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	29825	SHO ARTHRS SRG LSS&RESCJ ADS            	    11.14	  $414.74	      ---	  $523.02	004	1	0	0.00	    $0.00	Y	
K	29826	SHO ARTHRS SRG DECOMPRESSION            	    11.33	  $421.82	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	29827	SHO ARTHRS SRG RT8TR CUF RPR            	    13.27	  $494.04	      ---	  $623.03	004	1	0	0.00	    $0.00	Y	
K	29828	SHO ARTHRS SRG BICP TENODSIS            	    17.91	  $666.79	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	29830	ELBOW ARTHROSCOPY                       	    10.39	  $386.82	      ---	  $487.81	004	1	0	0.00	    $0.00	Y	
K	29834	ELBOW ARTHROSCOPY/SURGERY               	    11.04	  $411.02	      ---	  $518.33	004	1	0	0.00	    $0.00	Y	
K	29835	ELBOW ARTHROSCOPY/SURGERY               	     9.59	  $357.04	      ---	  $450.25	004	1	0	0.00	    $0.00	Y	
K	29836	ELBOW ARTHROSCOPY/SURGERY               	    11.03	  $410.65	      ---	  $517.86	004	1	0	0.00	    $0.00	Y	
K	29837	ELBOW ARTHROSCOPY/SURGERY               	    10.07	  $374.91	      ---	  $472.79	004	1	0	0.00	    $0.00	Y	
K	29838	ELBOW ARTHROSCOPY/SURGERY               	    11.28	  $419.95	      ---	  $529.60	004	1	0	0.00	    $0.00	Y	
K	29840	WRIST ARTHROSCOPY                       	     7.18	  $267.31	      ---	  $337.10	004	1	0	0.00	    $0.00	Y	
K	29843	WRIST ARTHROSCOPY/SURGERY               	     9.77	  $363.74	      ---	  $458.70	004	1	0	0.00	    $0.00	Y	
K	29844	WRIST ARTHROSCOPY/SURGERY               	    10.07	  $374.91	      ---	  $472.79	004	1	0	0.00	    $0.00	Y	
K	29845	WRIST ARTHROSCOPY/SURGERY               	    12.24	  $455.70	      ---	  $574.67	004	1	0	0.00	    $0.00	Y	
K	29846	WRIST ARTHROSCOPY/SURGERY               	    14.44	  $537.60	      ---	  $677.96	004	1	0	0.00	    $0.00	Y	
K	29847	WRIST ARTHROSCOPY/SURGERY               	    11.59	  $431.50	      ---	  $544.15	004	1	0	0.00	    $0.00	Y	
K	29848	WRIST ENDOSCOPY/SURGERY                 	     6.73	  $250.56	      ---	  $315.97	004	1	0	0.00	    $0.00	Y	
K	29850	KNEE ARTHROSCOPY/SURGERY                	    12.96	  $482.50	      ---	  $608.47	004	1	0	0.00	    $0.00	Y	
O	29850	KNEE ARTHROSCOPY/SURGERY                	     2.59	   $96.43	      ---	  $121.60	004	1	0	0.00	    $0.00	Y	
O	29851	KNEE ARTHROSCOPY/SURGERY                	     3.43	  $127.70	      ---	  $161.04	004	1	0	0.00	    $0.00	Y	
K	29851	KNEE ARTHROSCOPY/SURGERY                	    17.14	  $638.12	      ---	  $804.72	004	1	0	0.00	    $0.00	Y	
K	29855	TIBIAL ARTHROSCOPY/SURGERY              	    17.14	  $638.12	      ---	  $804.72	004	1	0	0.00	    $0.00	Y	
O	29855	TIBIAL ARTHROSCOPY/SURGERY              	     3.43	  $127.70	      ---	  $161.04	004	1	0	0.00	    $0.00	Y	
O	29856	TIBIAL ARTHROSCOPY/SURGERY              	     3.67	  $136.63	      ---	  $172.31	004	1	0	0.00	    $0.00	Y	
K	29856	TIBIAL ARTHROSCOPY/SURGERY              	    18.36	  $683.54	      ---	  $862.00	004	1	0	0.00	    $0.00	Y	
K	29860	HIP ARTHROSCOPY DX                      	    10.50	  $390.92	      ---	  $492.98	004	1	0	0.00	    $0.00	Y	
K	29861	HIP ARTHRO W/FB REMOVAL                 	    15.28	  $568.87	      ---	  $717.40	004	1	0	0.00	    $0.00	Y	
K	29862	HIP ARTHR0 W/DEBRIDEMENT                	    16.29	  $606.48	      ---	  $764.82	004	1	0	0.00	    $0.00	Y	
K	29863	HIP ARTHR0 W/SYNOVECTOMY                	    15.74	  $586.00	      ---	  $738.99	004	1	0	0.00	    $0.00	Y	
K	29866	AUTGRFT IMPLNT KNEE W/SCOPE             	    13.25	  $493.30	      ---	  $622.09	004	1	0	0.00	    $0.00	Y	
K	29867	ALLGRFT IMPLNT KNEE W/SCOPE             	    16.13	  $600.52	      ---	  $757.30	004	1	0	0.00	    $0.00	Y	
K	29868	MENISCAL TRNSPL KNEE W/SCPE             	    22.72	  $845.87	      ---	 $1066.70	004	1	0	0.00	    $0.00	Y	
K	29870	KNEE ARTHROSCOPY DX                     	     7.48	  $278.48	      ---	  $351.19	004	1	0	0.00	    $0.00	Y	
K	29871	KNEE ARTHROSCOPY/DRAINAGE               	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
K	29873	KNEE ARTHROSCOPY/SURGERY                	     5.30	  $197.32	      ---	  $248.84	004	1	0	0.00	    $0.00	Y	
K	29874	KNEE ARTHROSCOPY/SURGERY                	    12.25	  $456.07	      ---	  $575.14	004	1	0	0.00	    $0.00	Y	
K	29875	KNEE ARTHROSCOPY/SURGERY                	    12.00	  $446.76	      ---	  $563.40	004	1	0	0.00	    $0.00	Y	
K	29876	KNEE ARTHROSCOPY/SURGERY                	    14.00	  $521.22	      ---	  $657.30	004	1	0	0.00	    $0.00	Y	
K	29877	KNEE ARTHROSCOPY/SURGERY                	    12.82	  $477.29	      ---	  $601.90	004	1	0	0.00	    $0.00	Y	
K	29879	KNEE ARTHROSCOPY/SURGERY                	    13.74	  $511.54	      ---	  $645.09	004	1	0	0.00	    $0.00	Y	
K	29880	KNEE ARTHROSCOPY/SURGERY                	    14.80	  $551.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	29881	KNEE ARTHROSCOPY/SURGERY                	    14.80	  $551.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	29882	KNEE ARTHROSCOPY/SURGERY                	    15.00	  $558.45	      ---	  $704.25	004	1	0	0.00	    $0.00	Y	
K	29883	KNEE ARTHROSCOPY/SURGERY                	    15.67	  $583.39	      ---	  $735.71	004	1	0	0.00	    $0.00	Y	
K	29884	KNEE ARTHROSCOPY/SURGERY                	    15.50	  $577.07	      ---	  $727.73	004	1	0	0.00	    $0.00	Y	
K	29885	KNEE ARTHROSCOPY/SURGERY                	    16.60	  $618.02	      ---	  $779.37	004	1	0	0.00	    $0.00	Y	
K	29886	KNEE ARTHROSCOPY/SURGERY                	    13.45	  $500.74	      ---	  $631.48	004	1	0	0.00	    $0.00	Y	
K	29887	KNEE ARTHROSCOPY/SURGERY                	    16.60	  $618.02	      ---	  $779.37	004	1	0	0.00	    $0.00	Y	
K	29888	KNEE ARTHROSCOPY/SURGERY                	    18.12	  $674.61	      ---	  $850.73	004	1	0	0.00	    $0.00	Y	
O	29888	KNEE ARTHROSCOPY/SURGERY                	     3.62	  $134.77	      ---	  $169.96	004	1	0	0.00	    $0.00	Y	
O	29889	KNEE ARTHROSCOPY/SURGERY                	     3.62	  $134.77	      ---	  $169.96	004	1	0	0.00	    $0.00	Y	
K	29889	KNEE ARTHROSCOPY/SURGERY                	    18.12	  $674.61	      ---	  $850.73	004	1	0	0.00	    $0.00	Y	
K	29891	ANKLE ARTHROSCOPY/SURGERY               	    14.58	  $542.81	      ---	  $684.53	004	1	0	0.00	    $0.00	Y	
P	29891	ANKLE ARTHROSCOPY/SURGERY               	    14.58	  $542.81	      ---	       --	015	1	0	0.00	    $0.00	Y	
P	29892	ANKLE ARTHROSCOPY/SURGERY               	    15.22	  $566.64	      ---	       --	015	1	0	0.00	    $0.00	Y	
K	29892	ANKLE ARTHROSCOPY/SURGERY               	    15.22	  $566.64	      ---	  $714.58	004	1	0	0.00	    $0.00	Y	
K	29893	SCOPE PLANTAR FASCIOTOMY                	     8.47	  $315.34	      ---	  $397.67	004	1	0	0.00	    $0.00	Y	
P	29893	SCOPE PLANTAR FASCIOTOMY                	     8.47	  $315.34	      ---	       --	015	1	0	0.00	    $0.00	Y	
P	29894	ANKLE ARTHROSCOPY/SURGERY               	    11.33	  $421.82	      ---	       --	015	1	0	0.00	    $0.00	Y	
K	29894	ANKLE ARTHROSCOPY/SURGERY               	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	29895	ANKLE ARTHROSCOPY/SURGERY               	     9.59	  $357.04	      ---	  $450.25	004	1	0	0.00	    $0.00	Y	
P	29895	ANKLE ARTHROSCOPY/SURGERY               	     9.59	  $357.04	      ---	       --	015	1	0	0.00	    $0.00	Y	
P	29897	ANKLE ARTHROSCOPY/SURGERY               	    10.80	  $402.08	      ---	       --	015	1	0	0.00	    $0.00	Y	
K	29897	ANKLE ARTHROSCOPY/SURGERY               	    10.08	  $375.28	      ---	  $473.26	004	1	0	0.00	    $0.00	Y	
K	29898	ANKLE ARTHROSCOPY/SURGERY               	    11.17	  $415.86	      ---	  $524.43	004	1	0	0.00	    $0.00	Y	
P	29898	ANKLE ARTHROSCOPY/SURGERY               	    11.17	  $415.86	      ---	       --	015	1	0	0.00	    $0.00	Y	
P	29899	ANKLE ARTHROSCOPY/SURGERY               	    19.83	  $738.27	      ---	       --	015	1	0	0.00	    $0.00	Y	
K	29899	ANKLE ARTHROSCOPY/SURGERY               	    19.83	  $738.27	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	29900	MCP JOINT ARTHROSCOPY DX                	     8.90	  $331.35	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	29901	MCP JOINT ARTHROSCOPY SURG              	    10.92	  $406.55	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	29901	MCP JOINT ARTHROSCOPY SURG              	     2.18	   $81.16	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	29902	MCP JOINT ARTHROSCOPY SURG              	     2.34	   $87.12	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	29902	MCP JOINT ARTHROSCOPY SURG              	    11.71	  $435.96	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	29904	SUBTALAR ARTHRO W/FB RMVL               	    12.09	  $450.11	      ---	       --	004	0	0	0.00	    $0.00	Y	
P	29904	SUBTALAR ARTHRO W/FB RMVL               	    12.09	  $450.11	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	29905	SUBTALAR ARTHRO W/EXC                   	    13.03	  $485.11	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	29905	SUBTALAR ARTHRO W/EXC                   	    13.03	  $485.11	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	29906	SUBTALAR ARTHRO W/DEB                   	    13.73	  $511.17	      ---	       --	004	0	0	0.00	    $0.00	Y	
P	29906	SUBTALAR ARTHRO W/DEB                   	    13.73	  $511.17	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	29907	SUBTALAR ARTHRO W/FUSION                	    16.75	  $623.60	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	29907	SUBTALAR ARTHRO W/FUSION                	    16.75	  $623.60	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	29914	HIP ARTHRO W/FEMOROPLASTY               	    23.32	  $868.20	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	29914	HIP ARTHRO W/FEMOROPLASTY               	     4.66	  $173.49	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	29915	HIP ARTHRO ACETABULOPLASTY              	     4.75	  $176.84	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	29915	HIP ARTHRO ACETABULOPLASTY              	    23.76	  $884.58	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	29916	HIP ARTHRO W/LABRAL REPAIR              	    23.76	  $884.58	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	29916	HIP ARTHRO W/LABRAL REPAIR              	     4.75	  $176.84	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	29999	UNLISTED PX ARTHROSCOPY                 	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	29999	UNLISTED PX ARTHROSCOPY                 	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	30000	DRAINAGE OF NOSE LESION                 	     1.67	   $62.17	      ---	   $78.41	004	1	1	0.00	    $0.00	Y	
K	30020	DRAINAGE OF NOSE LESION                 	     1.77	   $65.90	      ---	   $83.10	004	1	1	0.00	    $0.00	Y	
K	30100	INTRANASAL BIOPSY                       	     0.97	   $36.11	      ---	   $45.54	004	1	1	0.00	    $0.00	Y	
K	30110	REMOVAL OF NOSE POLYP(S)                	     1.83	   $68.13	      ---	   $85.92	004	1	1	0.00	    $0.00	Y	
K	30115	REMOVAL OF NOSE POLYP(S)                	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	30117	REMOVAL OF INTRANASAL LESION            	     6.10	  $227.10	      ---	  $286.40	004	1	0	0.00	    $0.00	Y	
O	30117	REMOVAL OF INTRANASAL LESION            	     1.22	   $45.42	      ---	   $57.28	004	1	0	0.00	    $0.00	Y	
O	30118	REMOVAL OF INTRANASAL LESION            	     3.35	  $124.72	      ---	  $157.28	004	1	0	0.00	    $0.00	Y	
K	30118	REMOVAL OF INTRANASAL LESION            	    16.76	  $623.97	      ---	  $786.88	004	1	0	0.00	    $0.00	Y	
K	30120	REVISION OF NOSE                        	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
K	30124	REMOVAL OF NOSE LESION                  	     2.85	  $106.11	      ---	  $133.81	004	1	1	0.00	    $0.00	Y	
K	30125	REMOVAL OF NOSE LESION                  	    13.08	  $486.97	      ---	  $614.11	004	1	0	0.00	    $0.00	Y	
O	30125	REMOVAL OF NOSE LESION                  	     2.62	   $97.54	      ---	  $123.01	004	1	0	0.00	    $0.00	Y	
K	30130	EXCISE INFERIOR TURBINATE               	     3.22	  $119.88	      ---	  $151.18	004	1	0	0.00	    $0.00	Y	
K	30140	RESECT INFERIOR TURBINATE               	     6.41	  $238.64	      ---	  $300.95	004	1	0	0.00	    $0.00	Y	
K	30150	RHINECTOMY PARTIAL                      	    16.10	  $599.40	      ---	  $755.90	004	1	0	0.00	    $0.00	Y	
O	30150	RHINECTOMY PARTIAL                      	     3.22	  $119.88	      ---	  $151.18	004	1	0	0.00	    $0.00	Y	
O	30160	RHINECTOMY TOTAL                        	     3.38	  $125.84	      ---	  $158.69	004	1	0	0.00	    $0.00	Y	
K	30160	RHINECTOMY TOTAL                        	    16.89	  $628.81	      ---	  $792.99	004	1	0	0.00	    $0.00	Y	
K	30200	INJECTION TREATMENT OF NOSE             	     0.85	   $31.65	      ---	   $39.91	004	1	1	0.00	    $0.00	Y	
K	30210	NASAL SINUS THERAPY                     	     1.33	   $49.52	      ---	   $62.44	004	1	1	0.00	    $0.00	Y	
K	30220	INSERT NASAL SEPTAL BUTTON              	     1.71	   $63.66	      ---	   $80.28	004	1	0	0.00	    $0.00	Y	
K	30300	REMOVE NASAL FOREIGN BODY               	     1.51	   $56.22	      ---	   $70.89	004	1	1	0.00	    $0.00	Y	
X	30300	REMOVE NASAL FOREIGN BODY               	   199.41	  $199.41	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	30310	REMOVE NASAL FOREIGN BODY               	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	30320	REMOVE NASAL FOREIGN BODY               	     8.95	  $333.21	      ---	  $420.20	004	1	0	0.00	    $0.00	Y	
K	30400	RECONSTRUCTION OF NOSE                  	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	30400	RECONSTRUCTION OF NOSE                  	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
O	30410	RECONSTRUCTION OF NOSE                  	     3.96	  $147.43	      ---	  $185.92	004	1	0	0.00	    $0.00	Y	
K	30410	RECONSTRUCTION OF NOSE                  	    19.82	  $737.90	      ---	  $930.55	004	1	0	0.00	    $0.00	Y	
K	30420	RECONSTRUCTION OF NOSE                  	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
O	30420	RECONSTRUCTION OF NOSE                  	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	30430	REVISION OF NOSE                        	     6.32	  $235.29	      ---	  $296.72	004	1	1	0.00	    $0.00	Y	
K	30435	REVISION OF NOSE                        	    19.86	  $739.39	      ---	  $932.43	004	1	0	0.00	    $0.00	Y	
K	30450	REVISION OF NOSE                        	    27.67	 $1030.15	      ---	 $1299.11	004	1	0	0.00	    $0.00	Y	
O	30450	REVISION OF NOSE                        	     5.53	  $205.88	      ---	  $259.63	004	1	0	0.00	    $0.00	Y	
O	30460	REVISION OF NOSE                        	     2.68	   $99.78	      ---	  $125.83	004	1	0	0.00	    $0.00	Y	
K	30460	REVISION OF NOSE                        	    13.41	  $499.25	      ---	  $629.60	004	1	0	0.00	    $0.00	Y	
K	30462	REVISION OF NOSE                        	    26.82	  $998.51	      ---	 $1259.20	004	1	0	0.00	    $0.00	Y	
O	30462	REVISION OF NOSE                        	     5.37	  $199.93	      ---	  $252.12	004	1	0	0.00	    $0.00	Y	
O	30465	REPAIR NASAL STENOSIS                   	     3.78	  $140.73	      ---	  $177.47	004	1	0	0.00	    $0.00	Y	
K	30465	REPAIR NASAL STENOSIS                   	    18.88	  $702.90	      ---	  $886.42	004	1	0	0.00	    $0.00	Y	
K	30468	RPR NSL VLV COLLAPSE W/IMPLT            	    72.17	 $2686.89	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	30468	RPR NSL VLV COLLAPSE W/IMPLT            	    14.43	  $537.23	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	30469	RPR NSL VLV COLLAPSE W/RMDLG            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	30520	REPAIR OF NASAL SEPTUM                  	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
O	30520	REPAIR OF NASAL SEPTUM                  	     2.00	   $74.46	      ---	   $93.90	004	1	0	0.00	    $0.00	Y	
O	30540	RPR CHOANAL ATRESIA NTRANASL            	     2.30	   $85.63	      ---	  $107.99	004	1	0	0.00	    $0.00	Y	
K	30540	RPR CHOANAL ATRESIA NTRANASL            	    11.48	  $427.40	      ---	  $538.99	004	1	0	0.00	    $0.00	Y	
K	30545	RPR CHOANAL ATRESIA TRSNPLTN            	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
O	30545	RPR CHOANAL ATRESIA TRSNPLTN            	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
K	30560	LYSIS INTRANASAL SYNECHIA               	     1.51	   $56.22	      ---	   $70.89	004	1	1	0.00	    $0.00	Y	
K	30580	REPAIR UPPER JAW FISTULA                	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
O	30580	REPAIR UPPER JAW FISTULA                	     2.00	   $74.46	      ---	   $93.90	004	1	0	0.00	    $0.00	Y	
O	30600	REPAIR MOUTH/NOSE FISTULA               	     1.77	   $65.90	      ---	   $83.10	004	1	0	0.00	    $0.00	Y	
K	30600	REPAIR MOUTH/NOSE FISTULA               	     8.84	  $329.11	      ---	  $415.04	004	1	0	0.00	    $0.00	Y	
K	30620	INTRANASAL RECONSTRUCTION               	    10.18	  $379.00	      ---	  $477.95	004	1	0	0.00	    $0.00	Y	
O	30620	INTRANASAL RECONSTRUCTION               	     2.04	   $75.95	      ---	   $95.78	004	1	0	0.00	    $0.00	Y	
O	30630	REPAIR NASAL SEPTUM DEFECT              	     2.62	   $97.54	      ---	  $123.01	004	1	0	0.00	    $0.00	Y	
K	30630	REPAIR NASAL SEPTUM DEFECT              	    13.11	  $488.09	      ---	  $615.51	004	1	0	0.00	    $0.00	Y	
K	30801	ABLATE INF TURBINATE SUPERF             	     1.54	   $57.33	      ---	   $72.30	004	1	1	0.00	    $0.00	Y	
K	30802	ABLATE INF TURBINATE SUBMUC             	     2.20	   $81.91	      ---	  $103.29	004	1	1	0.00	    $0.00	Y	
K	30901	CONTROL OF NOSEBLEED                    	     1.47	   $54.73	      ---	   $69.02	004	1	1	0.00	    $0.00	Y	
X	30901	CONTROL OF NOSEBLEED                    	   147.26	  $147.26	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	30903	CONTROL OF NOSEBLEED                    	   231.53	  $231.53	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	30903	CONTROL OF NOSEBLEED                    	     1.77	   $65.90	      ---	   $83.10	004	1	1	0.00	    $0.00	Y	
K	30905	CONTROL OF NOSEBLEED                    	     2.82	  $104.99	      ---	  $132.40	004	1	1	0.00	    $0.00	Y	
X	30905	CONTROL OF NOSEBLEED                    	   331.84	  $331.84	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	30906	REPEAT CONTROL OF NOSEBLEED             	   351.04	  $351.04	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	30906	REPEAT CONTROL OF NOSEBLEED             	     3.19	  $118.76	      ---	  $149.77	004	1	1	0.00	    $0.00	Y	
K	30915	LIGATION NASAL SINUS ARTERY             	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	30915	LIGATION NASAL SINUS ARTERY             	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	30920	LIGATION UPPER JAW ARTERY               	     3.46	  $128.82	      ---	  $162.45	004	1	0	0.00	    $0.00	Y	
K	30920	LIGATION UPPER JAW ARTERY               	    17.31	  $644.45	      ---	  $812.70	004	1	0	0.00	    $0.00	Y	
K	30930	THER FX NASAL INF TURBINATE             	     2.04	   $75.95	      ---	   $95.78	004	1	0	0.00	    $0.00	Y	
K	30999	UNLISTED PROCEDURE NOSE                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	30999	UNLISTED PROCEDURE NOSE                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	31000	IRRIGATION MAXILLARY SINUS              	     1.48	   $55.10	      ---	   $69.49	004	1	1	0.00	    $0.00	Y	
K	31002	IRRIGATION SPHENOID SINUS               	     1.73	   $64.41	      ---	   $81.22	004	1	1	0.00	    $0.00	Y	
L	3100F	IMAGE TEST REF CAROT DIAM               	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	N	
R	3101 	REV - ADULT MED/SOC HR                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
K	31020	EXPLORATION MAXILLARY SINUS             	     3.40	  $126.58	      ---	  $159.63	004	1	0	0.00	    $0.00	Y	
R	3103 	REV - ADULT MED/SOC DAY                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
O	31030	EXPLORATION MAXILLARY SINUS             	     2.40	   $89.35	      ---	  $112.68	004	1	0	0.00	    $0.00	Y	
K	31030	EXPLORATION MAXILLARY SINUS             	    12.00	  $446.76	      ---	  $563.40	004	1	0	0.00	    $0.00	Y	
K	31032	EXPLORE SINUS REMOVE POLYPS             	    12.00	  $446.76	      ---	  $563.40	004	1	0	0.00	    $0.00	Y	
O	31032	EXPLORE SINUS REMOVE POLYPS             	     2.40	   $89.35	      ---	  $112.68	004	1	0	0.00	    $0.00	Y	
O	31040	EXPLORATION BEHIND UPPER JAW            	     2.73	  $101.64	      ---	  $128.17	004	1	0	0.00	    $0.00	Y	
K	31040	EXPLORATION BEHIND UPPER JAW            	    13.64	  $507.82	      ---	  $640.40	004	1	0	0.00	    $0.00	Y	
K	31050	EXPLORATION SPHENOID SINUS              	    11.00	  $409.53	      ---	  $516.45	004	1	0	0.00	    $0.00	Y	
O	31050	EXPLORATION SPHENOID SINUS              	     2.20	   $81.91	      ---	  $103.29	004	1	0	0.00	    $0.00	Y	
O	31051	SPHENOID SINUS SURGERY                  	     2.28	   $84.88	      ---	  $107.05	004	1	0	0.00	    $0.00	Y	
K	31051	SPHENOID SINUS SURGERY                  	    11.42	  $425.17	      ---	  $536.17	004	1	0	0.00	    $0.00	Y	
K	31070	EXPLORATION OF FRONTAL SINUS            	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
O	31070	EXPLORATION OF FRONTAL SINUS            	     2.00	   $74.46	      ---	   $93.90	004	1	0	0.00	    $0.00	Y	
O	31075	EXPLORATION OF FRONTAL SINUS            	     3.20	  $119.14	      ---	  $150.24	004	1	0	0.00	    $0.00	Y	
K	31075	EXPLORATION OF FRONTAL SINUS            	    16.00	  $595.68	      ---	  $751.20	004	1	0	0.00	    $0.00	Y	
K	31080	REMOVAL OF FRONTAL SINUS                	    24.00	  $893.52	      ---	 $1126.80	004	1	0	0.00	    $0.00	Y	
O	31080	REMOVAL OF FRONTAL SINUS                	     4.80	  $178.70	      ---	  $225.36	004	1	0	0.00	    $0.00	Y	
O	31081	REMOVAL OF FRONTAL SINUS                	     4.80	  $178.70	      ---	  $225.36	004	1	0	0.00	    $0.00	Y	
K	31081	REMOVAL OF FRONTAL SINUS                	    24.00	  $893.52	      ---	 $1126.80	004	1	0	0.00	    $0.00	Y	
K	31084	REMOVAL OF FRONTAL SINUS                	    24.00	  $893.52	      ---	 $1126.80	004	1	0	0.00	    $0.00	Y	
O	31084	REMOVAL OF FRONTAL SINUS                	     4.80	  $178.70	      ---	  $225.36	004	1	0	0.00	    $0.00	Y	
O	31085	REMOVAL OF FRONTAL SINUS                	     4.80	  $178.70	      ---	  $225.36	004	1	0	0.00	    $0.00	Y	
K	31085	REMOVAL OF FRONTAL SINUS                	    24.00	  $893.52	      ---	 $1126.80	004	1	0	0.00	    $0.00	Y	
K	31086	REMOVAL OF FRONTAL SINUS                	    21.67	  $806.77	      ---	 $1017.41	004	1	0	0.00	    $0.00	Y	
O	31086	REMOVAL OF FRONTAL SINUS                	     4.33	  $161.21	      ---	  $203.29	004	1	0	0.00	    $0.00	Y	
O	31087	REMOVAL OF FRONTAL SINUS                	     4.39	  $163.44	      ---	  $206.11	004	1	0	0.00	    $0.00	Y	
K	31087	REMOVAL OF FRONTAL SINUS                	    21.97	  $817.94	      ---	 $1031.49	004	1	0	0.00	    $0.00	Y	
K	31090	EXPLORATION OF SINUSES                  	    26.00	  $967.98	      ---	 $1220.70	004	1	0	0.00	    $0.00	Y	
O	31090	EXPLORATION OF SINUSES                  	     5.20	  $193.60	      ---	  $244.14	004	1	0	0.00	    $0.00	Y	
O	31200	REMOVAL OF ETHMOID SINUS                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	31200	REMOVAL OF ETHMOID SINUS                	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
K	31201	REMOVAL OF ETHMOID SINUS                	     7.22	  $268.80	      ---	  $338.98	004	1	0	0.00	    $0.00	Y	
O	31201	REMOVAL OF ETHMOID SINUS                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	31205	REMOVAL OF ETHMOID SINUS                	     2.94	  $109.46	      ---	  $138.03	004	1	0	0.00	    $0.00	Y	
K	31205	REMOVAL OF ETHMOID SINUS                	    14.72	  $548.03	      ---	  $691.10	004	1	0	0.00	    $0.00	Y	
K	31225	REMOVAL OF UPPER JAW                    	    27.18	 $1011.91	      ---	 $1276.10	004	1	0	0.00	    $0.00	Y	
O	31225	REMOVAL OF UPPER JAW                    	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
O	31230	REMOVAL OF UPPER JAW                    	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
K	31230	REMOVAL OF UPPER JAW                    	    27.18	 $1011.91	      ---	 $1276.10	004	1	0	0.00	    $0.00	Y	
K	31231	NASAL ENDOSCOPY DX                      	     1.32	   $49.14	      ---	   $61.97	004	1	0	0.00	    $0.00	Y	
K	31233	NSL/SINS NDSC DX MAX SINUSC             	     2.24	   $83.40	      ---	  $105.17	004	1	0	0.00	    $0.00	Y	
K	31235	NSL/SINS NDSC DX SPHN SINUSC            	     3.93	  $146.31	      ---	  $184.51	004	1	0	0.00	    $0.00	Y	
K	31237	NSL/SINS NDSC SURG BX POLYPC            	     2.75	  $102.38	      ---	  $129.11	004	1	0	0.00	    $0.00	Y	
K	31238	NSL/SINS NDSC SRG NSL HEMRRG            	     4.68	  $174.24	      ---	  $219.73	004	1	0	0.00	    $0.00	Y	
K	31239	NSL/SINUS ENDOSCOPY SURG DCR            	    12.19	  $453.83	      ---	  $572.32	004	1	0	0.00	    $0.00	Y	
K	31240	NSL/SNS NDSC CNCH BULL RESCJ            	     3.55	  $132.17	      ---	  $166.67	004	1	0	0.00	    $0.00	Y	
K	31241	NSL/SNS NDSC LIG SPHNPTN ART            	    10.21	  $380.12	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	31241	NSL/SNS NDSC LIG SPHNPTN ART            	     2.04	   $75.95	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	31242	NSL/SINUS NDSC RF ABLTJ PNN             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	31243	NSL/SINUS NDSC CRYOABLTJ PNN            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	31253	NSL/SINS NDSC TOTAL                     	    11.47	  $427.03	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	31254	NSL/SINS NDSC W/PRTL ETHMDCT            	     6.42	  $239.02	      ---	  $301.42	004	1	0	0.00	    $0.00	Y	
K	31255	NSL/SINS NDSC W/TOT ETHMDCT             	     9.63	  $358.52	      ---	  $452.13	004	1	0	0.00	    $0.00	Y	
K	31256	EXPLORATION MAXILLARY SINUS             	     4.55	  $169.40	      ---	  $213.62	004	1	0	0.00	    $0.00	Y	
K	31257	NSL/SINS NDSC TOT W/SPHENDT             	    10.22	  $380.49	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	31259	NSL/SINS NDSC SPHN TISS RMVL            	    10.83	  $403.20	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	31267	ENDOSCOPY MAXILLARY SINUS               	     6.97	  $259.49	      ---	  $327.24	004	1	0	0.00	    $0.00	Y	
K	31276	NSL/SINS NDSC FRNT TISS RMVL            	     9.07	  $337.68	      ---	  $425.84	004	1	0	0.00	    $0.00	Y	
K	31287	NASAL/SINUS ENDOSCOPY SURG              	     5.42	  $201.79	      ---	  $254.47	004	1	0	0.00	    $0.00	Y	
K	31288	NASAL/SINUS ENDOSCOPY SURG              	     6.33	  $235.67	      ---	  $297.19	004	1	0	0.00	    $0.00	Y	
K	31290	NASAL/SINUS ENDOSCOPY SURG              	    18.43	  $686.15	      ---	  $865.29	004	1	0	0.00	    $0.00	Y	
K	31291	NASAL/SINUS ENDOSCOPY SURG              	    19.36	  $720.77	      ---	  $908.95	004	1	0	0.00	    $0.00	Y	
K	31292	NSL/SINS NDSC MED/INF DCMPRN            	    14.94	  $556.22	      ---	  $701.43	004	1	0	0.00	    $0.00	Y	
K	31293	NSL/SINS NDSC MED&INF DCMPRN            	    16.37	  $609.46	      ---	  $768.57	004	1	0	0.00	    $0.00	Y	
K	31294	NSL/SINS NDSC SURG ON DCMPRN            	    18.73	  $697.32	      ---	  $879.37	004	1	0	0.00	    $0.00	Y	
K	31295	NSL/SINS NDSC SURG MAX SINS             	     4.01	  $149.29	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	31296	NSL/SINS NDSC SURG FRNT SINS            	     4.77	  $177.59	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	31297	NSL/SINS NDSC SURG SPHN SINS            	     3.92	  $145.94	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	31298	NSL/SINS NDSC SURG FRNT&SPHN            	    97.14	 $3616.52	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	31298	NSL/SINS NDSC SURG FRNT&SPHN            	    19.42	  $723.01	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	31299	UNLISTED PX ACCESSORY SINUS             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	31299	UNLISTED PX ACCESSORY SINUS             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	31300	REMOVAL OF LARYNX LESION                	    18.12	  $674.61	      ---	  $850.73	004	1	0	0.00	    $0.00	Y	
O	31300	REMOVAL OF LARYNX LESION                	     3.62	  $134.77	      ---	  $169.96	004	1	0	0.00	    $0.00	Y	
O	31360	REMOVAL OF LARYNX                       	     5.89	  $219.28	      ---	  $276.54	004	1	0	0.00	    $0.00	Y	
K	31360	REMOVAL OF LARYNX                       	    29.45	 $1096.42	      ---	 $1382.68	004	1	0	0.00	    $0.00	Y	
K	31365	REMOVAL OF LARYNX                       	    38.51	 $1433.73	      ---	 $1808.04	004	1	0	0.00	    $0.00	Y	
O	31365	REMOVAL OF LARYNX                       	     7.70	  $286.67	      ---	  $361.52	004	1	0	0.00	    $0.00	Y	
O	31367	PARTIAL REMOVAL OF LARYNX               	     5.89	  $219.28	      ---	  $276.54	004	1	0	0.00	    $0.00	Y	
K	31367	PARTIAL REMOVAL OF LARYNX               	    29.45	 $1096.42	      ---	 $1382.68	004	1	0	0.00	    $0.00	Y	
K	31368	PARTIAL REMOVAL OF LARYNX               	    38.51	 $1433.73	      ---	 $1808.04	004	1	0	0.00	    $0.00	Y	
O	31368	PARTIAL REMOVAL OF LARYNX               	     7.70	  $286.67	      ---	  $361.52	004	1	0	0.00	    $0.00	Y	
O	31370	PARTIAL REMOVAL OF LARYNX               	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
K	31370	PARTIAL REMOVAL OF LARYNX               	    33.98	 $1265.08	      ---	 $1595.36	004	1	0	0.00	    $0.00	Y	
K	31375	PARTIAL REMOVAL OF LARYNX               	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
O	31375	PARTIAL REMOVAL OF LARYNX               	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
O	31380	PARTIAL REMOVAL OF LARYNX               	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	31380	PARTIAL REMOVAL OF LARYNX               	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
K	31382	PARTIAL REMOVAL OF LARYNX               	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
O	31382	PARTIAL REMOVAL OF LARYNX               	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
O	31390	REMOVAL OF LARYNX & PHARYNX             	    10.89	  $405.43	      ---	  $511.29	004	1	0	0.00	    $0.00	Y	
K	31390	REMOVAL OF LARYNX & PHARYNX             	    54.47	 $2027.92	      ---	 $2557.37	004	1	0	0.00	    $0.00	Y	
K	31395	RECONSTRUCT LARYNX & PHARYNX            	    53.85	 $2004.84	      ---	 $2528.26	004	1	0	0.00	    $0.00	Y	
O	31395	RECONSTRUCT LARYNX & PHARYNX            	    10.77	  $400.97	      ---	  $505.65	004	1	0	0.00	    $0.00	Y	
O	31400	REVISION OF LARYNX                      	     4.17	  $155.25	      ---	  $195.78	004	1	0	0.00	    $0.00	Y	
K	31400	REVISION OF LARYNX                      	    20.86	  $776.62	      ---	  $979.38	004	1	0	0.00	    $0.00	Y	
K	31420	EPIGLOTTIDECTOMY                        	    18.12	  $674.61	      ---	  $850.73	004	1	0	0.00	    $0.00	Y	
O	31420	EPIGLOTTIDECTOMY                        	     3.62	  $134.77	      ---	  $169.96	004	1	0	0.00	    $0.00	Y	
K	31500	INSERT EMERGENCY AIRWAY                 	     1.59	   $59.20	      ---	   $74.65	004	1	0	0.00	    $0.00	Y	
K	31502	CHANGE OF WINDPIPE AIRWAY               	     1.60	   $59.57	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	31505	DIAGNOSTIC LARYNGOSCOPY                 	     1.59	   $59.20	      ---	   $74.65	004	1	1	0.00	    $0.00	Y	
K	31510	LARYNGOSCOPY WITH BIOPSY                	     2.02	   $75.20	      ---	   $94.84	004	1	0	0.00	    $0.00	Y	
K	31511	REMOVE FOREIGN BODY LARYNX              	     2.23	   $83.02	      ---	  $104.70	004	1	0	0.00	    $0.00	Y	
K	31512	REMOVAL OF LARYNX LESION                	     2.16	   $80.42	      ---	  $101.41	004	1	0	0.00	    $0.00	Y	
K	31513	INJECTION INTO VOCAL CORD               	     3.53	  $131.42	      ---	  $165.73	004	1	0	0.00	    $0.00	Y	
K	31515	LARYNGOSCOPY FOR ASPIRATION             	     1.89	   $70.36	      ---	   $88.74	004	1	0	0.00	    $0.00	Y	
K	31520	DX LARYNGOSCOPY NEWBORN                 	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	31525	DX LARYNGOSCOPY EXCL NB                 	     4.53	  $168.65	      ---	  $212.68	004	1	1	0.00	    $0.00	Y	
K	31526	DX LARYNGOSCOPY W/OPER SCOPE            	     3.71	  $138.12	      ---	  $174.18	004	1	0	0.00	    $0.00	Y	
K	31527	LARYNGOSCOPY FOR TREATMENT              	     7.00	  $260.61	      ---	  $328.65	004	1	0	0.00	    $0.00	Y	
K	31528	LARYNGOSCOPY AND DILATION               	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
K	31529	LARYNGOSCOPY AND DILATION               	     5.00	  $186.15	      ---	  $234.75	004	1	0	0.00	    $0.00	Y	
K	31530	LARYNGOSCOPY W/FB REMOVAL               	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
K	31531	LARYNGOSCOPY W/FB & OP SCOPE            	     4.98	  $185.41	      ---	  $233.81	004	1	0	0.00	    $0.00	Y	
K	31535	LARYNGOSCOPY W/BIOPSY                   	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
K	31536	LARYNGOSCOPY W/BX & OP SCOPE            	     7.20	  $268.06	      ---	  $338.04	004	1	0	0.00	    $0.00	Y	
K	31540	LARYNGOSCOPY W/EXC OF TUMOR             	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
K	31541	LARYNSCOP W/TUMR EXC + SCOPE            	     7.20	  $268.06	      ---	  $338.04	004	1	0	0.00	    $0.00	Y	
K	31545	REMOVE VC LESION W/SCOPE                	     5.54	  $206.25	      ---	  $260.10	004	1	0	0.00	    $0.00	Y	
O	31545	REMOVE VC LESION W/SCOPE                	     1.11	   $41.33	      ---	   $52.11	004	1	0	0.00	    $0.00	Y	
O	31546	REMOVE VC LESION SCOPE/GRAFT            	     1.74	   $64.78	      ---	   $81.69	004	1	0	0.00	    $0.00	Y	
K	31546	REMOVE VC LESION SCOPE/GRAFT            	     8.70	  $323.90	      ---	  $408.47	004	1	0	0.00	    $0.00	Y	
K	31551	LARYNGOPLASTY LARYNGEAL STEN            	    33.20	 $1236.04	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	31551	LARYNGOPLASTY LARYNGEAL STEN            	     6.64	  $247.21	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	31552	LARYNGOPLASTY LARYNGEAL STEN            	     6.74	  $250.93	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	31552	LARYNGOPLASTY LARYNGEAL STEN            	    33.73	 $1255.77	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	31553	LARYNGOPLASTY LARYNGEAL STEN            	    36.82	 $1370.81	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	31553	LARYNGOPLASTY LARYNGEAL STEN            	     7.36	  $274.01	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	31554	LARYNGOPLASTY LARYNGEAL STEN            	     7.78	  $289.65	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	31554	LARYNGOPLASTY LARYNGEAL STEN            	    38.93	 $1449.36	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	31560	LARYNGOSCOP W/ARYTENOIDECTOM            	    15.00	  $558.45	      ---	  $704.25	004	1	0	0.00	    $0.00	Y	
O	31560	LARYNGOSCOP W/ARYTENOIDECTOM            	     3.00	  $111.69	      ---	  $140.85	004	1	0	0.00	    $0.00	Y	
O	31561	LARYNSCOP REMVE CART + SCOP             	     4.11	  $153.02	      ---	  $192.96	004	1	0	0.00	    $0.00	Y	
K	31561	LARYNSCOP REMVE CART + SCOP             	    21.78	  $810.87	      ---	 $1022.57	004	1	0	0.00	    $0.00	Y	
K	31570	LARYNGOSCOPE W/VC INJ                   	     6.75	  $251.30	      ---	  $316.91	004	1	0	0.00	    $0.00	Y	
O	31570	LARYNGOSCOPE W/VC INJ                   	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	31571	LARYNGOSCOP W/VC INJ + SCOPE            	     1.19	   $44.30	      ---	   $55.87	004	1	0	0.00	    $0.00	Y	
K	31571	LARYNGOSCOP W/VC INJ + SCOPE            	     5.94	  $221.15	      ---	  $278.88	004	1	0	0.00	    $0.00	Y	
K	31572	LARGSC W/LASER DSTRJ LES                	    12.12	  $451.23	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	31572	LARGSC W/LASER DSTRJ LES                	     2.42	   $90.10	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	31573	LARGSC W/THER INJECTION                 	     1.26	   $46.91	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	31573	LARGSC W/THER INJECTION                 	     6.33	  $235.67	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	31574	LARGSC W/NJX AUGMENTATION               	    25.50	  $949.37	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	31574	LARGSC W/NJX AUGMENTATION               	     5.10	  $189.87	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	31575	DIAGNOSTIC LARYNGOSCOPY                 	     2.07	   $77.07	      ---	   $97.19	004	1	0	0.00	    $0.00	Y	
K	31576	LARYNGOSCOPY WITH BIOPSY                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	31577	LARGSC W/RMVL FOREIGN BDY(S)            	     4.08	  $151.90	      ---	  $191.56	004	1	0	0.00	    $0.00	Y	
K	31578	LARGSC W/REMOVAL LESION                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	31579	LARYNGOSCOPY TELESCOPIC                 	     4.22	  $157.11	      ---	  $198.13	004	1	0	0.00	    $0.00	Y	
K	31580	LARYNGOPLASTY LARYNGEAL WEB             	    22.96	  $854.80	      ---	 $1077.97	004	1	0	0.00	    $0.00	Y	
O	31580	LARYNGOPLASTY LARYNGEAL WEB             	     4.59	  $170.89	      ---	  $215.50	004	1	0	0.00	    $0.00	Y	
O	31584	LARYNGOPLASTY FX RDCTJ FIXJ             	     6.47	  $240.88	      ---	  $303.77	004	1	0	0.00	    $0.00	Y	
K	31584	LARYNGOPLASTY FX RDCTJ FIXJ             	    32.35	 $1204.39	      ---	 $1518.83	004	1	0	0.00	    $0.00	Y	
K	31587	LARYNGOPLASTY CRICOID SPLIT             	    26.11	  $972.08	      ---	 $1225.86	004	1	0	0.00	    $0.00	Y	
O	31587	LARYNGOPLASTY CRICOID SPLIT             	     5.22	  $194.34	      ---	  $245.08	004	1	0	0.00	    $0.00	Y	
O	31590	REINNERVATE LARYNX                      	     3.57	  $132.91	      ---	  $167.61	004	1	0	0.00	    $0.00	Y	
K	31590	REINNERVATE LARYNX                      	    17.84	  $664.18	      ---	  $837.59	004	1	0	0.00	    $0.00	Y	
K	31591	LARYNGOPLASTY MEDIALIZATION             	    24.61	  $916.23	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	31591	LARYNGOPLASTY MEDIALIZATION             	     4.92	  $183.17	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	31592	CRICOTRACHEAL RESECTION                 	     7.88	  $293.37	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	31592	CRICOTRACHEAL RESECTION                 	    39.42	 $1467.61	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	31599	UNLISTED PROCEDURE LARYNX               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	31599	UNLISTED PROCEDURE LARYNX               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	31600	PLANNED TRACHEOSTOMY                    	     5.40	  $201.04	      ---	  $253.53	004	1	0	0.00	    $0.00	Y	
K	31601	PLANNED TRACHEOSTOMY<2 YRS              	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
K	31603	EMER TRACHEOSTOMY TTRACH                	     2.86	  $106.48	      ---	  $134.28	004	1	0	0.00	    $0.00	Y	
K	31605	EMER TRACHEOSTOMY CTHYR MEM             	     5.40	  $201.04	      ---	  $253.53	004	1	0	0.00	    $0.00	Y	
K	31610	TRACHEOSTOMY FENEST SKIN FLP            	     8.82	  $328.37	      ---	  $414.10	004	1	0	0.00	    $0.00	Y	
K	31611	CONSTJ TRACHESOPHGL FSTL                	    18.00	  $670.14	      ---	  $845.10	004	1	0	0.00	    $0.00	Y	
O	31611	CONSTJ TRACHESOPHGL FSTL                	     3.60	  $134.03	      ---	  $169.02	004	1	0	0.00	    $0.00	Y	
K	31612	PERQ TRCHL PNXR TTRACH ASPIR            	     2.00	   $74.46	      ---	   $93.90	004	1	0	0.00	    $0.00	Y	
K	31613	TRACHEOSTOMA REVJ SIMPLE                	     6.04	  $224.87	      ---	  $283.58	004	1	0	0.00	    $0.00	Y	
K	31614	TRACHEOSTOMA REVJ COMPLEX               	     8.50	  $316.46	      ---	  $399.08	004	1	0	0.00	    $0.00	Y	
K	31615	TRCHEOBRNCHSC EST TRACHS INC            	     4.56	  $169.77	      ---	  $214.09	004	1	0	0.00	    $0.00	Y	
K	31622	DX BRONCHOSCOPE/WASH                    	     4.43	  $164.93	      ---	  $207.99	004	1	0	0.00	    $0.00	Y	
K	31623	DX BRONCHOSCOPE/BRUSH                   	     5.68	  $211.47	      ---	  $266.68	004	1	0	0.00	    $0.00	Y	
K	31624	DX BRONCHOSCOPE/LAVAGE                  	     5.73	  $213.33	      ---	  $269.02	004	1	0	0.00	    $0.00	Y	
K	31625	BRONCHOSCOPY W/BIOPSY(S)                	     5.41	  $201.41	      ---	  $254.00	004	1	0	0.00	    $0.00	Y	
K	31626	BRONCHOSCOPY W/MARKERS                  	    10.08	  $375.28	      ---	  $473.26	004	1	0	0.00	    $0.00	Y	
K	31627	NAVIGATIONAL BRONCHOSCOPY               	    29.04	 $1081.16	      ---	 $1363.43	004	1	0	0.00	    $0.00	Y	
K	31628	BRONCHOSCOPY/LUNG BX EACH               	     5.66	  $210.72	      ---	  $265.74	004	1	0	0.00	    $0.00	Y	
K	31629	BRONCHOSCOPY/NEEDLE BX EACH             	     5.00	  $186.15	      ---	  $234.75	004	1	0	0.00	    $0.00	Y	
K	31630	BRONCHOSCOPY DILATE/FX REPR             	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
K	31631	BRONCHOSCOPY DILATE W/STENT             	     5.20	  $193.60	      ---	  $244.14	004	1	0	0.00	    $0.00	Y	
K	31632	BRONCHOSCOPY/LUNG BX ADDL               	     1.59	   $59.20	      ---	   $74.65	004	1	0	0.00	    $0.00	Y	
K	31633	BRONCHOSCOPY/NEEDLE BX ADDL             	     1.96	   $72.97	      ---	   $92.02	004	1	0	0.00	    $0.00	Y	
K	31634	BRONCH W/BALLOON OCCLUSION              	     4.67	  $173.86	      ---	  $219.26	004	1	0	0.00	    $0.00	Y	
K	31635	BRONCHOSCOPY W/FB REMOVAL               	     5.60	  $208.49	      ---	  $262.92	004	1	0	0.00	    $0.00	Y	
K	31636	BRONCHOSCOPY BRONCH STENTS              	     3.82	  $142.22	      ---	  $179.35	004	1	0	0.00	    $0.00	Y	
K	31637	BRONCHOSCOPY STENT ADD-ON               	     1.41	   $52.49	      ---	   $66.20	004	1	0	0.00	    $0.00	Y	
K	31638	BRONCHOSCOPY REVISE STENT               	     4.25	  $158.23	      ---	  $199.54	004	1	0	0.00	    $0.00	Y	
K	31640	BRONCHOSCOPY W/TUMOR EXCISE             	     5.66	  $210.72	      ---	  $265.74	004	1	0	0.00	    $0.00	Y	
K	31641	BRONCHOSCOPY TREAT BLOCKAGE             	     5.66	  $210.72	      ---	  $265.74	004	1	0	0.00	    $0.00	Y	
K	31643	DIAG BRONCHOSCOPE/CATHETER              	     4.83	  $179.82	      ---	  $226.77	004	1	0	0.00	    $0.00	Y	
K	31645	BRNCHSC W/THER ASPIR 1ST                	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
K	31646	BRNCHSC W/THER ASPIR SBSQ               	     2.94	  $109.46	      ---	  $138.03	004	1	0	0.00	    $0.00	Y	
K	31647	BRONCHIAL VALVE INIT INSERT             	     4.97	  $185.03	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	31648	BRONCHIAL VALVE REMOV INIT              	     5.24	  $195.09	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	31649	BRONCHIAL VALVE REMOV ADDL              	     1.66	   $61.80	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	31651	BRONCHIAL VALVE ADDL INSERT             	     1.76	   $65.52	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	31652	BRONCH EBUS SAMPLNG 1/2 NODE            	    22.21	  $826.88	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	31653	BRONCH EBUS SAMPLNG 3/> NODE            	    23.59	  $878.26	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	31654	BRONCH EBUS IVNTJ PERPH LES             	     3.46	  $128.82	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	31660	BRONCH THERMOPLSTY 1 LOBE               	     5.01	  $186.52	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	31661	BRONCH THERMOPLSTY 2/> LOBES            	     5.28	  $196.57	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	31717	BRONCHIAL BRUSH BIOPSY                  	     6.28	  $233.80	      ---	  $294.85	004	1	0	0.00	    $0.00	Y	
K	31720	CLEARANCE OF AIRWAYS                    	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
K	31725	CLEARANCE OF AIRWAYS                    	     1.19	   $44.30	      ---	   $55.87	004	1	0	0.00	    $0.00	Y	
K	31730	INTRO WINDPIPE WIRE/TUBE                	     3.91	  $145.57	      ---	  $183.57	004	1	0	0.00	    $0.00	Y	
K	31750	TRACHEOPLASTY CERVICAL                  	    12.91	  $480.64	      ---	  $606.12	004	1	0	0.00	    $0.00	Y	
O	31750	TRACHEOPLASTY CERVICAL                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	31755	TRACHPLSTY TRCHPHRYNGL FSTLJ            	     6.61	  $246.09	      ---	  $310.34	004	1	0	0.00	    $0.00	Y	
K	31755	TRACHPLSTY TRCHPHRYNGL FSTLJ            	    33.06	 $1230.82	      ---	 $1552.17	004	1	0	0.00	    $0.00	Y	
K	31760	TRACHEOPLASTY INTRATHORACIC             	    32.10	 $1195.08	      ---	 $1507.10	004	1	0	0.00	    $0.00	Y	
O	31760	TRACHEOPLASTY INTRATHORACIC             	     6.42	  $239.02	      ---	  $301.42	004	1	0	0.00	    $0.00	Y	
O	31766	CARINAL RECONSTRUCTION                  	     9.35	  $348.10	      ---	  $438.98	004	1	0	0.00	    $0.00	Y	
K	31766	CARINAL RECONSTRUCTION                  	    46.75	 $1740.50	      ---	 $2194.91	004	1	0	0.00	    $0.00	Y	
K	31770	REPAIR/GRAFT OF BRONCHUS                	    34.77	 $1294.49	      ---	 $1632.45	004	1	0	0.00	    $0.00	Y	
O	31770	REPAIR/GRAFT OF BRONCHUS                	     6.95	  $258.75	      ---	  $326.30	004	1	0	0.00	    $0.00	Y	
O	31775	RECONSTRUCT BRONCHUS                    	     7.92	  $294.86	      ---	  $371.84	004	1	0	0.00	    $0.00	Y	
K	31775	RECONSTRUCT BRONCHUS                    	    39.58	 $1473.56	      ---	 $1858.28	004	1	0	0.00	    $0.00	Y	
K	31780	RECONSTRUCT WINDPIPE                    	    27.95	 $1040.58	      ---	 $1312.25	004	1	0	0.00	    $0.00	Y	
O	31780	RECONSTRUCT WINDPIPE                    	     5.57	  $207.37	      ---	  $261.51	004	1	0	0.00	    $0.00	Y	
O	31781	RECONSTRUCT WINDPIPE                    	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
K	31781	RECONSTRUCT WINDPIPE                    	    30.13	 $1121.74	      ---	 $1414.60	004	1	0	0.00	    $0.00	Y	
K	31785	REMOVE WINDPIPE LESION                  	    30.00	 $1116.90	      ---	 $1408.50	004	1	0	0.00	    $0.00	Y	
O	31785	REMOVE WINDPIPE LESION                  	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
O	31786	REMOVE WINDPIPE LESION                  	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
K	31786	REMOVE WINDPIPE LESION                  	    33.98	 $1265.08	      ---	 $1595.36	004	1	0	0.00	    $0.00	Y	
K	31800	REPAIR OF WINDPIPE INJURY               	    12.65	  $470.96	      ---	  $593.92	004	1	0	0.00	    $0.00	Y	
O	31800	REPAIR OF WINDPIPE INJURY               	     2.53	   $94.19	      ---	  $118.78	004	1	0	0.00	    $0.00	Y	
O	31805	REPAIR OF WINDPIPE INJURY               	     4.80	  $178.70	      ---	  $225.36	004	1	0	0.00	    $0.00	Y	
K	31805	REPAIR OF WINDPIPE INJURY               	    24.01	  $893.89	      ---	 $1127.27	004	1	0	0.00	    $0.00	Y	
K	31820	CLOSURE OF WINDPIPE LESION              	     5.57	  $207.37	      ---	  $261.51	004	1	0	0.00	    $0.00	Y	
O	31820	CLOSURE OF WINDPIPE LESION              	     1.11	   $41.33	      ---	   $52.11	004	1	0	0.00	    $0.00	Y	
O	31825	REPAIR OF WINDPIPE DEFECT               	     1.58	   $58.82	      ---	   $74.18	004	1	0	0.00	    $0.00	Y	
K	31825	REPAIR OF WINDPIPE DEFECT               	     7.88	  $293.37	      ---	  $369.97	004	1	0	0.00	    $0.00	Y	
K	31830	REVISE WINDPIPE SCAR                    	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
O	31830	REVISE WINDPIPE SCAR                    	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	31899	UNLISTED PX TRACHEA BRONCHI             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	31899	UNLISTED PX TRACHEA BRONCHI             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	32035	THORACOSTOMY W/RIB RESECTION            	    11.33	  $421.82	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	32035	THORACOSTOMY W/RIB RESECTION            	     2.27	   $84.51	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	32036	THORACOSTOMY W/FLAP DRAINAGE            	     2.27	   $84.51	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	32036	THORACOSTOMY W/FLAP DRAINAGE            	    11.33	  $421.82	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	32096	OPEN WEDGE/BX LUNG INFILTR              	    17.90	  $666.42	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	32096	OPEN WEDGE/BX LUNG INFILTR              	     3.58	  $133.28	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	32097	OPEN WEDGE/BX LUNG NODULE               	     3.58	  $133.28	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	32097	OPEN WEDGE/BX LUNG NODULE               	    17.90	  $666.42	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	32098	OPEN BIOPSY OF LUNG PLEURA              	    16.83	  $626.58	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	32098	OPEN BIOPSY OF LUNG PLEURA              	     3.37	  $125.47	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	32100	EXPLORATION OF CHEST                    	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	32100	EXPLORATION OF CHEST                    	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	32110	EXPLORE/REPAIR CHEST                    	    18.12	  $674.61	      ---	  $850.73	004	1	0	0.00	    $0.00	Y	
O	32110	EXPLORE/REPAIR CHEST                    	     3.62	  $134.77	      ---	  $169.96	004	1	0	0.00	    $0.00	Y	
O	32120	RE-EXPLORATION OF CHEST                 	     3.62	  $134.77	      ---	  $169.96	004	1	0	0.00	    $0.00	Y	
K	32120	RE-EXPLORATION OF CHEST                 	    18.12	  $674.61	      ---	  $850.73	004	1	0	0.00	    $0.00	Y	
K	32124	EXPLORE CHEST FREE ADHESIONS            	    15.86	  $590.47	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	32124	EXPLORE CHEST FREE ADHESIONS            	     3.17	  $118.02	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	32140	REMOVAL OF LUNG LESION(S)               	     3.62	  $134.77	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	32140	REMOVAL OF LUNG LESION(S)               	    18.12	  $674.61	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	32141	REMOVE/TREAT LUNG LESIONS               	    18.12	  $674.61	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	32141	REMOVE/TREAT LUNG LESIONS               	     3.62	  $134.77	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	32150	REMOVAL OF LUNG LESION(S)               	     3.17	  $118.02	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	32150	REMOVAL OF LUNG LESION(S)               	    15.86	  $590.47	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	32151	REMOVE LUNG FOREIGN BODY                	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
O	32151	REMOVE LUNG FOREIGN BODY                	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
O	32160	OPEN CHEST HEART MASSAGE                	     3.00	  $111.69	      ---	  $140.85	004	1	0	0.00	    $0.00	Y	
K	32160	OPEN CHEST HEART MASSAGE                	    15.01	  $558.82	      ---	  $704.72	004	1	0	0.00	    $0.00	Y	
K	32200	DRAIN OPEN LUNG LESION                  	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
O	32200	DRAIN OPEN LUNG LESION                  	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
O	32215	TREAT CHEST LINING                      	     2.32	   $86.37	      ---	  $108.92	004	1	0	0.00	    $0.00	Y	
K	32215	TREAT CHEST LINING                      	    11.59	  $431.50	      ---	  $544.15	004	1	0	0.00	    $0.00	Y	
K	32220	RELEASE OF LUNG                         	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
O	32220	RELEASE OF LUNG                         	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
O	32225	PARTIAL RELEASE OF LUNG                 	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
K	32225	PARTIAL RELEASE OF LUNG                 	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
K	32310	REMOVAL OF CHEST LINING                 	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
O	32310	REMOVAL OF CHEST LINING                 	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
O	32320	FREE/REMOVE CHEST LINING                	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
K	32320	FREE/REMOVE CHEST LINING                	    30.13	 $1121.74	      ---	 $1414.60	004	1	0	0.00	    $0.00	Y	
K	32400	NEEDLE BIOPSY CHEST LINING              	     3.60	  $134.03	      ---	  $169.02	004	1	1	0.00	    $0.00	Y	
K	32408	CORE NDL BX LNG/MED PERQ                	    23.60	  $878.63	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	32440	REMOVE LUNG PNEUMONECTOMY               	    33.07	 $1231.20	      ---	 $1552.64	004	1	0	0.00	    $0.00	Y	
O	32440	REMOVE LUNG PNEUMONECTOMY               	     6.61	  $246.09	      ---	  $310.34	004	1	0	0.00	    $0.00	Y	
O	32442	SLEEVE PNEUMONECTOMY                    	     4.84	  $180.19	      ---	  $227.24	004	1	0	0.00	    $0.00	Y	
K	32442	SLEEVE PNEUMONECTOMY                    	    24.18	  $900.22	      ---	 $1135.25	004	1	0	0.00	    $0.00	Y	
K	32445	REMOVAL OF LUNG EXTRAPLEURAL            	    37.06	 $1379.74	      ---	 $1739.97	004	1	0	0.00	    $0.00	Y	
O	32445	REMOVAL OF LUNG EXTRAPLEURAL            	     7.41	  $275.87	      ---	  $347.90	004	1	0	0.00	    $0.00	Y	
O	32480	PARTIAL REMOVAL OF LUNG                 	     5.75	  $214.07	      ---	  $269.96	004	1	0	0.00	    $0.00	Y	
K	32480	PARTIAL REMOVAL OF LUNG                 	    28.74	 $1069.99	      ---	 $1349.34	004	1	0	0.00	    $0.00	Y	
K	32482	BILOBECTOMY                             	    20.57	  $765.82	      ---	  $965.76	004	1	0	0.00	    $0.00	Y	
O	32482	BILOBECTOMY                             	     4.11	  $153.02	      ---	  $192.96	004	1	0	0.00	    $0.00	Y	
O	32484	SEGMENTECTOMY                           	     4.21	  $156.74	      ---	  $197.66	004	1	0	0.00	    $0.00	Y	
K	32484	SEGMENTECTOMY                           	    21.06	  $784.06	      ---	  $988.77	004	1	0	0.00	    $0.00	Y	
K	32486	SLEEVE LOBECTOMY                        	    22.32	  $830.97	      ---	 $1047.92	004	1	0	0.00	    $0.00	Y	
O	32486	SLEEVE LOBECTOMY                        	     4.46	  $166.05	      ---	  $209.40	004	1	0	0.00	    $0.00	Y	
O	32488	COMPLETION PNEUMONECTOMY                	     4.78	  $177.96	      ---	  $224.42	004	1	0	0.00	    $0.00	Y	
K	32488	COMPLETION PNEUMONECTOMY                	    23.90	  $889.80	      ---	 $1122.11	004	1	0	0.00	    $0.00	Y	
K	32491	LUNG VOLUME REDUCTION                   	    27.14	 $1010.42	      ---	       --	004	0	0	0.00	    $0.00	N	
O	32491	LUNG VOLUME REDUCTION                   	     5.43	  $202.16	      ---	       --	004	0	0	0.00	    $0.00	N	
O	32501	REPAIR BRONCHUS ADD-ON                  	     1.17	   $43.56	      ---	   $54.93	004	1	0	0.00	    $0.00	Y	
K	32501	REPAIR BRONCHUS ADD-ON                  	     5.80	  $215.93	      ---	  $272.31	004	1	0	0.00	    $0.00	Y	
K	32503	RESECT APICAL LUNG TUMOR                	    40.19	 $1496.27	      ---	 $1886.92	004	1	0	0.00	    $0.00	Y	
O	32503	RESECT APICAL LUNG TUMOR                	     8.04	  $299.33	      ---	  $377.48	004	1	0	0.00	    $0.00	Y	
O	32504	RESECT APICAL LUNG TUM/CHEST            	     9.18	  $341.77	      ---	  $431.00	004	1	0	0.00	    $0.00	Y	
K	32504	RESECT APICAL LUNG TUM/CHEST            	    45.91	 $1709.23	      ---	 $2155.47	004	1	0	0.00	    $0.00	Y	
K	32505	WEDGE RESECT OF LUNG INITIAL            	    20.70	  $770.66	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	32505	WEDGE RESECT OF LUNG INITIAL            	     4.14	  $154.13	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	32506	WEDGE RESECT OF LUNG ADD-ON             	     0.68	   $25.32	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	32506	WEDGE RESECT OF LUNG ADD-ON             	     3.42	  $127.33	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	32507	WEDGE RESECT OF LUNG DIAG               	     3.42	  $127.33	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	32507	WEDGE RESECT OF LUNG DIAG               	     0.68	   $25.32	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	32540	REMOVAL OF LUNG LESION                  	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	32540	REMOVAL OF LUNG LESION                  	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
K	32550	INSERT PLEURAL CATH                     	    16.10	  $599.40	      ---	  $755.90	004	1	0	0.00	    $0.00	Y	
K	32551	INSERTION OF CHEST TUBE                 	     3.53	  $131.42	      ---	  $165.73	004	1	0	0.00	    $0.00	Y	
K	32552	REMOVE LUNG CATHETER                    	     4.10	  $152.64	      ---	  $192.50	004	1	0	0.00	    $0.00	Y	
K	32553	INS MARK THOR FOR RT PERQ               	    13.95	  $519.36	      ---	  $654.95	004	1	0	0.00	    $0.00	Y	
K	32554	ASPIRATE PLEURA W/O IMAGING             	     1.99	   $74.09	      ---	   $93.43	004	1	0	0.00	    $0.00	Y	
K	32555	ASPIRATE PLEURA W/ IMAGING              	     2.48	   $92.33	      ---	  $116.44	004	1	0	0.00	    $0.00	Y	
K	32556	INSERT CATH PLEURA W/O IMAGE            	     2.48	   $92.33	      ---	  $116.44	004	1	0	0.00	    $0.00	Y	
K	32557	INSERT CATH PLEURA W/ IMAGE             	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	32560	TREAT PLEURODESIS W/AGENT               	     6.07	  $225.99	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	32561	LYSE CHEST FIBRIN INIT DAY              	     2.14	   $79.67	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	32561	LYSE CHEST FIBRIN INIT DAY              	     0.43	   $16.01	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	32562	LYSE CHEST FIBRIN SUBQ DAY              	     0.38	   $14.15	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	32562	LYSE CHEST FIBRIN SUBQ DAY              	     1.91	   $71.11	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	32601	THORACOSCOPY DIAGNOSTIC                 	     4.96	  $184.66	      ---	  $232.87	004	1	0	0.00	    $0.00	Y	
K	32604	THORACOSCOPY WBX SAC                    	     7.17	  $266.94	      ---	  $336.63	004	1	0	0.00	    $0.00	Y	
O	32604	THORACOSCOPY WBX SAC                    	     1.43	   $53.24	      ---	       --	004	0	0	0.00	    $0.00	N	
O	32606	THORACOSCOPY W/BX MED SPACE             	     1.37	   $51.01	      ---	       --	004	0	0	0.00	    $0.00	N	
K	32606	THORACOSCOPY W/BX MED SPACE             	     6.82	  $253.91	      ---	  $320.20	004	1	0	0.00	    $0.00	Y	
K	32607	THORACOSCOPY W/BX INFILTRATE            	     6.82	  $253.91	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	32607	THORACOSCOPY W/BX INFILTRATE            	     1.36	   $50.63	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	32608	THORACOSCOPY W/BX NODULE                	     1.67	   $62.17	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	32608	THORACOSCOPY W/BX NODULE                	     8.36	  $311.24	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	32609	THORACOSCOPY W/BX PLEURA                	     5.79	  $215.56	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	32609	THORACOSCOPY W/BX PLEURA                	     1.16	   $43.19	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	32650	THORACOSCOPY W/PLEURODESIS              	    10.49	  $390.54	      ---	  $492.51	004	1	0	0.00	    $0.00	Y	
K	32651	THORACOSCOPY REMOVE CORTEX              	    13.86	  $516.01	      ---	  $650.73	004	1	0	0.00	    $0.00	Y	
O	32651	THORACOSCOPY REMOVE CORTEX              	     2.77	  $103.13	      ---	       --	004	0	0	0.00	    $0.00	N	
O	32652	THORACOSCOPY REM TOTL CORTEX            	     3.84	  $142.96	      ---	       --	004	0	0	0.00	    $0.00	N	
K	32652	THORACOSCOPY REM TOTL CORTEX            	    19.22	  $715.56	      ---	  $902.38	004	1	0	0.00	    $0.00	Y	
K	32653	THORACOSCOPY REMOV FB/FIBRIN            	    13.01	  $484.36	      ---	  $610.82	004	1	0	0.00	    $0.00	Y	
O	32653	THORACOSCOPY REMOV FB/FIBRIN            	     2.61	   $97.17	      ---	       --	004	0	0	0.00	    $0.00	N	
O	32654	THORACOSCOPY CONTRL BLEEDING            	     2.66	   $99.03	      ---	       --	004	0	0	0.00	    $0.00	N	
K	32654	THORACOSCOPY CONTRL BLEEDING            	    13.33	  $496.28	      ---	  $625.84	004	1	0	0.00	    $0.00	Y	
K	32655	THORACOSCOPY RESECT BULLAE              	    15.04	  $559.94	      ---	  $706.13	004	1	0	0.00	    $0.00	Y	
O	32655	THORACOSCOPY RESECT BULLAE              	     3.01	  $112.06	      ---	       --	004	0	0	0.00	    $0.00	N	
O	32656	THORACOSCOPY W/PLEURECTOMY              	     2.96	  $110.20	      ---	       --	004	0	0	0.00	    $0.00	N	
K	32656	THORACOSCOPY W/PLEURECTOMY              	    14.78	  $550.26	      ---	  $693.92	004	1	0	0.00	    $0.00	Y	
K	32658	THORACOSCOPY W/SAC FB REMOVE            	    14.35	  $534.25	      ---	  $673.73	004	1	0	0.00	    $0.00	Y	
O	32658	THORACOSCOPY W/SAC FB REMOVE            	     2.87	  $106.85	      ---	       --	004	0	0	0.00	    $0.00	N	
O	32659	THORACOSCOPY W/SAC DRAINAGE             	     2.93	  $109.08	      ---	       --	004	0	0	0.00	    $0.00	N	
K	32659	THORACOSCOPY W/SAC DRAINAGE             	    14.69	  $546.91	      ---	  $689.70	004	1	0	0.00	    $0.00	Y	
K	32661	THORACOSCOPY W/PERICARD EXC             	    12.63	  $470.21	      ---	  $592.98	004	1	0	0.00	    $0.00	Y	
O	32661	THORACOSCOPY W/PERICARD EXC             	     2.52	   $93.82	      ---	       --	004	0	0	0.00	    $0.00	N	
O	32662	THORACOSCOPY W/MEDIAST EXC              	     3.50	  $130.31	      ---	       --	004	0	0	0.00	    $0.00	N	
K	32662	THORACOSCOPY W/MEDIAST EXC              	    17.48	  $650.78	      ---	  $820.69	004	1	0	0.00	    $0.00	Y	
K	32663	THORACOSCOPY W/LOBECTOMY                	    20.04	  $746.09	      ---	  $940.88	004	1	0	0.00	    $0.00	Y	
O	32663	THORACOSCOPY W/LOBECTOMY                	     4.01	  $149.29	      ---	       --	004	0	0	0.00	    $0.00	N	
O	32664	THORACOSCOPY W/ TH NRV EXC              	     2.75	  $102.38	      ---	       --	004	0	0	0.00	    $0.00	N	
K	32664	THORACOSCOPY W/ TH NRV EXC              	    13.77	  $512.66	      ---	  $646.50	004	1	0	0.00	    $0.00	Y	
K	32665	THORACOSCOP W/ESOPH MUSC EXC            	    16.72	  $622.49	      ---	  $785.00	004	1	0	0.00	    $0.00	Y	
O	32665	THORACOSCOP W/ESOPH MUSC EXC            	     3.34	  $124.35	      ---	       --	004	0	0	0.00	    $0.00	N	
O	32666	THORACOSCOPY W/WEDGE RESECT             	     3.87	  $144.08	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	32666	THORACOSCOPY W/WEDGE RESECT             	    19.37	  $721.15	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	32667	THORACOSCOPY W/W RESECT ADDL            	     3.42	  $127.33	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	32667	THORACOSCOPY W/W RESECT ADDL            	     0.68	   $25.32	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	32668	THORACOSCOPY W/W RESECT DIAG            	     0.69	   $25.69	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	32668	THORACOSCOPY W/W RESECT DIAG            	     3.44	  $128.07	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	32669	THORACOSCOPY REMOVE SEGMENT             	    29.64	 $1103.50	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	32669	THORACOSCOPY REMOVE SEGMENT             	     5.93	  $220.77	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	32670	THORACOSCOPY BILOBECTOMY                	     7.06	  $262.84	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	32670	THORACOSCOPY BILOBECTOMY                	    35.32	 $1314.96	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	32671	THORACOSCOPY PNEUMONECTOMY              	    39.10	 $1455.69	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	32671	THORACOSCOPY PNEUMONECTOMY              	     7.82	  $291.14	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	32672	THORACOSCOPY FOR LVRS                   	     6.70	  $249.44	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	32672	THORACOSCOPY FOR LVRS                   	    33.50	 $1247.21	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	32673	THORACOSCOPY W/THYMUS RESECT            	    26.62	  $991.06	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	32673	THORACOSCOPY W/THYMUS RESECT            	     5.32	  $198.06	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	32674	THORACOSCOPY LYMPH NODE EXC             	     0.94	   $35.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	32674	THORACOSCOPY LYMPH NODE EXC             	     4.70	  $174.98	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	32701	THORAX STEREO RAD TARGETW/TX            	     4.72	  $175.73	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	32800	REPAIR LUNG HERNIA                      	    24.31	  $905.06	      ---	 $1141.35	004	1	0	0.00	    $0.00	Y	
O	32800	REPAIR LUNG HERNIA                      	     4.86	  $180.94	      ---	  $228.18	004	1	0	0.00	    $0.00	Y	
O	32810	CLOSE CHEST AFTER DRAINAGE              	     4.62	  $172.00	      ---	  $216.91	004	1	0	0.00	    $0.00	Y	
K	32810	CLOSE CHEST AFTER DRAINAGE              	    23.12	  $860.76	      ---	 $1085.48	004	1	0	0.00	    $0.00	Y	
K	32815	CLOSE BRONCHIAL FISTULA                 	    38.34	 $1427.40	      ---	 $1800.06	004	1	0	0.00	    $0.00	Y	
O	32815	CLOSE BRONCHIAL FISTULA                 	     7.67	  $285.55	      ---	  $360.11	004	1	0	0.00	    $0.00	Y	
O	32820	RECONSTRUCT INJURED CHEST               	     7.37	  $274.39	      ---	  $346.02	004	1	0	0.00	    $0.00	Y	
K	32820	RECONSTRUCT INJURED CHEST               	    36.84	 $1371.55	      ---	 $1729.64	004	1	0	0.00	    $0.00	Y	
K	32851	LUNG TRANSPLANT SINGLE                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	32851	LUNG TRANSPLANT SINGLE                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	32852	LUNG TRANSPLANT WITH BYPASS             	    12.48	  $464.63	      ---	  $585.94	004	1	0	0.00	    $0.00	Y	
K	32852	LUNG TRANSPLANT WITH BYPASS             	    62.38	 $2322.41	      ---	 $2928.74	004	1	0	0.00	    $0.00	Y	
K	32853	LUNG TRANSPLANT DOUBLE                  	    71.72	 $2670.14	      ---	 $3367.25	004	1	0	0.00	    $0.00	Y	
O	32853	LUNG TRANSPLANT DOUBLE                  	    14.34	  $533.88	      ---	  $673.26	004	1	0	0.00	    $0.00	Y	
O	32854	LUNG TRANSPLANT WITH BYPASS             	    15.15	  $564.03	      ---	  $711.29	004	1	0	0.00	    $0.00	Y	
K	32854	LUNG TRANSPLANT WITH BYPASS             	    75.76	 $2820.54	      ---	 $3556.93	004	1	0	0.00	    $0.00	Y	
K	32900	REMOVAL OF RIB(S)                       	    16.89	  $628.81	      ---	  $792.99	004	1	0	0.00	    $0.00	Y	
O	32900	REMOVAL OF RIB(S)                       	     3.38	  $125.84	      ---	  $158.69	004	1	0	0.00	    $0.00	Y	
O	32905	REVISE & REPAIR CHEST WALL              	     6.81	  $253.54	      ---	  $319.73	004	1	0	0.00	    $0.00	Y	
K	32905	REVISE & REPAIR CHEST WALL              	    34.03	 $1266.94	      ---	 $1597.71	004	1	0	0.00	    $0.00	Y	
K	32906	REVISE & REPAIR CHEST WALL              	    40.31	 $1500.74	      ---	 $1892.55	004	1	0	0.00	    $0.00	Y	
O	32906	REVISE & REPAIR CHEST WALL              	     8.06	  $300.07	      ---	  $378.42	004	1	0	0.00	    $0.00	Y	
O	32940	REVISION OF LUNG                        	     3.27	  $121.74	      ---	  $153.53	004	1	0	0.00	    $0.00	Y	
K	32940	REVISION OF LUNG                        	    16.33	  $607.97	      ---	  $766.69	004	1	0	0.00	    $0.00	Y	
K	32960	THERAPEUTIC PNEUMOTHORAX                	     1.76	   $65.52	      ---	   $82.63	004	1	1	0.00	    $0.00	Y	
K	32994	ABLATE PULM TUMOR PERQ CRYBL            	   154.67	 $5758.36	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	32994	ABLATE PULM TUMOR PERQ CRYBL            	    30.93	 $1151.52	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	32998	ABLATE PULM TUMOR PERQ RF               	    69.56	 $2589.72	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	32999	UNLISTED PX LUNGS & PLEURA              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	32999	UNLISTED PX LUNGS & PLEURA              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	33016	PERICARDIOCENTESIS W/IMAGING            	     5.39	  $200.67	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33017	PRCRD DRG 6YR+ W/O CGEN CAR             	     5.60	  $208.49	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33017	PRCRD DRG 6YR+ W/O CGEN CAR             	     1.12	   $41.70	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33018	PRCRD DRG 0-5YR OR W/ANOMLY             	     1.28	   $47.65	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33018	PRCRD DRG 0-5YR OR W/ANOMLY             	     6.41	  $238.64	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33019	PERQ PRCRD DRG INSJ CATH CT             	     5.19	  $193.22	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33019	PERQ PRCRD DRG INSJ CATH CT             	     1.03	   $38.35	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33020	INCISION OF HEART SAC                   	     4.16	  $154.88	      ---	  $195.31	004	1	0	0.00	    $0.00	Y	
K	33020	INCISION OF HEART SAC                   	    20.78	  $773.64	      ---	  $975.62	004	1	0	0.00	    $0.00	Y	
K	33025	INCISION OF HEART SAC                   	    20.81	  $774.76	      ---	  $977.03	004	1	0	0.00	    $0.00	Y	
O	33025	INCISION OF HEART SAC                   	     4.16	  $154.88	      ---	  $195.31	004	1	0	0.00	    $0.00	Y	
O	33030	PARTIAL REMOVAL OF HEART SAC            	     6.30	  $234.55	      ---	  $295.79	004	1	0	0.00	    $0.00	Y	
K	33030	PARTIAL REMOVAL OF HEART SAC            	    31.52	 $1173.49	      ---	 $1479.86	004	1	0	0.00	    $0.00	Y	
K	33031	PARTIAL REMOVAL OF HEART SAC            	    36.27	 $1350.33	      ---	 $1702.88	004	1	0	0.00	    $0.00	Y	
O	33031	PARTIAL REMOVAL OF HEART SAC            	     7.25	  $269.92	      ---	  $340.39	004	1	0	0.00	    $0.00	Y	
O	33050	RESECT HEART SAC LESION                 	     3.74	  $139.24	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33050	RESECT HEART SAC LESION                 	    18.80	  $699.92	      ---	  $882.66	004	1	0	0.00	    $0.00	Y	
K	33120	EXC ICAR TUM RESC W/CARD BYP            	    50.00	 $1861.50	      ---	 $2347.50	004	1	0	0.00	    $0.00	Y	
O	33120	EXC ICAR TUM RESC W/CARD BYP            	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
O	33130	RESCJ EXTERNAL CARDIAC TUMOR            	     4.76	  $177.21	      ---	  $223.48	004	1	0	0.00	    $0.00	Y	
K	33130	RESCJ EXTERNAL CARDIAC TUMOR            	    23.56	  $877.14	      ---	 $1106.14	004	1	0	0.00	    $0.00	Y	
K	33202	INSERT EPICARD ELTRD OPEN               	    18.00	  $670.14	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33202	INSERT EPICARD ELTRD OPEN               	     3.60	  $134.03	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33203	INSERT EPICARD ELTRD ENDO               	     3.70	  $137.75	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33203	INSERT EPICARD ELTRD ENDO               	    18.50	  $688.76	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33206	INSERT HEART PM ATRIAL                  	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
K	33207	INSERT HEART PM VENTRICULAR             	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
K	33208	INSRT HEART PM ATRIAL & VENT            	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
K	33210	INSERT ELECTRD/PM CATH SNGL             	     7.00	  $260.61	      ---	  $328.65	004	1	0	0.00	    $0.00	Y	
K	33211	INSERT CARD ELECTRODES DUAL             	     4.71	  $175.35	      ---	  $221.13	004	1	0	0.00	    $0.00	Y	
K	33212	INSERT PULSE GEN SNGL LEAD              	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
K	33213	INSERT PULSE GEN DUAL LEADS             	     9.56	  $355.92	      ---	  $448.84	004	1	0	0.00	    $0.00	Y	
K	33214	UPGRADE OF PACEMAKER SYSTEM             	    10.66	  $396.87	      ---	  $500.49	004	1	0	0.00	    $0.00	Y	
O	33214	UPGRADE OF PACEMAKER SYSTEM             	     2.13	   $79.30	      ---	  $100.00	004	1	0	0.00	    $0.00	Y	
O	33215	REPOSITION PACING-DEFIB LEAD            	     0.81	   $30.16	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33215	REPOSITION PACING-DEFIB LEAD            	     4.06	  $151.15	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33216	INSERT 1 ELECTRODE PM-DEFIB             	    12.00	  $446.76	      ---	  $563.40	004	1	0	0.00	    $0.00	Y	
O	33216	INSERT 1 ELECTRODE PM-DEFIB             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	33217	INSERT 2 ELECTRODE PM-DEFIB             	     1.69	   $62.92	      ---	   $79.35	004	1	0	0.00	    $0.00	Y	
K	33217	INSERT 2 ELECTRODE PM-DEFIB             	     8.44	  $314.22	      ---	  $396.26	004	1	0	0.00	    $0.00	Y	
K	33218	REPAIR LEAD PACE-DEFIB ONE              	     5.66	  $210.72	      ---	  $265.74	004	1	0	0.00	    $0.00	Y	
K	33220	REPAIR LEAD PACE-DEFIB DUAL             	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
K	33221	INSERT PULSE GEN MULT LEADS             	     7.82	  $291.14	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33222	RELOCATION POCKET PACEMAKER             	     8.26	  $307.52	      ---	  $387.81	004	1	0	0.00	    $0.00	Y	
O	33222	RELOCATION POCKET PACEMAKER             	     1.65	   $61.43	      ---	   $77.47	004	1	0	0.00	    $0.00	Y	
O	33223	RELOCATE POCKET FOR DEFIB               	     1.98	   $73.72	      ---	   $92.96	004	1	0	0.00	    $0.00	Y	
K	33223	RELOCATE POCKET FOR DEFIB               	     9.92	  $369.32	      ---	  $465.74	004	1	0	0.00	    $0.00	Y	
K	33224	INSERT PACING LEAD & CONNECT            	     7.51	  $279.60	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33225	L VENTRIC PACING LEAD ADD-ON            	     6.94	  $258.38	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33226	REPOSITION L VENTRIC LEAD               	     7.22	  $268.80	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33227	REMOVE&REPLACE PM GEN SINGL             	     7.47	  $278.11	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33228	REMV&REPLC PM GEN DUAL LEAD             	     7.78	  $289.65	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33229	REMV&REPLC PM GEN MULT LEADS            	     8.10	  $301.56	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33230	INSRT PULSE GEN W/DUAL LEADS            	     8.40	  $312.73	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33231	INSRT PULSE GEN W/MULT LEADS            	     8.72	  $324.65	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33233	REMOVAL OF PM GENERATOR                 	     4.18	  $155.62	      ---	  $196.25	004	1	0	0.00	    $0.00	N	
K	33234	REMOVAL OF PACEMAKER SYSTEM             	     7.15	  $266.19	      ---	  $335.69	004	1	0	0.00	    $0.00	Y	
O	33234	REMOVAL OF PACEMAKER SYSTEM             	     1.43	   $53.24	      ---	   $67.14	004	1	0	0.00	    $0.00	Y	
O	33235	REMOVAL PACEMAKER ELECTRODE             	     1.73	   $64.41	      ---	   $81.22	004	1	0	0.00	    $0.00	Y	
K	33235	REMOVAL PACEMAKER ELECTRODE             	     8.69	  $323.53	      ---	  $408.00	004	1	0	0.00	    $0.00	Y	
K	33236	REMOVE ELECTRODE/THORACOTOMY            	    12.14	  $451.97	      ---	  $569.97	004	1	0	0.00	    $0.00	Y	
O	33236	REMOVE ELECTRODE/THORACOTOMY            	     2.42	   $90.10	      ---	  $113.62	004	1	0	0.00	    $0.00	Y	
O	33237	REMOVE ELECTRODE/THORACOTOMY            	     3.64	  $135.52	      ---	  $170.90	004	1	0	0.00	    $0.00	Y	
K	33237	REMOVE ELECTRODE/THORACOTOMY            	    18.18	  $676.84	      ---	  $853.55	004	1	0	0.00	    $0.00	Y	
K	33238	REMOVE ELECTRODE/THORACOTOMY            	    20.28	  $755.02	      ---	  $952.15	004	1	0	0.00	    $0.00	Y	
O	33238	REMOVE ELECTRODE/THORACOTOMY            	     4.05	  $150.78	      ---	  $190.15	004	1	0	0.00	    $0.00	Y	
K	33240	INSRT PULSE GEN W/SINGL LEAD            	    10.31	  $383.84	      ---	  $484.05	004	1	0	0.00	    $0.00	Y	
K	33241	REMOVE PULSE GENERATOR                  	     4.03	  $150.04	      ---	  $189.21	004	1	0	0.00	    $0.00	Y	
K	33243	REMOVE ELTRD/THORACOTOMY                	    24.07	  $896.13	      ---	 $1130.09	004	1	0	0.00	    $0.00	Y	
O	33243	REMOVE ELTRD/THORACOTOMY                	     4.81	  $179.08	      ---	  $225.83	004	1	0	0.00	    $0.00	Y	
O	33244	REMOVE ELCTRD TRANSVENOUSLY             	     2.93	  $109.08	      ---	  $137.56	004	1	0	0.00	    $0.00	Y	
K	33244	REMOVE ELCTRD TRANSVENOUSLY             	    14.67	  $546.16	      ---	  $688.76	004	1	0	0.00	    $0.00	Y	
K	33249	INSJ/RPLCMT DEFIB W/LEAD(S)             	    24.04	  $895.01	      ---	 $1128.68	004	1	0	0.00	    $0.00	Y	
K	33250	ABLATE HEART DYSRHYTHM FOCUS            	    41.13	 $1531.27	      ---	 $1931.05	004	1	0	0.00	    $0.00	Y	
O	33250	ABLATE HEART DYSRHYTHM FOCUS            	     8.23	  $306.40	      ---	  $386.40	004	1	0	0.00	    $0.00	Y	
O	33251	ABLATE HEART DYSRHYTHM FOCUS            	     8.84	  $329.11	      ---	  $415.04	004	1	0	0.00	    $0.00	Y	
K	33251	ABLATE HEART DYSRHYTHM FOCUS            	    44.19	 $1645.19	      ---	 $2074.72	004	1	0	0.00	    $0.00	Y	
K	33254	ABLATE ATRIA LMTD                       	    31.31	 $1165.67	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33254	ABLATE ATRIA LMTD                       	     6.26	  $233.06	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33255	ABLATE ATRIA W/O BYPASS EXT             	     7.54	  $280.71	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33255	ABLATE ATRIA W/O BYPASS EXT             	    37.70	 $1403.57	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33256	ABLATE ATRIA W/BYPASS EXTEN             	    44.97	 $1674.23	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33256	ABLATE ATRIA W/BYPASS EXTEN             	     8.99	  $334.70	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33257	ABLATE ATRIA LMTD ADD-ON                	     2.48	   $92.33	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33257	ABLATE ATRIA LMTD ADD-ON                	    12.38	  $460.91	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33258	ABLATE ATRIA X10SV ADD-ON               	    13.96	  $519.73	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33258	ABLATE ATRIA X10SV ADD-ON               	     2.79	  $103.87	      ---	  $130.99	004	1	0	0.00	    $0.00	Y	
O	33259	ABLATE ATRIA W/BYPASS ADD-ON            	     3.65	  $135.89	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33259	ABLATE ATRIA W/BYPASS ADD-ON            	    18.24	  $679.08	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33261	ABLATE HEART DYSRHYTHM FOCUS            	    33.25	 $1237.90	      ---	 $1561.09	004	1	0	0.00	    $0.00	Y	
O	33261	ABLATE HEART DYSRHYTHM FOCUS            	     6.65	  $247.58	      ---	  $312.22	004	1	0	0.00	    $0.00	Y	
K	33262	RMVL& REPLC PULSE GEN 1 LEAD            	     8.10	  $301.56	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33263	RMVL & RPLCMT DFB GEN 2 LEAD            	     8.42	  $313.48	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33264	RMVL & RPLCMT DFB GEN MLT LD            	     8.73	  $325.02	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33265	ABLATE ATRIA LMTD ENDO                  	    31.31	 $1165.67	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33265	ABLATE ATRIA LMTD ENDO                  	     6.26	  $233.06	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33266	ABLATE ATRIA X10SV ENDO                 	     8.56	  $318.69	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33266	ABLATE ATRIA X10SV ENDO                 	    42.78	 $1592.70	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33267	EXCL LAA OPEN ANY METHOD                	    23.41	  $871.55	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33267	EXCL LAA OPEN ANY METHOD                	     4.68	  $174.24	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33268	EXCL LAA OPN OTH PX ANY METH            	     0.57	   $21.22	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33268	EXCL LAA OPN OTH PX ANY METH            	     2.89	  $107.59	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33269	EXCL LAA THRSCP ANY METHOD              	    18.57	  $691.36	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33269	EXCL LAA THRSCP ANY METHOD              	     3.71	  $138.12	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33270	INS/REP SUBQ DEFIBRILLATOR              	    13.67	  $508.93	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33271	INSJ SUBQ IMPLTBL DFB ELCTRD            	    11.52	  $428.89	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33272	RMVL OF SUBQ DEFIBRILLATOR              	     8.49	  $316.08	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33273	REPOS PREV IMPLTBL SUBQ DFB             	     9.26	  $344.75	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33274	TCAT INSJ/RPL PERM LDLS PM              	    11.22	  $417.72	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33275	TCAT RMVL PERM LDLS PM W/IMG            	    11.85	  $441.18	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33276	INSJ PHRNC NRV STIM SYS                 	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33276	INSJ PHRNC NRV STIM SYS                 	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33277	INSJ PHRNC NRV STIM TRANSVNS            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33278	RMVL PHRNC NRV STIM SYS                 	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33279	RMVL PHRNC NRV STIM TRANSVNS            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33280	RMVL PHRNC NRV STIM PG ONLY             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33281	REPOSG PHRNC NRV STIM TRNSVN            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33285	INSJ SUBQ CAR RHYTHM MNTR               	   129.92	 $4836.92	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33285	INSJ SUBQ CAR RHYTHM MNTR               	    25.98	  $967.24	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33286	RMVL SUBQ CAR RHYTHM MNTR               	     0.62	   $23.08	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33286	RMVL SUBQ CAR RHYTHM MNTR               	     3.10	  $115.41	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33287	RMV&RPLCMT PHRNC NRV STIM PG            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33288	RMV&RPLCMT PHRNC NRV STIM LD            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33289	TCAT IMPL WRLS P-ART PRS SNR            	     7.41	  $275.87	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33289	TCAT IMPL WRLS P-ART PRS SNR            	     1.48	   $55.10	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33300	REPAIR OF HEART WOUND                   	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
K	33300	REPAIR OF HEART WOUND                   	    27.18	 $1011.91	      ---	 $1276.10	004	1	0	0.00	    $0.00	Y	
K	33305	REPAIR OF HEART WOUND                   	    32.85	 $1223.01	      ---	 $1542.31	004	1	0	0.00	    $0.00	Y	
O	33305	REPAIR OF HEART WOUND                   	     6.57	  $244.60	      ---	  $308.46	004	1	0	0.00	    $0.00	Y	
O	33310	EXPLORATORY HEART SURGERY               	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
K	33310	EXPLORATORY HEART SURGERY               	    27.18	 $1011.91	      ---	 $1276.10	004	1	0	0.00	    $0.00	Y	
K	33315	EXPLORATORY HEART SURGERY               	    40.00	 $1489.20	      ---	 $1878.00	004	1	0	0.00	    $0.00	Y	
O	33315	EXPLORATORY HEART SURGERY               	     8.00	  $297.84	      ---	  $375.60	004	1	0	0.00	    $0.00	Y	
O	33320	REPAIR MAJOR BLOOD VESSEL(S)            	     3.74	  $139.24	      ---	  $175.59	004	1	0	0.00	    $0.00	Y	
K	33320	REPAIR MAJOR BLOOD VESSEL(S)            	    18.80	  $699.92	      ---	  $882.66	004	1	0	0.00	    $0.00	Y	
K	33321	REPAIR MAJOR VESSEL                     	    33.21	 $1236.41	      ---	 $1559.21	004	1	0	0.00	    $0.00	Y	
O	33321	REPAIR MAJOR VESSEL                     	     6.65	  $247.58	      ---	  $312.22	004	1	0	0.00	    $0.00	Y	
O	33322	REPAIR MAJOR BLOOD VESSEL(S)            	     6.57	  $244.60	      ---	  $308.46	004	1	0	0.00	    $0.00	Y	
K	33322	REPAIR MAJOR BLOOD VESSEL(S)            	    32.85	 $1223.01	      ---	 $1542.31	004	1	0	0.00	    $0.00	Y	
K	33330	INSERT MAJOR VESSEL GRAFT               	    32.85	 $1223.01	      ---	 $1542.31	004	1	0	0.00	    $0.00	Y	
O	33330	INSERT MAJOR VESSEL GRAFT               	     6.57	  $244.60	      ---	  $308.46	004	1	0	0.00	    $0.00	Y	
O	33335	INSERT MAJOR VESSEL GRAFT               	     9.27	  $345.12	      ---	  $435.23	004	1	0	0.00	    $0.00	Y	
K	33335	INSERT MAJOR VESSEL GRAFT               	    46.33	 $1724.87	      ---	 $2175.19	004	1	0	0.00	    $0.00	Y	
K	33340	PERQ CLSR TCAT L ATR APNDGE             	    18.23	  $678.70	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33340	PERQ CLSR TCAT L ATR APNDGE             	     3.64	  $135.52	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33361	REPLACE AORTIC VALVE PERQ               	     5.79	  $215.56	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33361	REPLACE AORTIC VALVE PERQ               	    28.98	 $1078.93	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33362	REPLACE AORTIC VALVE OPEN               	    31.70	 $1180.19	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33362	REPLACE AORTIC VALVE OPEN               	     6.34	  $236.04	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33363	REPLACE AORTIC VALVE OPEN               	     6.57	  $244.60	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33363	REPLACE AORTIC VALVE OPEN               	    32.83	 $1222.26	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33364	REPLACE AORTIC VALVE OPEN               	    34.98	 $1302.31	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33364	REPLACE AORTIC VALVE OPEN               	     6.99	  $260.24	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33365	REPLACE AORTIC VALVE OPEN               	     7.62	  $283.69	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33365	REPLACE AORTIC VALVE OPEN               	    38.10	 $1418.46	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33366	TRCATH REPLACE AORTIC VALVE             	    43.17	 $1607.22	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33366	TRCATH REPLACE AORTIC VALVE             	     8.63	  $321.29	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33367	REPLACE AORTIC VALVE W/BYP              	     2.66	   $99.03	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33367	REPLACE AORTIC VALVE W/BYP              	    13.33	  $496.28	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33368	REPLACE AORTIC VALVE W/BYP              	    16.16	  $601.64	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33368	REPLACE AORTIC VALVE W/BYP              	     3.23	  $120.25	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33369	REPLACE AORTIC VALVE W/BYP              	     4.26	  $158.60	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33369	REPLACE AORTIC VALVE W/BYP              	    21.34	  $794.49	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33370	TCAT PLMT&RMVL CEPD PERQ                	     2.96	  $110.20	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33370	TCAT PLMT&RMVL CEPD PERQ                	     0.59	   $21.97	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33390	VALVULOPLASTY AORTIC VALVE              	     8.67	  $322.78	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33390	VALVULOPLASTY AORTIC VALVE              	    43.36	 $1614.29	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33391	VALVULOPLASTY AORTIC VALVE              	    51.38	 $1912.88	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33391	VALVULOPLASTY AORTIC VALVE              	    10.27	  $382.35	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33404	PREPARE HEART-AORTA CONDUIT             	    10.29	  $383.10	      ---	  $483.12	004	1	0	0.00	    $0.00	Y	
K	33404	PREPARE HEART-AORTA CONDUIT             	    51.45	 $1915.48	      ---	 $2415.58	004	1	0	0.00	    $0.00	Y	
K	33405	REPLACEMENT AORTIC VALVE OPN            	    52.00	 $1935.96	      ---	 $2441.40	004	1	0	0.00	    $0.00	Y	
O	33405	REPLACEMENT AORTIC VALVE OPN            	    10.40	  $387.19	      ---	  $488.28	004	1	0	0.00	    $0.00	Y	
O	33406	REPLACEMENT AORTIC VALVE OPN            	     9.89	  $368.20	      ---	  $464.34	004	1	0	0.00	    $0.00	Y	
K	33406	REPLACEMENT AORTIC VALVE OPN            	    49.45	 $1841.02	      ---	 $2321.68	004	1	0	0.00	    $0.00	Y	
K	33410	REPLACEMENT AORTIC VALVE OPN            	    39.79	 $1481.38	      ---	 $1868.14	004	1	0	0.00	    $0.00	Y	
O	33410	REPLACEMENT AORTIC VALVE OPN            	     7.96	  $296.35	      ---	  $373.72	004	1	0	0.00	    $0.00	Y	
O	33411	REPLACEMENT OF AORTIC VALVE             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	33411	REPLACEMENT OF AORTIC VALVE             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	33412	REPLACEMENT OF AORTIC VALVE             	    59.22	 $2204.76	      ---	 $2780.38	004	1	0	0.00	    $0.00	Y	
O	33412	REPLACEMENT OF AORTIC VALVE             	    11.84	  $440.80	      ---	  $555.89	004	1	0	0.00	    $0.00	Y	
O	33413	REPLACEMENT OF AORTIC VALVE             	     9.79	  $364.48	      ---	  $459.64	004	1	0	0.00	    $0.00	Y	
K	33413	REPLACEMENT OF AORTIC VALVE             	    48.95	 $1822.41	      ---	 $2298.20	004	1	0	0.00	    $0.00	Y	
K	33414	REPAIR OF AORTIC VALVE                  	    41.95	 $1561.80	      ---	 $1969.55	004	1	0	0.00	    $0.00	Y	
O	33414	REPAIR OF AORTIC VALVE                  	     8.39	  $312.36	      ---	  $393.91	004	1	0	0.00	    $0.00	Y	
O	33415	REVISION SUBVALVULAR TISSUE             	     7.48	  $278.48	      ---	  $351.19	004	1	0	0.00	    $0.00	Y	
K	33415	REVISION SUBVALVULAR TISSUE             	    37.60	 $1399.85	      ---	 $1765.32	004	1	0	0.00	    $0.00	Y	
K	33416	REVISE VENTRICLE MUSCLE                 	    37.60	 $1399.85	      ---	 $1765.32	004	1	0	0.00	    $0.00	Y	
O	33416	REVISE VENTRICLE MUSCLE                 	    11.78	  $438.57	      ---	  $553.07	004	1	0	0.00	    $0.00	Y	
O	33417	REPAIR OF AORTIC VALVE                  	     7.48	  $278.48	      ---	  $351.19	004	1	0	0.00	    $0.00	Y	
K	33417	REPAIR OF AORTIC VALVE                  	    37.60	 $1399.85	      ---	 $1765.32	004	1	0	0.00	    $0.00	Y	
K	33418	REPAIR TCAT MITRAL VALVE                	    42.83	 $1594.56	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33418	REPAIR TCAT MITRAL VALVE                	     8.56	  $318.69	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33419	REPAIR TCAT MITRAL VALVE                	     2.00	   $74.46	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33419	REPAIR TCAT MITRAL VALVE                	    10.01	  $372.67	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33420	REVISION OF MITRAL VALVE                	    32.00	 $1191.36	      ---	 $1502.40	004	1	0	0.00	    $0.00	Y	
O	33420	REVISION OF MITRAL VALVE                	     6.40	  $238.27	      ---	  $300.48	004	1	0	0.00	    $0.00	Y	
O	33422	REVISION OF MITRAL VALVE                	     8.27	  $307.89	      ---	  $388.28	004	1	0	0.00	    $0.00	Y	
K	33422	REVISION OF MITRAL VALVE                	    41.34	 $1539.09	      ---	 $1940.91	004	1	0	0.00	    $0.00	Y	
K	33425	REPAIR OF MITRAL VALVE                  	    52.00	 $1935.96	      ---	 $2441.40	004	1	0	0.00	    $0.00	Y	
O	33425	REPAIR OF MITRAL VALVE                  	    10.40	  $387.19	      ---	  $488.28	004	1	0	0.00	    $0.00	Y	
O	33426	REPAIR OF MITRAL VALVE                  	    10.40	  $387.19	      ---	  $488.28	004	1	0	0.00	    $0.00	Y	
K	33426	REPAIR OF MITRAL VALVE                  	    52.00	 $1935.96	      ---	 $2441.40	004	1	0	0.00	    $0.00	Y	
K	33427	REPAIR OF MITRAL VALVE                  	    51.19	 $1905.80	      ---	 $2403.37	004	1	0	0.00	    $0.00	Y	
O	33427	REPAIR OF MITRAL VALVE                  	    10.24	  $381.24	      ---	  $480.77	004	1	0	0.00	    $0.00	Y	
O	33430	REPLACEMENT OF MITRAL VALVE             	    10.40	  $387.19	      ---	  $488.28	004	1	0	0.00	    $0.00	Y	
K	33430	REPLACEMENT OF MITRAL VALVE             	    52.00	 $1935.96	      ---	 $2441.40	004	1	0	0.00	    $0.00	Y	
K	33440	RPLCMT A-VALVE TLCJ AUTOL PV            	    75.94	 $2827.25	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33440	RPLCMT A-VALVE TLCJ AUTOL PV            	    15.18	  $565.15	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33460	REVISION OF TRICUSPID VALVE             	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
K	33460	REVISION OF TRICUSPID VALVE             	    50.00	 $1861.50	      ---	 $2347.50	004	1	0	0.00	    $0.00	Y	
K	33463	VALVULOPLASTY TRICUSPID                 	    34.58	 $1287.41	      ---	 $1623.53	004	1	0	0.00	    $0.00	Y	
O	33463	VALVULOPLASTY TRICUSPID                 	     6.92	  $257.63	      ---	  $324.89	004	1	0	0.00	    $0.00	Y	
O	33464	VALVULOPLASTY TRICUSPID                 	     7.41	  $275.87	      ---	  $347.90	004	1	0	0.00	    $0.00	Y	
K	33464	VALVULOPLASTY TRICUSPID                 	    37.04	 $1379.00	      ---	 $1739.03	004	1	0	0.00	    $0.00	Y	
K	33465	REPLACE TRICUSPID VALVE                 	    52.00	 $1935.96	      ---	 $2441.40	004	1	0	0.00	    $0.00	Y	
O	33465	REPLACE TRICUSPID VALVE                 	    10.40	  $387.19	      ---	  $488.28	004	1	0	0.00	    $0.00	Y	
O	33468	REVISION OF TRICUSPID VALVE             	    10.19	  $379.37	      ---	  $478.42	004	1	0	0.00	    $0.00	Y	
K	33468	REVISION OF TRICUSPID VALVE             	    50.74	 $1889.05	      ---	 $2382.24	004	1	0	0.00	    $0.00	Y	
K	33474	REVISION OF PULMONARY VALVE             	    50.00	 $1861.50	      ---	 $2347.50	004	1	0	0.00	    $0.00	Y	
O	33474	REVISION OF PULMONARY VALVE             	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
O	33475	REPLACEMENT PULMONARY VALVE             	     7.84	  $291.88	      ---	  $368.09	004	1	0	0.00	    $0.00	Y	
K	33475	REPLACEMENT PULMONARY VALVE             	    39.18	 $1458.67	      ---	 $1839.50	004	1	0	0.00	    $0.00	Y	
K	33476	REVISION OF HEART CHAMBER               	    36.97	 $1376.39	      ---	 $1735.74	004	1	0	0.00	    $0.00	Y	
O	33476	REVISION OF HEART CHAMBER               	     7.39	  $275.13	      ---	  $346.96	004	1	0	0.00	    $0.00	Y	
K	33477	IMPLANT TCAT PULM VLV PERQ              	    29.98	 $1116.16	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33478	REVISION OF HEART CHAMBER               	    44.40	 $1653.01	      ---	 $2084.58	004	1	0	0.00	    $0.00	Y	
O	33478	REVISION OF HEART CHAMBER               	     8.92	  $332.09	      ---	  $418.79	004	1	0	0.00	    $0.00	Y	
O	33496	REPAIR PROSTH VALVE CLOT                	     9.10	  $338.79	      ---	  $427.25	004	1	0	0.00	    $0.00	Y	
K	33496	REPAIR PROSTH VALVE CLOT                	    45.47	 $1692.85	      ---	 $2134.82	004	1	0	0.00	    $0.00	Y	
K	33500	REPAIR HEART VESSEL FISTULA             	    39.98	 $1488.46	      ---	 $1877.06	004	1	0	0.00	    $0.00	Y	
O	33500	REPAIR HEART VESSEL FISTULA             	     8.04	  $299.33	      ---	  $377.48	004	1	0	0.00	    $0.00	Y	
O	33501	REPAIR HEART VESSEL FISTULA             	     5.86	  $218.17	      ---	  $275.13	004	1	0	0.00	    $0.00	Y	
K	33501	REPAIR HEART VESSEL FISTULA             	    29.30	 $1090.84	      ---	 $1375.64	004	1	0	0.00	    $0.00	Y	
K	33502	CORONARY ARTERY CORRECTION              	    36.24	 $1349.22	      ---	 $1701.47	004	1	0	0.00	    $0.00	Y	
O	33502	CORONARY ARTERY CORRECTION              	     7.25	  $269.92	      ---	  $340.39	004	1	0	0.00	    $0.00	Y	
O	33503	CORONARY ARTERY GRAFT                   	     6.57	  $244.60	      ---	  $308.46	004	1	0	0.00	    $0.00	Y	
K	33503	CORONARY ARTERY GRAFT                   	    32.85	 $1223.01	      ---	 $1542.31	004	1	0	0.00	    $0.00	Y	
K	33504	CORONARY ARTERY GRAFT                   	    50.00	 $1861.50	      ---	 $2347.50	004	1	0	0.00	    $0.00	Y	
O	33504	CORONARY ARTERY GRAFT                   	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
O	33505	REPAIR ARTERY W/TUNNEL                  	     7.26	  $270.29	      ---	  $340.86	004	1	0	0.00	    $0.00	Y	
K	33505	REPAIR ARTERY W/TUNNEL                  	    36.30	 $1351.45	      ---	 $1704.29	004	1	0	0.00	    $0.00	Y	
K	33506	REPAIR ARTERY TRANSLOCATION             	    36.30	 $1351.45	      ---	 $1704.29	004	1	0	0.00	    $0.00	Y	
O	33506	REPAIR ARTERY TRANSLOCATION             	     7.26	  $270.29	      ---	  $340.86	004	1	0	0.00	    $0.00	Y	
O	33507	REPAIR ART INTRAMURAL                   	     7.74	  $288.16	      ---	  $363.39	004	1	0	0.00	    $0.00	Y	
K	33507	REPAIR ART INTRAMURAL                   	    38.72	 $1441.55	      ---	 $1817.90	004	1	0	0.00	    $0.00	Y	
K	33508	ENDOSCOPIC VEIN HARVEST                 	     0.34	   $12.66	      ---	   $15.96	004	1	0	0.00	    $0.00	Y	
K	33509	NDSC HRV UXTR ART 1 SGM CAB             	     3.80	  $141.47	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33509	NDSC HRV UXTR ART 1 SGM CAB             	     0.76	   $28.29	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33510	CABG VEIN SINGLE                        	     9.76	  $363.36	      ---	  $458.23	004	1	0	0.00	    $0.00	Y	
K	33510	CABG VEIN SINGLE                        	    48.67	 $1811.98	      ---	 $2285.06	004	1	0	0.00	    $0.00	Y	
K	33511	CABG VEIN TWO                           	    53.55	 $1993.67	      ---	 $2514.17	004	1	0	0.00	    $0.00	Y	
O	33511	CABG VEIN TWO                           	    10.71	  $398.73	      ---	  $502.83	004	1	0	0.00	    $0.00	Y	
O	33512	CABG VEIN THREE                         	    11.67	  $434.47	      ---	  $547.91	004	1	0	0.00	    $0.00	Y	
K	33512	CABG VEIN THREE                         	    58.33	 $2171.63	      ---	 $2738.59	004	1	0	0.00	    $0.00	Y	
K	33513	CABG VEIN FOUR                          	    63.10	 $2349.21	      ---	 $2962.55	004	1	0	0.00	    $0.00	Y	
O	33513	CABG VEIN FOUR                          	    12.60	  $469.10	      ---	  $591.57	004	1	0	0.00	    $0.00	Y	
O	33514	CABG VEIN FIVE                          	    13.57	  $505.21	      ---	  $637.11	004	1	0	0.00	    $0.00	Y	
K	33514	CABG VEIN FIVE                          	    67.84	 $2525.68	      ---	 $3185.09	004	1	0	0.00	    $0.00	Y	
K	33516	CABG VEIN SIX OR MORE                   	    72.61	 $2703.27	      ---	 $3409.04	004	1	0	0.00	    $0.00	Y	
O	33516	CABG VEIN SIX OR MORE                   	    14.52	  $540.58	      ---	  $681.71	004	1	0	0.00	    $0.00	Y	
O	33517	CABG ARTERY-VEIN SINGLE                 	     0.95	   $35.37	      ---	   $44.60	004	1	0	0.00	    $0.00	Y	
K	33517	CABG ARTERY-VEIN SINGLE                 	     4.76	  $177.21	      ---	  $223.48	004	1	0	0.00	    $0.00	Y	
K	33518	CABG ARTERY-VEIN TWO                    	     9.53	  $354.80	      ---	  $447.43	004	1	0	0.00	    $0.00	Y	
O	33518	CABG ARTERY-VEIN TWO                    	     1.91	   $71.11	      ---	   $89.67	004	1	0	0.00	    $0.00	Y	
O	33519	CABG ARTERY-VEIN THREE                  	     2.86	  $106.48	      ---	  $134.28	004	1	0	0.00	    $0.00	Y	
K	33519	CABG ARTERY-VEIN THREE                  	    14.29	  $532.02	      ---	  $670.92	004	1	0	0.00	    $0.00	Y	
K	33521	CABG ARTERY-VEIN FOUR                   	    19.05	  $709.23	      ---	  $894.40	004	1	0	0.00	    $0.00	Y	
O	33521	CABG ARTERY-VEIN FOUR                   	     3.81	  $141.85	      ---	  $178.88	004	1	0	0.00	    $0.00	Y	
O	33522	CABG ARTERY-VEIN FIVE                   	     4.76	  $177.21	      ---	  $223.48	004	1	0	0.00	    $0.00	Y	
K	33522	CABG ARTERY-VEIN FIVE                   	    23.82	  $886.82	      ---	 $1118.35	004	1	0	0.00	    $0.00	Y	
K	33523	CABG ART-VEIN SIX OR MORE               	    28.59	 $1064.41	      ---	 $1342.30	004	1	0	0.00	    $0.00	Y	
O	33523	CABG ART-VEIN SIX OR MORE               	     5.72	  $212.96	      ---	  $268.55	004	1	0	0.00	    $0.00	Y	
O	33530	CORONARY ARTERY BYPASS/REOP             	     3.10	  $115.41	      ---	  $145.55	004	1	0	0.00	    $0.00	Y	
K	33530	CORONARY ARTERY BYPASS/REOP             	    15.51	  $577.44	      ---	  $728.19	004	1	0	0.00	    $0.00	Y	
K	33533	CABG ARTERIAL SINGLE                    	    50.28	 $1871.92	      ---	 $2360.65	004	1	0	0.00	    $0.00	Y	
O	33533	CABG ARTERIAL SINGLE                    	    10.06	  $374.53	      ---	  $472.32	004	1	0	0.00	    $0.00	Y	
O	33534	CABG ARTERIAL TWO                       	    11.31	  $421.07	      ---	  $531.00	004	1	0	0.00	    $0.00	Y	
K	33534	CABG ARTERIAL TWO                       	    56.54	 $2104.98	      ---	 $2654.55	004	1	0	0.00	    $0.00	Y	
K	33535	CABG ARTERIAL THREE                     	    62.79	 $2337.67	      ---	 $2947.99	004	1	0	0.00	    $0.00	Y	
O	33535	CABG ARTERIAL THREE                     	    12.56	  $467.61	      ---	  $589.69	004	1	0	0.00	    $0.00	Y	
O	33536	CABG ARTERIAL FOUR OR MORE              	    13.81	  $514.15	      ---	  $648.38	004	1	0	0.00	    $0.00	Y	
K	33536	CABG ARTERIAL FOUR OR MORE              	    69.06	 $2571.10	      ---	 $3242.37	004	1	0	0.00	    $0.00	Y	
K	33542	REMOVAL OF HEART LESION                 	    52.68	 $1961.28	      ---	 $2473.33	004	1	0	0.00	    $0.00	Y	
O	33542	REMOVAL OF HEART LESION                 	    10.54	  $392.40	      ---	  $494.85	004	1	0	0.00	    $0.00	Y	
O	33545	REPAIR OF HEART DAMAGE                  	    12.56	  $467.61	      ---	  $589.69	004	1	0	0.00	    $0.00	Y	
K	33545	REPAIR OF HEART DAMAGE                  	    62.78	 $2337.30	      ---	 $2947.52	004	1	0	0.00	    $0.00	Y	
K	33548	RESTORE/REMODEL VENTRICLE               	    51.06	 $1900.96	      ---	 $2397.27	004	1	0	0.00	    $0.00	Y	
O	33548	RESTORE/REMODEL VENTRICLE               	    10.21	  $380.12	      ---	  $479.36	004	1	0	0.00	    $0.00	Y	
O	33572	OPEN CORONARY ENDARTERECTOMY            	     1.47	   $54.73	      ---	   $69.02	004	1	0	0.00	    $0.00	Y	
K	33572	OPEN CORONARY ENDARTERECTOMY            	     7.36	  $274.01	      ---	  $345.55	004	1	0	0.00	    $0.00	Y	
K	33600	CLOSURE OF VALVE                        	    40.57	 $1510.42	      ---	 $1904.76	004	1	0	0.00	    $0.00	Y	
O	33600	CLOSURE OF VALVE                        	     8.11	  $301.94	      ---	  $380.76	004	1	0	0.00	    $0.00	Y	
O	33602	CLOSURE OF VALVE                        	     7.84	  $291.88	      ---	  $368.09	004	1	0	0.00	    $0.00	Y	
K	33602	CLOSURE OF VALVE                        	    39.18	 $1458.67	      ---	 $1839.50	004	1	0	0.00	    $0.00	Y	
K	33606	ANASTOMOSIS/ARTERY-AORTA                	    41.95	 $1561.80	      ---	 $1969.55	004	1	0	0.00	    $0.00	Y	
O	33606	ANASTOMOSIS/ARTERY-AORTA                	     8.39	  $312.36	      ---	  $393.91	004	1	0	0.00	    $0.00	Y	
O	33608	REPAIR ANOMALY W/CONDUIT                	     8.59	  $319.81	      ---	  $403.30	004	1	0	0.00	    $0.00	Y	
K	33608	REPAIR ANOMALY W/CONDUIT                	    42.95	 $1599.03	      ---	 $2016.50	004	1	0	0.00	    $0.00	Y	
K	33610	REPAIR BY ENLARGEMENT                   	    41.95	 $1561.80	      ---	 $1969.55	004	1	0	0.00	    $0.00	Y	
O	33610	REPAIR BY ENLARGEMENT                   	     8.39	  $312.36	      ---	  $393.91	004	1	0	0.00	    $0.00	Y	
O	33611	REPAIR DOUBLE VENTRICLE                 	     8.94	  $332.84	      ---	  $419.73	004	1	0	0.00	    $0.00	Y	
K	33611	REPAIR DOUBLE VENTRICLE                 	    44.68	 $1663.44	      ---	 $2097.73	004	1	0	0.00	    $0.00	Y	
K	33612	REPAIR DOUBLE VENTRICLE                 	    45.92	 $1709.60	      ---	 $2155.94	004	1	0	0.00	    $0.00	Y	
O	33612	REPAIR DOUBLE VENTRICLE                 	     9.19	  $342.14	      ---	  $431.47	004	1	0	0.00	    $0.00	Y	
O	33615	REPAIR MODIFIED FONTAN                  	     8.73	  $325.02	      ---	  $409.87	004	1	0	0.00	    $0.00	Y	
K	33615	REPAIR MODIFIED FONTAN                  	    43.68	 $1626.21	      ---	 $2050.78	004	1	0	0.00	    $0.00	Y	
K	33617	REPAIR SINGLE VENTRICLE                 	    46.07	 $1715.19	      ---	 $2162.99	004	1	0	0.00	    $0.00	Y	
O	33617	REPAIR SINGLE VENTRICLE                 	     9.22	  $343.26	      ---	  $432.88	004	1	0	0.00	    $0.00	Y	
O	33619	REPAIR SINGLE VENTRICLE                 	    10.14	  $377.51	      ---	  $476.07	004	1	0	0.00	    $0.00	Y	
K	33619	REPAIR SINGLE VENTRICLE                 	    50.67	 $1886.44	      ---	 $2378.96	004	1	0	0.00	    $0.00	Y	
K	33620	APPLY R&L PULM ART BANDS                	    37.51	 $1396.50	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33620	APPLY R&L PULM ART BANDS                	     7.50	  $279.23	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33621	TRANSTHOR CATH FOR STENT                	     4.05	  $150.78	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33621	TRANSTHOR CATH FOR STENT                	    20.24	  $753.54	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33622	REDO COMPL CARDIAC ANOMALY              	    79.23	 $2949.73	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33622	REDO COMPL CARDIAC ANOMALY              	    15.85	  $590.10	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33641	REPAIR HEART SEPTUM DEFECT              	     9.20	  $342.52	      ---	  $431.94	004	1	0	0.00	    $0.00	Y	
K	33641	REPAIR HEART SEPTUM DEFECT              	    46.00	 $1712.58	      ---	 $2159.70	004	1	0	0.00	    $0.00	Y	
K	33645	REVISION OF HEART VEINS                 	    37.60	 $1399.85	      ---	 $1765.32	004	1	0	0.00	    $0.00	Y	
O	33645	REVISION OF HEART VEINS                 	     7.48	  $278.48	      ---	  $351.19	004	1	0	0.00	    $0.00	Y	
O	33647	REPAIR HEART SEPTUM DEFECTS             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	33647	REPAIR HEART SEPTUM DEFECTS             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	33660	REPAIR OF HEART DEFECTS                 	    50.00	 $1861.50	      ---	 $2347.50	004	1	0	0.00	    $0.00	Y	
O	33660	REPAIR OF HEART DEFECTS                 	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
O	33665	REPAIR OF HEART DEFECTS                 	     9.35	  $348.10	      ---	  $438.98	004	1	0	0.00	    $0.00	Y	
K	33665	REPAIR OF HEART DEFECTS                 	    46.76	 $1740.87	      ---	 $2195.38	004	1	0	0.00	    $0.00	Y	
K	33670	REPAIR OF HEART CHAMBERS                	    49.80	 $1854.05	      ---	 $2338.11	004	1	0	0.00	    $0.00	Y	
O	33670	REPAIR OF HEART CHAMBERS                	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
O	33675	CLOSE MULT VSD                          	    10.20	  $379.75	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33675	CLOSE MULT VSD                          	    51.02	 $1899.47	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33676	CLOSE MULT VSD W/RESECTION              	    51.57	 $1919.95	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33676	CLOSE MULT VSD W/RESECTION              	    10.31	  $383.84	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33677	CL MULT VSD W/REM PUL BAND              	    10.72	  $399.11	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33677	CL MULT VSD W/REM PUL BAND              	    53.60	 $1995.53	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33681	CLOSURE 1 VSD W/WO PATCH                	    37.60	 $1399.85	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33681	CLOSURE 1 VSD W/WO PATCH                	     7.48	  $278.48	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33684	CLSR 1 VSD W/WO PATCH W/VLVT            	     9.30	  $346.24	      ---	  $436.64	004	1	0	0.00	    $0.00	Y	
K	33684	CLSR 1 VSD W/WO PATCH W/VLVT            	    46.49	 $1730.82	      ---	 $2182.71	004	1	0	0.00	    $0.00	Y	
K	33688	CLSR 1VSD W/WO PTCH RMVL BND            	    42.00	 $1563.66	      ---	 $1971.90	004	1	0	0.00	    $0.00	Y	
O	33688	CLSR 1VSD W/WO PTCH RMVL BND            	     8.40	  $312.73	      ---	  $394.38	004	1	0	0.00	    $0.00	Y	
O	33690	BANDING PULMONARY ARTERY                	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
K	33690	BANDING PULMONARY ARTERY                	    27.18	 $1011.91	      ---	 $1276.10	004	1	0	0.00	    $0.00	Y	
K	33692	COMP RPR TOF WO PULM ATRESIA            	    50.00	 $1861.50	      ---	 $2347.50	004	1	0	0.00	    $0.00	Y	
O	33692	COMP RPR TOF WO PULM ATRESIA            	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
O	33694	CMP RPR TOF WO PLM ATRS PTCH            	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
K	33694	CMP RPR TOF WO PLM ATRS PTCH            	    50.00	 $1861.50	      ---	 $2347.50	004	1	0	0.00	    $0.00	Y	
K	33697	COMPL RPR TOF W/PULM ATRESIA            	    46.07	 $1715.19	      ---	 $2162.99	004	1	0	0.00	    $0.00	Y	
O	33697	COMPL RPR TOF W/PULM ATRESIA            	     9.22	  $343.26	      ---	  $432.88	004	1	0	0.00	    $0.00	Y	
O	33702	REPAIR OF HEART DEFECTS                 	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
K	33702	REPAIR OF HEART DEFECTS                 	    50.00	 $1861.50	      ---	 $2347.50	004	1	0	0.00	    $0.00	Y	
K	33710	REPAIR OF HEART DEFECTS                 	    50.00	 $1861.50	      ---	 $2347.50	004	1	0	0.00	    $0.00	Y	
O	33710	REPAIR OF HEART DEFECTS                 	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
O	33720	REPAIR OF HEART DEFECT                  	     8.69	  $323.53	      ---	  $408.00	004	1	0	0.00	    $0.00	Y	
K	33720	REPAIR OF HEART DEFECT                  	    43.43	 $1616.90	      ---	 $2039.04	004	1	0	0.00	    $0.00	Y	
K	33724	REPAIR VENOUS ANOMALY                   	    35.65	 $1327.25	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33724	REPAIR VENOUS ANOMALY                   	     7.13	  $265.45	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33726	REPAIR PUL VENOUS STENOSIS              	     9.40	  $349.96	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33726	REPAIR PUL VENOUS STENOSIS              	    47.01	 $1750.18	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33730	REPAIR HEART-VEIN DEFECT(S)             	    50.00	 $1861.50	      ---	 $2347.50	004	1	0	0.00	    $0.00	Y	
O	33730	REPAIR HEART-VEIN DEFECT(S)             	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
O	33732	REPAIR HEART-VEIN DEFECT                	     7.76	  $288.90	      ---	  $364.33	004	1	0	0.00	    $0.00	Y	
K	33732	REPAIR HEART-VEIN DEFECT                	    38.77	 $1443.41	      ---	 $1820.25	004	1	0	0.00	    $0.00	Y	
K	33735	REVISION OF HEART CHAMBER               	    33.98	 $1265.08	      ---	 $1595.36	004	1	0	0.00	    $0.00	Y	
O	33735	REVISION OF HEART CHAMBER               	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
O	33736	REVISION OF HEART CHAMBER               	     5.70	  $212.21	      ---	  $267.62	004	1	0	0.00	    $0.00	Y	
K	33736	REVISION OF HEART CHAMBER               	    28.51	 $1061.43	      ---	 $1338.54	004	1	0	0.00	    $0.00	Y	
K	33741	TAS CONGENITAL CAR ANOMAL               	    16.85	  $627.33	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33741	TAS CONGENITAL CAR ANOMAL               	     3.37	  $125.47	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33745	TIS CGEN CAR ANOMAL 1ST SHNT            	     4.78	  $177.96	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33745	TIS CGEN CAR ANOMAL 1ST SHNT            	    23.92	  $890.54	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33746	TIS CGEN CAR ANOMAL EA ADDL             	     9.48	  $352.94	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33746	TIS CGEN CAR ANOMAL EA ADDL             	     1.89	   $70.36	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33750	SHUNT SUBCLAVIAN TO PULM ART            	     6.15	  $228.96	      ---	  $288.74	004	1	0	0.00	    $0.00	Y	
K	33750	SHUNT SUBCLAVIAN TO PULM ART            	    30.76	 $1145.19	      ---	 $1444.18	004	1	0	0.00	    $0.00	Y	
K	33755	SHUNT AS-AORT TO PULM ART               	    30.10	 $1120.62	      ---	 $1413.20	004	1	0	0.00	    $0.00	Y	
O	33755	SHUNT AS-AORT TO PULM ART               	     6.02	  $224.12	      ---	  $282.64	004	1	0	0.00	    $0.00	Y	
O	33762	SHUNT DESC AORTA TO PULM ART            	     6.21	  $231.20	      ---	  $291.56	004	1	0	0.00	    $0.00	Y	
K	33762	SHUNT DESC AORTA TO PULM ART            	    31.04	 $1155.62	      ---	 $1457.33	004	1	0	0.00	    $0.00	Y	
K	33764	SHUNT CENTRAL W/PROSTC GRAFT            	    31.88	 $1186.89	      ---	 $1496.77	004	1	0	0.00	    $0.00	Y	
O	33764	SHUNT CENTRAL W/PROSTC GRAFT            	     6.38	  $237.53	      ---	  $299.54	004	1	0	0.00	    $0.00	Y	
O	33766	SHUNT SUPR V/C P-ART 1 LUNG             	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
K	33766	SHUNT SUPR V/C P-ART 1 LUNG             	    33.98	 $1265.08	      ---	 $1595.36	004	1	0	0.00	    $0.00	Y	
K	33767	SHUNT SUPR V/C P-ART BTH LNG            	    33.51	 $1247.58	      ---	 $1573.29	004	1	0	0.00	    $0.00	Y	
O	33767	SHUNT SUPR V/C P-ART BTH LNG            	     6.70	  $249.44	      ---	  $314.57	004	1	0	0.00	    $0.00	Y	
O	33768	ANAST CAVOPULM SEC SUP V/C              	     1.91	   $71.11	      ---	   $89.67	004	1	0	0.00	    $0.00	Y	
K	33768	ANAST CAVOPULM SEC SUP V/C              	     9.53	  $354.80	      ---	  $447.43	004	1	0	0.00	    $0.00	Y	
K	33770	RPR TGA W/O SURG ENLGMNT VSD            	    45.83	 $1706.25	      ---	 $2151.72	004	1	0	0.00	    $0.00	Y	
O	33770	RPR TGA W/O SURG ENLGMNT VSD            	     9.16	  $341.03	      ---	  $430.06	004	1	0	0.00	    $0.00	Y	
O	33771	RPR TGA W/SURG ENLGMNT VSD              	     8.93	  $332.46	      ---	  $419.26	004	1	0	0.00	    $0.00	Y	
K	33771	RPR TGA W/SURG ENLGMNT VSD              	    44.66	 $1662.69	      ---	 $2096.79	004	1	0	0.00	    $0.00	Y	
K	33774	RPR TGA ATRIAL BAFFLE PX                	    47.03	 $1750.93	      ---	 $2208.06	004	1	0	0.00	    $0.00	Y	
O	33774	RPR TGA ATRIAL BAFFLE PX                	     9.41	  $350.33	      ---	  $441.80	004	1	0	0.00	    $0.00	Y	
O	33775	RPR TGA ATR BFL RMVL PLM BND            	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
K	33775	RPR TGA ATR BFL RMVL PLM BND            	    49.80	 $1854.05	      ---	 $2338.11	004	1	0	0.00	    $0.00	Y	
K	33776	RPR TGA ATR BFL CLSR VSD                	    52.10	 $1939.68	      ---	 $2446.10	004	1	0	0.00	    $0.00	Y	
O	33776	RPR TGA ATR BFL CLSR VSD                	    10.40	  $387.19	      ---	  $488.28	004	1	0	0.00	    $0.00	Y	
O	33777	RPR TGA BFL RPR SBPULM OBSTR            	    10.40	  $387.19	      ---	  $488.28	004	1	0	0.00	    $0.00	Y	
K	33777	RPR TGA BFL RPR SBPULM OBSTR            	    52.10	 $1939.68	      ---	 $2446.10	004	1	0	0.00	    $0.00	Y	
K	33778	RPR TGA AORTIC PULM ART RCNS            	    53.34	 $1985.85	      ---	 $2504.31	004	1	0	0.00	    $0.00	Y	
O	33778	RPR TGA AORTIC PULM ART RCNS            	    10.71	  $398.73	      ---	  $502.83	004	1	0	0.00	    $0.00	Y	
O	33779	RPR TGA RCNSTJ RMVL PLM BND             	    10.62	  $395.38	      ---	  $498.61	004	1	0	0.00	    $0.00	Y	
K	33779	RPR TGA RCNSTJ RMVL PLM BND             	    53.10	 $1976.91	      ---	 $2493.05	004	1	0	0.00	    $0.00	Y	
K	33780	RPR TGA RCNSTJ CLSR VSD                 	    56.40	 $2099.77	      ---	 $2647.98	004	1	0	0.00	    $0.00	Y	
O	33780	RPR TGA RCNSTJ CLSR VSD                 	    11.28	  $419.95	      ---	  $529.60	004	1	0	0.00	    $0.00	Y	
O	33781	RPR TGA RCNSTJ RPR SBPL OBST            	    11.28	  $419.95	      ---	  $529.60	004	1	0	0.00	    $0.00	Y	
K	33781	RPR TGA RCNSTJ RPR SBPL OBST            	    56.40	 $2099.77	      ---	 $2647.98	004	1	0	0.00	    $0.00	Y	
K	33782	NIKAIDOH PROC                           	    71.76	 $2671.62	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33782	NIKAIDOH PROC                           	    14.35	  $534.25	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33783	NIKAIDOH PROC W/OSTIA IMPLT             	    15.51	  $577.44	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33783	NIKAIDOH PROC W/OSTIA IMPLT             	    77.54	 $2886.81	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33786	REPAIR ARTERIAL TRUNK                   	    49.80	 $1854.05	      ---	 $2338.11	004	1	0	0.00	    $0.00	Y	
O	33786	REPAIR ARTERIAL TRUNK                   	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
O	33788	REVISION OF PULMONARY ARTERY            	     6.57	  $244.60	      ---	  $308.46	004	1	0	0.00	    $0.00	Y	
K	33788	REVISION OF PULMONARY ARTERY            	    32.85	 $1223.01	      ---	 $1542.31	004	1	0	0.00	    $0.00	Y	
K	33800	AORTIC SUSPENSION                       	    24.63	  $916.97	      ---	 $1156.38	004	1	0	0.00	    $0.00	Y	
O	33800	AORTIC SUSPENSION                       	     4.93	  $183.54	      ---	  $231.46	004	1	0	0.00	    $0.00	Y	
O	33802	DIVISION ABERRANT VESSEL                	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	33802	DIVISION ABERRANT VESSEL                	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
K	33803	DIV ABERRANT VSL W/REANAST              	    28.15	 $1048.02	      ---	 $1321.64	004	1	0	0.00	    $0.00	Y	
O	33803	DIV ABERRANT VSL W/REANAST              	     5.65	  $210.35	      ---	  $265.27	004	1	0	0.00	    $0.00	Y	
O	33814	OBLTRJ A-PULM SEP DEF W/BYP             	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
K	33814	OBLTRJ A-PULM SEP DEF W/BYP             	    50.00	 $1861.50	      ---	 $2347.50	004	1	0	0.00	    $0.00	Y	
K	33820	REPAIR PDA BY LIGATION                  	    18.80	  $699.92	      ---	  $882.66	004	1	0	0.00	    $0.00	Y	
O	33820	REPAIR PDA BY LIGATION                  	     3.74	  $139.24	      ---	  $175.59	004	1	0	0.00	    $0.00	Y	
O	33822	REPAIR PDA DIV<18 YEARS                 	     5.08	  $189.13	      ---	  $238.51	004	1	0	0.00	    $0.00	Y	
K	33822	REPAIR PDA DIV<18 YEARS                 	    25.41	  $946.01	      ---	 $1193.00	004	1	0	0.00	    $0.00	Y	
K	33824	REPAIR PDA DIV 18 YRS&OLDER             	    36.00	 $1340.28	      ---	 $1690.20	004	1	0	0.00	    $0.00	Y	
O	33824	REPAIR PDA DIV 18 YRS&OLDER             	     7.20	  $268.06	      ---	  $338.04	004	1	0	0.00	    $0.00	Y	
O	33840	EXC COA W/DIRECT ANASTOMOSIS            	     8.00	  $297.84	      ---	  $375.60	004	1	0	0.00	    $0.00	Y	
K	33840	EXC COA W/DIRECT ANASTOMOSIS            	    40.00	 $1489.20	      ---	 $1878.00	004	1	0	0.00	    $0.00	Y	
K	33845	EXCISION COA W/GRAFT                    	    37.60	 $1399.85	      ---	 $1765.32	004	1	0	0.00	    $0.00	Y	
O	33845	EXCISION COA W/GRAFT                    	     7.48	  $278.48	      ---	  $351.19	004	1	0	0.00	    $0.00	Y	
O	33851	EXC COA RPR L SUBCL ART/PRST            	     7.92	  $294.86	      ---	  $371.84	004	1	0	0.00	    $0.00	Y	
K	33851	EXC COA RPR L SUBCL ART/PRST            	    39.62	 $1475.05	      ---	 $1860.16	004	1	0	0.00	    $0.00	Y	
K	33852	RPR HYPOPL A-ARCH WO BYP                	    37.60	 $1399.85	      ---	 $1765.32	004	1	0	0.00	    $0.00	Y	
O	33852	RPR HYPOPL A-ARCH WO BYP                	     7.48	  $278.48	      ---	  $351.19	004	1	0	0.00	    $0.00	Y	
O	33853	RPR HYPOPL A-ARCH W/BYP                 	     8.68	  $323.16	      ---	  $407.53	004	1	0	0.00	    $0.00	Y	
K	33853	RPR HYPOPL A-ARCH W/BYP                 	    43.36	 $1614.29	      ---	 $2035.75	004	1	0	0.00	    $0.00	Y	
K	33858	AS-AORT GRF F/AORTIC DSJ                	    77.09	 $2870.06	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33858	AS-AORT GRF F/AORTIC DSJ                	    15.41	  $573.71	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33859	AS-AORT GRF F/DS OTH/THN DSJ            	    11.08	  $412.51	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33859	AS-AORT GRF F/DS OTH/THN DSJ            	    55.43	 $2063.66	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33863	ASCENDING AORTIC GRAFT                  	    54.46	 $2027.55	      ---	 $2556.90	004	1	0	0.00	    $0.00	Y	
O	33863	ASCENDING AORTIC GRAFT                  	    10.89	  $405.43	      ---	  $511.29	004	1	0	0.00	    $0.00	Y	
O	33864	ASCENDING AORTIC GRAFT                  	    13.18	  $490.69	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33864	ASCENDING AORTIC GRAFT                  	    65.91	 $2453.83	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33866	AORTIC HEMIARCH GRAFT                   	    23.17	  $862.62	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33866	AORTIC HEMIARCH GRAFT                   	     4.63	  $172.37	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33871	TRANSVRS A-ARCH GRF HYPTHRM             	    14.81	  $551.38	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33871	TRANSVRS A-ARCH GRF HYPTHRM             	    74.07	 $2757.63	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33875	THORACIC AORTIC GRAFT                   	    47.00	 $1749.81	      ---	 $2206.65	004	1	0	0.00	    $0.00	Y	
O	33875	THORACIC AORTIC GRAFT                   	     9.40	  $349.96	      ---	  $441.33	004	1	0	0.00	    $0.00	Y	
O	33877	THORACOABDOMINAL GRAFT                  	    12.45	  $463.51	      ---	  $584.53	004	1	0	0.00	    $0.00	Y	
K	33877	THORACOABDOMINAL GRAFT                  	    62.26	 $2317.94	      ---	 $2923.11	004	1	0	0.00	    $0.00	Y	
K	33880	ENDOVASC TAA REPR INCL SUBCL            	    40.14	 $1494.41	      ---	 $1884.57	004	1	0	0.00	    $0.00	Y	
O	33880	ENDOVASC TAA REPR INCL SUBCL            	     8.03	  $298.96	      ---	  $377.01	004	1	0	0.00	    $0.00	Y	
O	33881	ENDOVASC TAA REPR W/O SUBCL             	     6.90	  $256.89	      ---	  $323.96	004	1	0	0.00	    $0.00	Y	
K	33881	ENDOVASC TAA REPR W/O SUBCL             	    34.52	 $1285.18	      ---	 $1620.71	004	1	0	0.00	    $0.00	Y	
K	33883	INSERT ENDOVASC PROSTH TAA              	    25.51	  $949.74	      ---	 $1197.69	004	1	0	0.00	    $0.00	Y	
O	33883	INSERT ENDOVASC PROSTH TAA              	     5.10	  $189.87	      ---	  $239.45	004	1	0	0.00	    $0.00	Y	
O	33884	ENDOVASC PROSTH TAA ADD-ON              	     1.88	   $69.99	      ---	   $88.27	004	1	0	0.00	    $0.00	Y	
K	33884	ENDOVASC PROSTH TAA ADD-ON              	     9.40	  $349.96	      ---	  $441.33	004	1	0	0.00	    $0.00	Y	
K	33886	ENDOVASC PROSTH DELAYED                 	    22.06	  $821.29	      ---	 $1035.72	004	1	0	0.00	    $0.00	Y	
O	33886	ENDOVASC PROSTH DELAYED                 	     4.41	  $164.18	      ---	  $207.05	004	1	0	0.00	    $0.00	Y	
O	33889	ARTERY TRANSPOSE/ENDOVAS TAA            	     3.75	  $139.61	      ---	  $176.06	004	1	0	0.00	    $0.00	Y	
K	33889	ARTERY TRANSPOSE/ENDOVAS TAA            	    18.74	  $697.69	      ---	  $879.84	004	1	0	0.00	    $0.00	Y	
K	33891	CAR-CAR BP GRFT/ENDOVAS TAA             	    23.94	  $891.29	      ---	 $1123.98	004	1	0	0.00	    $0.00	Y	
O	33891	CAR-CAR BP GRFT/ENDOVAS TAA             	     4.79	  $178.33	      ---	  $224.89	004	1	0	0.00	    $0.00	Y	
O	33894	EVASC ST RPR THRC/AA ACRS BR            	     4.33	  $161.21	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33894	EVASC ST RPR THRC/AA ACRS BR            	    21.69	  $807.52	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33895	EVASC ST RPR THRC/AA X CRSG             	    17.25	  $642.22	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33895	EVASC ST RPR THRC/AA X CRSG             	     3.45	  $128.44	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33897	PERQ TRLUML ANGP NT/RECR COA            	     2.56	   $95.31	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33897	PERQ TRLUML ANGP NT/RECR COA            	    12.84	  $478.03	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33900	PERQ P-ART REVSC 1 NM NT UNI            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33900	PERQ P-ART REVSC 1 NM NT UNI            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33901	PERQ P-ART REVSC 1 NM NT BI             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33901	PERQ P-ART REVSC 1 NM NT BI             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33902	PERQ P-ART REVSC 1 ABNOR UNI            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33902	PERQ P-ART REVSC 1 ABNOR UNI            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33903	PERQ P-ART REVSC 1 ABNOR BI             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33903	PERQ P-ART REVSC 1 ABNOR BI             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33904	PERQ P-ART REVSC EACH ADDL              	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33904	PERQ P-ART REVSC EACH ADDL              	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33910	REMOVE LUNG ARTERY EMBOLI               	     7.70	  $286.67	      ---	  $361.52	004	1	0	0.00	    $0.00	Y	
K	33910	REMOVE LUNG ARTERY EMBOLI               	    38.51	 $1433.73	      ---	 $1808.04	004	1	0	0.00	    $0.00	Y	
K	33915	REMOVE LUNG ARTERY EMBOLI               	    29.70	 $1105.73	      ---	 $1394.42	004	1	0	0.00	    $0.00	Y	
O	33915	REMOVE LUNG ARTERY EMBOLI               	     5.94	  $221.15	      ---	  $278.88	004	1	0	0.00	    $0.00	Y	
O	33916	SURGERY OF GREAT VESSEL                 	     7.70	  $286.67	      ---	  $361.52	004	1	0	0.00	    $0.00	Y	
K	33916	SURGERY OF GREAT VESSEL                 	    38.51	 $1433.73	      ---	 $1808.04	004	1	0	0.00	    $0.00	Y	
K	33917	REPAIR PULMONARY ARTERY                 	    33.51	 $1247.58	      ---	 $1573.29	004	1	0	0.00	    $0.00	Y	
O	33917	REPAIR PULMONARY ARTERY                 	     6.70	  $249.44	      ---	  $314.57	004	1	0	0.00	    $0.00	Y	
O	33920	REPAIR PULMONARY ATRESIA                	     8.80	  $327.62	      ---	  $413.16	004	1	0	0.00	    $0.00	Y	
K	33920	REPAIR PULMONARY ATRESIA                	    44.01	 $1638.49	      ---	 $2066.27	004	1	0	0.00	    $0.00	Y	
K	33922	TRANSECT PULMONARY ARTERY               	    32.19	 $1198.43	      ---	 $1511.32	004	1	0	0.00	    $0.00	Y	
O	33922	TRANSECT PULMONARY ARTERY               	     6.43	  $239.39	      ---	  $301.89	004	1	0	0.00	    $0.00	Y	
O	33924	REMOVE PULMONARY SHUNT                  	     1.39	   $51.75	      ---	   $65.26	004	1	0	0.00	    $0.00	Y	
K	33924	REMOVE PULMONARY SHUNT                  	     6.94	  $258.38	      ---	  $325.83	004	1	0	0.00	    $0.00	Y	
K	33925	RPR PUL ART UNIFOCAL W/O CPB            	    39.58	 $1473.56	      ---	 $1858.28	004	1	0	0.00	    $0.00	Y	
O	33925	RPR PUL ART UNIFOCAL W/O CPB            	     7.92	  $294.86	      ---	  $371.84	004	1	0	0.00	    $0.00	Y	
O	33926	REPR PUL ART UNIFOCAL W/CPB             	    10.66	  $396.87	      ---	  $500.49	004	1	0	0.00	    $0.00	Y	
K	33926	REPR PUL ART UNIFOCAL W/CPB             	    53.30	 $1984.36	      ---	 $2502.44	004	1	0	0.00	    $0.00	Y	
K	33935	TRANSPLANTATION HEART/LUNG              	    91.83	 $3418.83	      ---	 $4311.42	004	1	0	0.00	    $0.00	Y	
O	33935	TRANSPLANTATION HEART/LUNG              	    18.37	  $683.92	      ---	  $862.47	004	1	0	0.00	    $0.00	Y	
O	33945	TRANSPLANTATION OF HEART                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	33945	TRANSPLANTATION OF HEART                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	33946	ECMO/ECLS INITIATION VENOUS             	     5.70	  $212.21	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33947	ECMO/ECLS INITIATION ARTERY             	     6.29	  $234.18	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33948	ECMO/ECLS DAILY MGMT-VENOUS             	     4.51	  $167.91	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33949	ECMO/ECLS DAILY MGMT ARTERY             	     4.39	  $163.44	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33951	ECMO/ECLS INSJ PRPH CANNULA             	     8.12	  $302.31	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33952	ECMO/ECLS INSJ PRPH CANNULA             	     7.89	  $293.74	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33953	ECMO/ECLS INSJ PRPH CANNULA             	     9.07	  $337.68	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33954	ECMO/ECLS INSJ PRPH CANNULA             	     8.81	  $328.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33955	ECMO/ECLS INSJ CTR CANNULA              	    16.43	  $611.69	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33956	ECMO/ECLS INSJ CTR CANNULA              	    15.44	  $574.83	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33957	ECMO/ECLS REPOS PERPH CNULA             	     3.64	  $135.52	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33958	ECMO/ECLS REPOS PERPH CNULA             	     3.51	  $130.68	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33959	ECMO/ECLS REPOS PERPH CNULA             	     4.64	  $172.75	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33962	ECMO/ECLS REPOS PERPH CNULA             	     4.32	  $160.83	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33963	ECMO/ECLS REPOS PERPH CNULA             	     9.26	  $344.75	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33964	ECMO/ECLS REPOS PERPH CNULA             	     9.44	  $351.45	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33965	ECMO/ECLS RMVL PERPH CANNULA            	     3.65	  $135.89	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33966	ECMO/ECLS RMVL PRPH CANNULA             	     4.35	  $161.95	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33967	INSERT I-AORT PERCUT DEVICE             	     5.82	  $216.68	      ---	  $273.25	004	1	0	0.00	    $0.00	Y	
K	33968	REMOVE AORTIC ASSIST DEVICE             	     0.72	   $26.81	      ---	   $33.80	004	1	0	0.00	    $0.00	Y	
O	33968	REMOVE AORTIC ASSIST DEVICE             	     0.14	    $5.21	      ---	    $6.57	004	1	0	0.00	    $0.00	Y	
K	33969	ECMO/ECLS RMVL PERPH CANNULA            	     5.39	  $200.67	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33970	AORTIC CIRCULATION ASSIST               	    12.50	  $465.38	      ---	  $586.88	004	1	0	0.00	    $0.00	Y	
O	33970	AORTIC CIRCULATION ASSIST               	     2.50	   $93.08	      ---	  $117.38	004	1	0	0.00	    $0.00	Y	
O	33971	AORTIC CIRCULATION ASSIST               	     3.53	  $131.42	      ---	  $165.73	004	1	0	0.00	    $0.00	Y	
K	33971	AORTIC CIRCULATION ASSIST               	    17.66	  $657.48	      ---	  $829.14	004	1	0	0.00	    $0.00	Y	
K	33973	INSERT BALLOON DEVICE                   	    12.35	  $459.79	      ---	  $579.83	004	1	0	0.00	    $0.00	Y	
O	33973	INSERT BALLOON DEVICE                   	     2.47	   $91.96	      ---	  $115.97	004	1	0	0.00	    $0.00	Y	
O	33974	REMOVE INTRA-AORTIC BALLOON             	     2.88	  $107.22	      ---	  $135.22	004	1	0	0.00	    $0.00	Y	
K	33974	REMOVE INTRA-AORTIC BALLOON             	    14.38	  $535.37	      ---	  $675.14	004	1	0	0.00	    $0.00	Y	
K	33975	IMPLANT VENTRICULAR DEVICE              	    27.92	 $1039.46	      ---	 $1310.84	004	1	0	0.00	    $0.00	Y	
O	33975	IMPLANT VENTRICULAR DEVICE              	     5.58	  $207.74	      ---	  $261.98	004	1	0	0.00	    $0.00	Y	
O	33976	IMPLANT VENTRICULAR DEVICE              	     7.55	  $281.09	      ---	  $354.47	004	1	0	0.00	    $0.00	Y	
K	33976	IMPLANT VENTRICULAR DEVICE              	    37.73	 $1404.69	      ---	 $1771.42	004	1	0	0.00	    $0.00	Y	
K	33977	REMOVE VENTRICULAR DEVICE               	    24.41	  $908.78	      ---	 $1146.05	004	1	0	0.00	    $0.00	Y	
O	33977	REMOVE VENTRICULAR DEVICE               	     4.88	  $181.68	      ---	  $229.12	004	1	0	0.00	    $0.00	Y	
O	33978	REMOVE VENTRICULAR DEVICE               	     5.58	  $207.74	      ---	  $261.98	004	1	0	0.00	    $0.00	Y	
K	33978	REMOVE VENTRICULAR DEVICE               	    27.92	 $1039.46	      ---	 $1310.84	004	1	0	0.00	    $0.00	Y	
K	33979	INSERT INTRACORPOREAL DEVICE            	    27.92	 $1039.46	      ---	 $1310.84	004	1	0	0.00	    $0.00	Y	
O	33979	INSERT INTRACORPOREAL DEVICE            	     5.58	  $207.74	      ---	  $261.98	004	1	0	0.00	    $0.00	Y	
K	33980	REMOVE INTRACORPOREAL DEVICE            	    27.92	 $1039.46	      ---	 $1310.84	004	1	0	0.00	    $0.00	Y	
K	33981	REPLACE VAD PUMP EXT                    	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33981	REPLACE VAD PUMP EXT                    	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33982	REPLACE VAD INTRA W/O BP                	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33982	REPLACE VAD INTRA W/O BP                	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33983	REPLACE VAD INTRA W/BP                  	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33983	REPLACE VAD INTRA W/BP                  	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33984	ECMO/ECLS RMVL PRPH CANNULA             	     5.24	  $195.09	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33985	ECMO/ECLS RMVL CTR CANNULA              	    10.14	  $377.51	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33986	ECMO/ECLS RMVL CTR CANNULA              	     9.55	  $355.55	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33987	ARTERY EXPOS/GRAFT ARTERY               	     3.83	  $142.59	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33988	INSERTION OF LEFT HEART VENT            	    14.25	  $530.53	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33989	REMOVAL OF LEFT HEART VENT              	     9.06	  $337.30	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33990	INSJ PERQ VAD L HRT ARTERIAL            	     9.43	  $351.08	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33990	INSJ PERQ VAD L HRT ARTERIAL            	     1.88	   $69.99	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33991	INSJ PERQ VAD L HRT ARTL&VEN            	     2.74	  $102.01	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33991	INSJ PERQ VAD L HRT ARTL&VEN            	    13.74	  $511.54	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33992	RMVL PERQ LEFT HEART VAD                	     4.46	  $166.05	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33992	RMVL PERQ LEFT HEART VAD                	     0.89	   $33.13	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33993	REPOSG PERQ R/L HRT VAD                 	     0.78	   $29.04	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33993	REPOSG PERQ R/L HRT VAD                 	     3.92	  $145.94	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33995	INSJ PERQ VAD R HRT VENOUS              	     8.11	  $301.94	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33995	INSJ PERQ VAD R HRT VENOUS              	     1.62	   $60.31	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	33997	RMVL PERQ RIGHT HEART VAD               	     0.72	   $26.81	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33997	RMVL PERQ RIGHT HEART VAD               	     3.61	  $134.40	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	33999	UNLISTED PX CARDIAC SURGERY             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	33999	UNLISTED PX CARDIAC SURGERY             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	34001	REMOVAL OF ARTERY CLOT                  	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
K	34001	REMOVAL OF ARTERY CLOT                  	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
K	34051	REMOVAL OF ARTERY CLOT                  	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
O	34051	REMOVAL OF ARTERY CLOT                  	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
O	34101	REMOVAL OF ARTERY CLOT                  	     2.80	  $104.24	      ---	  $131.46	004	1	0	0.00	    $0.00	Y	
K	34101	REMOVAL OF ARTERY CLOT                  	    14.00	  $521.22	      ---	  $657.30	004	1	0	0.00	    $0.00	Y	
K	34111	REMOVAL OF ARM ARTERY CLOT              	    14.00	  $521.22	      ---	  $657.30	004	1	0	0.00	    $0.00	Y	
O	34111	REMOVAL OF ARM ARTERY CLOT              	     2.80	  $104.24	      ---	  $131.46	004	1	0	0.00	    $0.00	Y	
O	34151	REMOVAL OF ARTERY CLOT                  	     4.41	  $164.18	      ---	  $207.05	004	1	0	0.00	    $0.00	Y	
K	34151	REMOVAL OF ARTERY CLOT                  	    22.07	  $821.67	      ---	 $1036.19	004	1	0	0.00	    $0.00	Y	
K	34201	REMOVAL OF ARTERY CLOT                  	    14.00	  $521.22	      ---	  $657.30	004	1	0	0.00	    $0.00	Y	
O	34201	REMOVAL OF ARTERY CLOT                  	     2.80	  $104.24	      ---	  $131.46	004	1	0	0.00	    $0.00	Y	
O	34203	REMOVAL OF LEG ARTERY CLOT              	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
K	34203	REMOVAL OF LEG ARTERY CLOT              	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
K	34401	REMOVAL OF VEIN CLOT                    	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	34401	REMOVAL OF VEIN CLOT                    	     4.08	  $151.90	      ---	  $191.56	004	1	0	0.00	    $0.00	Y	
O	34421	REMOVAL OF VEIN CLOT                    	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	34421	REMOVAL OF VEIN CLOT                    	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	34451	REMOVAL OF VEIN CLOT                    	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
O	34451	REMOVAL OF VEIN CLOT                    	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
O	34471	REMOVAL OF VEIN CLOT                    	     3.32	  $123.60	      ---	  $155.87	004	1	0	0.00	    $0.00	Y	
K	34471	REMOVAL OF VEIN CLOT                    	    16.60	  $618.02	      ---	  $779.37	004	1	0	0.00	    $0.00	Y	
K	34490	REMOVAL OF VEIN CLOT                    	    16.60	  $618.02	      ---	  $779.37	004	1	0	0.00	    $0.00	Y	
O	34490	REMOVAL OF VEIN CLOT                    	     3.32	  $123.60	      ---	  $155.87	004	1	0	0.00	    $0.00	Y	
O	34501	REPAIR VALVE FEMORAL VEIN               	     3.50	  $130.31	      ---	  $164.33	004	1	0	0.00	    $0.00	Y	
K	34501	REPAIR VALVE FEMORAL VEIN               	    17.49	  $651.15	      ---	  $821.16	004	1	0	0.00	    $0.00	Y	
K	34502	RECONSTRUCT VENA CAVA                   	    35.16	 $1309.01	      ---	 $1650.76	004	1	0	0.00	    $0.00	Y	
O	34502	RECONSTRUCT VENA CAVA                   	     7.03	  $261.73	      ---	  $330.06	004	1	0	0.00	    $0.00	Y	
O	34510	TRANSPOSITION OF VEIN VALVE             	     4.31	  $160.46	      ---	  $202.35	004	1	0	0.00	    $0.00	Y	
K	34510	TRANSPOSITION OF VEIN VALVE             	    21.53	  $801.56	      ---	 $1010.83	004	1	0	0.00	    $0.00	Y	
K	34520	CROSS-OVER VEIN GRAFT                   	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
O	34520	CROSS-OVER VEIN GRAFT                   	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
O	34530	LEG VEIN FUSION                         	     3.40	  $126.58	      ---	  $159.63	004	1	0	0.00	    $0.00	Y	
K	34530	LEG VEIN FUSION                         	    16.99	  $632.54	      ---	  $797.68	004	1	0	0.00	    $0.00	Y	
K	34701	EVASC RPR A-AO NDGFT                    	    27.67	 $1030.15	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	34701	EVASC RPR A-AO NDGFT                    	     5.53	  $205.88	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	34702	EVASC RPR A-AO NDGFT RPT                	     8.26	  $307.52	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	34702	EVASC RPR A-AO NDGFT RPT                	    41.32	 $1538.34	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	34703	EVASC RPR A-UNILAC NDGFT                	    31.02	 $1154.87	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	34703	EVASC RPR A-UNILAC NDGFT                	     6.20	  $230.83	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	34704	EVASC RPR A-UNILAC NDGFT RPT            	    10.32	  $384.21	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	34704	EVASC RPR A-UNILAC NDGFT RPT            	    51.60	 $1921.07	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	34705	EVAC RPR A-BIILIAC NDGFT                	    34.29	 $1276.62	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	34705	EVAC RPR A-BIILIAC NDGFT                	     6.85	  $255.03	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	34706	EVASC RPR A-BIILIAC RPT                 	    10.31	  $383.84	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	34706	EVASC RPR A-BIILIAC RPT                 	    51.55	 $1919.21	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	34707	EVASC RPR ILIO-ILIAC NDGFT              	    25.78	  $959.79	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	34707	EVASC RPR ILIO-ILIAC NDGFT              	     5.15	  $191.73	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	34708	EVASC RPR ILIO-ILIAC RPT                	     8.28	  $308.26	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	34708	EVASC RPR ILIO-ILIAC RPT                	    41.43	 $1542.44	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	34709	PLMT XTN PROSTH EVASC RPR               	     7.20	  $268.06	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	34709	PLMT XTN PROSTH EVASC RPR               	     1.44	   $53.61	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	34710	DLYD PLMT XTN PROSTH 1ST VSL            	     3.61	  $134.40	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	34710	DLYD PLMT XTN PROSTH 1ST VSL            	    18.06	  $672.37	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	34711	DLYD PLMT XTN PROSTH EA ADDL            	     6.64	  $247.21	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	34711	DLYD PLMT XTN PROSTH EA ADDL            	     1.32	   $49.14	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	34712	TCAT DLVR ENHNCD FIXJ DEV               	     3.12	  $116.16	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	34712	TCAT DLVR ENHNCD FIXJ DEV               	    15.64	  $582.28	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	34713	PERQ ACCESS & CLSR FEM ART              	     2.89	  $107.59	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	34713	PERQ ACCESS & CLSR FEM ART              	     0.57	   $21.22	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	34714	OPN FEM ART EXPOS CNDT CRTJ             	     1.21	   $45.05	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	34714	OPN FEM ART EXPOS CNDT CRTJ             	     6.09	  $226.73	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	34715	OPN AX/SUBCLA ART EXPOS                 	     6.81	  $253.54	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	34715	OPN AX/SUBCLA ART EXPOS                 	     1.36	   $50.63	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	34716	OPN AX/SUBCLA ART EXPOS CNDT            	     1.69	   $62.92	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	34716	OPN AX/SUBCLA ART EXPOS CNDT            	     8.48	  $315.71	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	34717	EVASC RPR A-ILIAC NDGFT                 	     9.99	  $371.93	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	34717	EVASC RPR A-ILIAC NDGFT                 	     1.99	   $74.09	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	34718	EVASC RPR N/A A-ILIAC NDGFT             	     5.61	  $208.86	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	34718	EVASC RPR N/A A-ILIAC NDGFT             	    28.05	 $1044.30	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	34808	ENDOVAS ILIAC A DEVICE ADDON            	     5.23	  $194.71	      ---	  $245.55	004	1	0	0.00	    $0.00	Y	
O	34808	ENDOVAS ILIAC A DEVICE ADDON            	     1.05	   $39.09	      ---	   $49.30	004	1	0	0.00	    $0.00	Y	
O	34812	OPN FEM ART EXPOS                       	     1.71	   $63.66	      ---	   $80.28	004	1	0	0.00	    $0.00	Y	
K	34812	OPN FEM ART EXPOS                       	     8.56	  $318.69	      ---	  $401.89	004	1	0	0.00	    $0.00	Y	
K	34813	FEMORAL ENDOVAS GRAFT ADD-ON            	     6.08	  $226.36	      ---	  $285.46	004	1	0	0.00	    $0.00	Y	
O	34813	FEMORAL ENDOVAS GRAFT ADD-ON            	     1.22	   $45.42	      ---	   $57.28	004	1	0	0.00	    $0.00	Y	
O	34820	OPN ILIAC ART EXPOS                     	     2.47	   $91.96	      ---	  $115.97	004	1	0	0.00	    $0.00	Y	
K	34820	OPN ILIAC ART EXPOS                     	    12.36	  $460.16	      ---	  $580.30	004	1	0	0.00	    $0.00	Y	
K	34830	OPEN AORTIC TUBE PROSTH REPR            	    42.95	 $1599.03	      ---	 $2016.50	004	1	0	0.00	    $0.00	Y	
O	34830	OPEN AORTIC TUBE PROSTH REPR            	     8.59	  $319.81	      ---	  $403.30	004	1	0	0.00	    $0.00	Y	
O	34831	OPEN AORTOILIAC PROSTH REPR             	     9.28	  $345.49	      ---	  $435.70	004	1	0	0.00	    $0.00	Y	
K	34831	OPEN AORTOILIAC PROSTH REPR             	    46.42	 $1728.22	      ---	 $2179.42	004	1	0	0.00	    $0.00	Y	
K	34832	OPEN AORTOFEMOR PROSTH REPR             	    46.42	 $1728.22	      ---	 $2179.42	004	1	0	0.00	    $0.00	Y	
O	34832	OPEN AORTOFEMOR PROSTH REPR             	     9.28	  $345.49	      ---	  $435.70	004	1	0	0.00	    $0.00	Y	
O	34833	OPN ILAC ART EXPOS CNDT CRTJ            	     2.02	   $75.20	      ---	   $94.84	004	1	0	0.00	    $0.00	Y	
K	34833	OPN ILAC ART EXPOS CNDT CRTJ            	    10.10	  $376.02	      ---	  $474.20	004	1	0	0.00	    $0.00	Y	
K	34834	OPN BRACH ART EXPOS                     	     4.62	  $172.00	      ---	  $216.91	004	1	0	0.00	    $0.00	Y	
O	34834	OPN BRACH ART EXPOS                     	     0.92	   $34.25	      ---	   $43.19	004	1	0	0.00	    $0.00	Y	
K	34839	PLNNING PT SPEC FENEST GRAFT            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	34841	ENDOVASC VISC AORTA 1 GRAFT             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	34841	ENDOVASC VISC AORTA 1 GRAFT             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	34842	ENDOVASC VISC AORTA 2 GRAFT             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	34842	ENDOVASC VISC AORTA 2 GRAFT             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	34843	ENDOVASC VISC AORTA 3 GRAFT             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	34843	ENDOVASC VISC AORTA 3 GRAFT             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	34844	ENDOVASC VISC AORTA 4 GRAFT             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	34844	ENDOVASC VISC AORTA 4 GRAFT             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	34845	VISC & INFRAREN ABD 1 PROSTH            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	34845	VISC & INFRAREN ABD 1 PROSTH            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	34846	VISC & INFRAREN ABD 2 PROSTH            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	34846	VISC & INFRAREN ABD 2 PROSTH            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	34847	VISC & INFRAREN ABD 3 PROSTH            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	34847	VISC & INFRAREN ABD 3 PROSTH            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	34848	VISC & INFRAREN ABD 4+ PROST            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	34848	VISC & INFRAREN ABD 4+ PROST            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	35001	REPAIR DEFECT OF ARTERY                 	    28.00	 $1042.44	      ---	 $1314.60	004	1	0	0.00	    $0.00	Y	
O	35001	REPAIR DEFECT OF ARTERY                 	     5.60	  $208.49	      ---	  $262.92	004	1	0	0.00	    $0.00	Y	
O	35002	REPAIR ARTERY RUPTURE NECK              	     5.89	  $219.28	      ---	  $276.54	004	1	0	0.00	    $0.00	Y	
K	35002	REPAIR ARTERY RUPTURE NECK              	    29.47	 $1097.17	      ---	 $1383.62	004	1	0	0.00	    $0.00	Y	
K	35005	REPAIR DEFECT OF ARTERY                 	    24.99	  $930.38	      ---	 $1173.28	004	1	0	0.00	    $0.00	Y	
O	35005	REPAIR DEFECT OF ARTERY                 	     5.00	  $186.15	      ---	  $234.75	004	1	0	0.00	    $0.00	Y	
O	35011	REPAIR DEFECT OF ARTERY                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	35011	REPAIR DEFECT OF ARTERY                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	35013	REPAIR ARTERY RUPTURE ARM               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	35013	REPAIR ARTERY RUPTURE ARM               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	35021	REPAIR DEFECT OF ARTERY                 	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
K	35021	REPAIR DEFECT OF ARTERY                 	    30.00	 $1116.90	      ---	 $1408.50	004	1	0	0.00	    $0.00	Y	
K	35022	REPAIR ARTERY RUPTURE CHEST             	    33.77	 $1257.26	      ---	 $1585.50	004	1	0	0.00	    $0.00	Y	
O	35022	REPAIR ARTERY RUPTURE CHEST             	     6.75	  $251.30	      ---	  $316.91	004	1	0	0.00	    $0.00	Y	
O	35045	REPAIR DEFECT OF ARM ARTERY             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	35045	REPAIR DEFECT OF ARM ARTERY             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	35081	REPAIR DEFECT OF ARTERY                 	    40.00	 $1489.20	      ---	 $1878.00	004	1	0	0.00	    $0.00	Y	
O	35081	REPAIR DEFECT OF ARTERY                 	     8.00	  $297.84	      ---	  $375.60	004	1	0	0.00	    $0.00	Y	
O	35082	REPAIR ARTERY RUPTURE AORTA             	     8.61	  $320.55	      ---	  $404.24	004	1	0	0.00	    $0.00	Y	
K	35082	REPAIR ARTERY RUPTURE AORTA             	    43.27	 $1610.94	      ---	 $2031.53	004	1	0	0.00	    $0.00	Y	
K	35091	REPAIR DEFECT OF ARTERY                 	    40.32	 $1501.11	      ---	 $1893.02	004	1	0	0.00	    $0.00	Y	
O	35091	REPAIR DEFECT OF ARTERY                 	     8.06	  $300.07	      ---	  $378.42	004	1	0	0.00	    $0.00	Y	
O	35092	REPAIR ARTERY RUPTURE AORTA             	    10.77	  $400.97	      ---	  $505.65	004	1	0	0.00	    $0.00	Y	
K	35092	REPAIR ARTERY RUPTURE AORTA             	    53.85	 $2004.84	      ---	 $2528.26	004	1	0	0.00	    $0.00	Y	
K	35102	REPAIR DEFECT OF ARTERY                 	    40.00	 $1489.20	      ---	 $1878.00	004	1	0	0.00	    $0.00	Y	
O	35102	REPAIR DEFECT OF ARTERY                 	     8.00	  $297.84	      ---	  $375.60	004	1	0	0.00	    $0.00	Y	
O	35103	REPAIR ARTERY RUPTURE AORTA             	     9.00	  $335.07	      ---	  $422.55	004	1	0	0.00	    $0.00	Y	
K	35103	REPAIR ARTERY RUPTURE AORTA             	    45.00	 $1675.35	      ---	 $2112.75	004	1	0	0.00	    $0.00	Y	
K	35111	REPAIR DEFECT OF ARTERY                 	    24.00	  $893.52	      ---	 $1126.80	004	1	0	0.00	    $0.00	Y	
O	35111	REPAIR DEFECT OF ARTERY                 	     4.80	  $178.70	      ---	  $225.36	004	1	0	0.00	    $0.00	Y	
O	35112	REPAIR ARTERY RUPTURE SPLEEN            	     5.37	  $199.93	      ---	  $252.12	004	1	0	0.00	    $0.00	Y	
K	35112	REPAIR ARTERY RUPTURE SPLEEN            	    26.85	  $999.63	      ---	 $1260.61	004	1	0	0.00	    $0.00	Y	
K	35121	REPAIR DEFECT OF ARTERY                 	    33.71	 $1255.02	      ---	 $1582.68	004	1	0	0.00	    $0.00	Y	
O	35121	REPAIR DEFECT OF ARTERY                 	     6.74	  $250.93	      ---	  $316.44	004	1	0	0.00	    $0.00	Y	
O	35122	REPAIR ARTERY RUPTURE BELLY             	     9.22	  $343.26	      ---	  $432.88	004	1	0	0.00	    $0.00	Y	
K	35122	REPAIR ARTERY RUPTURE BELLY             	    46.08	 $1715.56	      ---	 $2163.46	004	1	0	0.00	    $0.00	Y	
K	35131	REPAIR DEFECT OF ARTERY                 	    32.00	 $1191.36	      ---	 $1502.40	004	1	0	0.00	    $0.00	Y	
O	35131	REPAIR DEFECT OF ARTERY                 	     6.40	  $238.27	      ---	  $300.48	004	1	0	0.00	    $0.00	Y	
O	35132	REPAIR ARTERY RUPTURE GROIN             	     6.39	  $237.90	      ---	  $300.01	004	1	0	0.00	    $0.00	Y	
K	35132	REPAIR ARTERY RUPTURE GROIN             	    31.95	 $1189.50	      ---	 $1500.05	004	1	0	0.00	    $0.00	Y	
K	35141	REPAIR DEFECT OF ARTERY                 	    28.00	 $1042.44	      ---	 $1314.60	004	1	0	0.00	    $0.00	Y	
O	35141	REPAIR DEFECT OF ARTERY                 	     5.60	  $208.49	      ---	  $262.92	004	1	0	0.00	    $0.00	Y	
O	35142	REPAIR ARTERY RUPTURE THIGH             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	35142	REPAIR ARTERY RUPTURE THIGH             	    47.54	 $1769.91	      ---	 $2232.00	004	1	0	0.00	    $0.00	Y	
K	35151	REPAIR DEFECT OF ARTERY                 	    28.00	 $1042.44	      ---	 $1314.60	004	1	0	0.00	    $0.00	Y	
O	35151	REPAIR DEFECT OF ARTERY                 	     5.60	  $208.49	      ---	  $262.92	004	1	0	0.00	    $0.00	Y	
O	35152	REPAIR RUPTD POPLITEAL ART              	     5.00	  $186.15	      ---	  $234.75	004	1	0	0.00	    $0.00	Y	
K	35152	REPAIR RUPTD POPLITEAL ART              	    25.00	  $930.75	      ---	 $1173.75	004	1	0	0.00	    $0.00	Y	
K	35180	RPR CGEN AV FISTULA HEAD&NCK            	    28.00	 $1042.44	      ---	 $1314.60	004	1	0	0.00	    $0.00	Y	
O	35180	RPR CGEN AV FISTULA HEAD&NCK            	     5.60	  $208.49	      ---	  $262.92	004	1	0	0.00	    $0.00	Y	
O	35182	RPR CGEN AV FISTULA THRX&ABD            	     4.88	  $181.68	      ---	  $229.12	004	1	0	0.00	    $0.00	Y	
K	35182	RPR CGEN AV FISTULA THRX&ABD            	    24.42	  $909.16	      ---	 $1146.52	004	1	0	0.00	    $0.00	Y	
K	35184	RPR CGEN AV FISTULA XTR                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	35184	RPR CGEN AV FISTULA XTR                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	35188	RPR ACQ AV FISTULA HEAD&NECK            	     4.22	  $157.11	      ---	  $198.13	004	1	0	0.00	    $0.00	Y	
K	35188	RPR ACQ AV FISTULA HEAD&NECK            	    21.10	  $785.55	      ---	  $990.65	004	1	0	0.00	    $0.00	Y	
K	35189	RPR ACQ AV FISTULA THRX&ABD             	    26.54	  $988.08	      ---	 $1246.05	004	1	0	0.00	    $0.00	Y	
O	35189	RPR ACQ AV FISTULA THRX&ABD             	     5.31	  $197.69	      ---	  $249.30	004	1	0	0.00	    $0.00	Y	
O	35190	REPAIR ACQ AV FISTULA XTR               	     3.43	  $127.70	      ---	  $161.04	004	1	0	0.00	    $0.00	Y	
K	35190	REPAIR ACQ AV FISTULA XTR               	    17.13	  $637.75	      ---	  $804.25	004	1	0	0.00	    $0.00	Y	
K	35201	REPAIR BLOOD VESSEL DIR NECK            	    28.00	 $1042.44	      ---	 $1314.60	004	1	0	0.00	    $0.00	Y	
O	35201	REPAIR BLOOD VESSEL DIR NECK            	     5.60	  $208.49	      ---	  $262.92	004	1	0	0.00	    $0.00	Y	
O	35206	REPAIR BLOOD VESSEL DIR UXTR            	     2.76	  $102.75	      ---	  $129.58	004	1	0	0.00	    $0.00	Y	
K	35206	REPAIR BLOOD VESSEL DIR UXTR            	    13.78	  $513.03	      ---	  $646.97	004	1	0	0.00	    $0.00	Y	
K	35207	RPR BLD VSL DIR HAND FINGER             	    16.38	  $609.83	      ---	  $769.04	004	1	0	0.00	    $0.00	Y	
O	35207	RPR BLD VSL DIR HAND FINGER             	     3.28	  $122.11	      ---	  $154.00	004	1	0	0.00	    $0.00	Y	
O	35211	RPR BLVSL DIR NTRATHRC W/BYP            	     7.30	  $271.78	      ---	  $342.74	004	1	0	0.00	    $0.00	Y	
K	35211	RPR BLVSL DIR NTRATHRC W/BYP            	    36.49	 $1358.52	      ---	 $1713.21	004	1	0	0.00	    $0.00	Y	
K	35216	RPR BLVSL DIR NTRTHRC WO BYP            	    29.42	 $1095.31	      ---	 $1381.27	004	1	0	0.00	    $0.00	Y	
O	35216	RPR BLVSL DIR NTRTHRC WO BYP            	     5.88	  $218.91	      ---	  $276.07	004	1	0	0.00	    $0.00	Y	
O	35221	RPR BLD VSL DIR INTRA-ABDL              	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
K	35221	RPR BLD VSL DIR INTRA-ABDL              	    34.00	 $1265.82	      ---	 $1596.30	004	1	0	0.00	    $0.00	Y	
K	35226	REPAIR BLOOD VESSEL DIR LXTR            	    14.29	  $532.02	      ---	  $670.92	004	1	0	0.00	    $0.00	Y	
O	35226	REPAIR BLOOD VESSEL DIR LXTR            	     2.86	  $106.48	      ---	  $134.28	004	1	0	0.00	    $0.00	Y	
O	35231	REPAIR BLVSL VN GRF NECK                	     5.60	  $208.49	      ---	  $262.92	004	1	0	0.00	    $0.00	Y	
K	35231	REPAIR BLVSL VN GRF NECK                	    28.00	 $1042.44	      ---	 $1314.60	004	1	0	0.00	    $0.00	Y	
K	35236	REPAIR BLVSL VN GRF UXTR                	    28.00	 $1042.44	      ---	 $1314.60	004	1	0	0.00	    $0.00	Y	
O	35236	REPAIR BLVSL VN GRF UXTR                	     5.60	  $208.49	      ---	  $262.92	004	1	0	0.00	    $0.00	Y	
O	35241	RPR BLVSL VN GRF NTRTHRC W/B            	     9.51	  $354.06	      ---	  $446.49	004	1	0	0.00	    $0.00	Y	
K	35241	RPR BLVSL VN GRF NTRTHRC W/B            	    47.54	 $1769.91	      ---	 $2232.00	004	1	0	0.00	    $0.00	Y	
K	35246	RPR BLVSL VN GRF NTRTHRC W/O            	    38.22	 $1422.93	      ---	 $1794.43	004	1	0	0.00	    $0.00	Y	
O	35246	RPR BLVSL VN GRF NTRTHRC W/O            	     7.64	  $284.44	      ---	  $358.70	004	1	0	0.00	    $0.00	Y	
O	35251	RPR BLVSL VN GRF INTRA-ABDL             	     4.52	  $168.28	      ---	  $212.21	004	1	0	0.00	    $0.00	Y	
K	35251	RPR BLVSL VN GRF INTRA-ABDL             	    22.61	  $841.77	      ---	 $1061.54	004	1	0	0.00	    $0.00	Y	
K	35256	REPAIR BLVSL VN GRF LXTR                	    32.00	 $1191.36	      ---	 $1502.40	004	1	0	0.00	    $0.00	Y	
O	35256	REPAIR BLVSL VN GRF LXTR                	     6.40	  $238.27	      ---	  $300.48	004	1	0	0.00	    $0.00	Y	
O	35261	RPR BLVSL GRF OTH/THN VN NCK            	     6.40	  $238.27	      ---	  $300.48	004	1	0	0.00	    $0.00	Y	
K	35261	RPR BLVSL GRF OTH/THN VN NCK            	    32.00	 $1191.36	      ---	 $1502.40	004	1	0	0.00	    $0.00	Y	
K	35266	RPR BLVSL GRF OTH/TH VN UXTR            	    14.91	  $555.10	      ---	  $700.02	004	1	0	0.00	    $0.00	Y	
O	35266	RPR BLVSL GRF OTH/TH VN UXTR            	     2.98	  $110.95	      ---	  $139.91	004	1	0	0.00	    $0.00	Y	
O	35271	RPR BLVS GR OT/TH VN NTRTH W            	     7.30	  $271.78	      ---	  $342.74	004	1	0	0.00	    $0.00	Y	
K	35271	RPR BLVS GR OT/TH VN NTRTH W            	    36.48	 $1358.15	      ---	 $1712.74	004	1	0	0.00	    $0.00	Y	
K	35276	RPR BLVS GR OT/T VN NTRTH WO            	    36.17	 $1346.61	      ---	 $1698.18	004	1	0	0.00	    $0.00	Y	
O	35276	RPR BLVS GR OT/T VN NTRTH WO            	     7.23	  $269.17	      ---	  $339.45	004	1	0	0.00	    $0.00	Y	
O	35281	RPR BLVSL GR OT/TH VN NTR-AB            	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
K	35281	RPR BLVSL GR OT/TH VN NTR-AB            	    34.00	 $1265.82	      ---	 $1596.30	004	1	0	0.00	    $0.00	Y	
K	35286	RPR BLVSL GRF OTH/TH VN LXTR            	    28.00	 $1042.44	      ---	 $1314.60	004	1	0	0.00	    $0.00	Y	
O	35286	RPR BLVSL GRF OTH/TH VN LXTR            	     5.60	  $208.49	      ---	  $262.92	004	1	0	0.00	    $0.00	Y	
O	35301	RECHANNELING OF ARTERY                  	     6.00	  $223.38	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	35301	RECHANNELING OF ARTERY                  	    30.00	 $1116.90	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	35302	RECHANNELING OF ARTERY                  	    26.50	  $986.60	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	35302	RECHANNELING OF ARTERY                  	     5.30	  $197.32	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	35303	RECHANNELING OF ARTERY                  	     5.82	  $216.68	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	35303	RECHANNELING OF ARTERY                  	    29.12	 $1084.14	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	35304	RECHANNELING OF ARTERY                  	    30.29	 $1127.70	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	35304	RECHANNELING OF ARTERY                  	     6.06	  $225.61	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	35305	RECHANNELING OF ARTERY                  	     5.82	  $216.68	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	35305	RECHANNELING OF ARTERY                  	    29.12	 $1084.14	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	35306	RECHANNELING OF ARTERY                  	    10.87	  $404.69	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	35306	RECHANNELING OF ARTERY                  	     2.17	   $80.79	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	35311	RECHANNELING OF ARTERY                  	     6.57	  $244.60	      ---	  $308.46	004	1	0	0.00	    $0.00	Y	
K	35311	RECHANNELING OF ARTERY                  	    32.87	 $1223.75	      ---	 $1543.25	004	1	0	0.00	    $0.00	Y	
K	35321	RECHANNELING OF ARTERY                  	    30.00	 $1116.90	      ---	 $1408.50	004	1	0	0.00	    $0.00	Y	
O	35321	RECHANNELING OF ARTERY                  	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
O	35331	RECHANNELING OF ARTERY                  	     8.00	  $297.84	      ---	  $375.60	004	1	0	0.00	    $0.00	Y	
K	35331	RECHANNELING OF ARTERY                  	    40.00	 $1489.20	      ---	 $1878.00	004	1	0	0.00	    $0.00	Y	
K	35341	RECHANNELING OF ARTERY                  	    40.00	 $1489.20	      ---	 $1878.00	004	1	0	0.00	    $0.00	Y	
O	35341	RECHANNELING OF ARTERY                  	     8.00	  $297.84	      ---	  $375.60	004	1	0	0.00	    $0.00	Y	
O	35351	RECHANNELING OF ARTERY                  	     6.40	  $238.27	      ---	  $300.48	004	1	0	0.00	    $0.00	Y	
K	35351	RECHANNELING OF ARTERY                  	    32.00	 $1191.36	      ---	 $1502.40	004	1	0	0.00	    $0.00	Y	
K	35355	RECHANNELING OF ARTERY                  	    32.00	 $1191.36	      ---	 $1502.40	004	1	0	0.00	    $0.00	Y	
O	35355	RECHANNELING OF ARTERY                  	     6.40	  $238.27	      ---	  $300.48	004	1	0	0.00	    $0.00	Y	
O	35361	RECHANNELING OF ARTERY                  	     6.40	  $238.27	      ---	  $300.48	004	1	0	0.00	    $0.00	Y	
K	35361	RECHANNELING OF ARTERY                  	    32.00	 $1191.36	      ---	 $1502.40	004	1	0	0.00	    $0.00	Y	
K	35363	RECHANNELING OF ARTERY                  	    32.06	 $1193.59	      ---	 $1505.22	004	1	0	0.00	    $0.00	Y	
O	35363	RECHANNELING OF ARTERY                  	     6.41	  $238.64	      ---	  $300.95	004	1	0	0.00	    $0.00	Y	
O	35371	RECHANNELING OF ARTERY                  	     5.60	  $208.49	      ---	  $262.92	004	1	0	0.00	    $0.00	Y	
K	35371	RECHANNELING OF ARTERY                  	    28.00	 $1042.44	      ---	 $1314.60	004	1	0	0.00	    $0.00	Y	
K	35372	RECHANNELING OF ARTERY                  	    28.00	 $1042.44	      ---	 $1314.60	004	1	0	0.00	    $0.00	Y	
O	35372	RECHANNELING OF ARTERY                  	     5.60	  $208.49	      ---	  $262.92	004	1	0	0.00	    $0.00	Y	
O	35390	REOPERATION CAROTID ADD-ON              	     0.79	   $29.41	      ---	   $37.09	004	1	0	0.00	    $0.00	Y	
K	35390	REOPERATION CAROTID ADD-ON              	     3.94	  $146.69	      ---	  $184.98	004	1	0	0.00	    $0.00	Y	
K	35400	ANGIOSCOPY                              	     3.78	  $140.73	      ---	  $177.47	004	1	0	0.00	    $0.00	Y	
O	35400	ANGIOSCOPY                              	     1.70	   $63.29	      ---	   $79.82	004	1	0	0.00	    $0.00	Y	
O	35500	HARVEST VEIN FOR BYPASS                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	35500	HARVEST VEIN FOR BYPASS                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	35501	ART BYP GRFT IPSILAT CAROTID            	    30.00	 $1116.90	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	35501	ART BYP GRFT IPSILAT CAROTID            	     6.00	  $223.38	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	35506	ART BYP GRFT SUBCLAV-CAROTID            	     6.00	  $223.38	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	35506	ART BYP GRFT SUBCLAV-CAROTID            	    30.00	 $1116.90	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	35508	ART BYP GRFT CAROTID-VERTBRL            	    32.00	 $1191.36	      ---	 $1502.40	004	1	0	0.00	    $0.00	Y	
O	35508	ART BYP GRFT CAROTID-VERTBRL            	     6.40	  $238.27	      ---	  $300.48	004	1	0	0.00	    $0.00	Y	
O	35509	ART BYP GRFT CONTRAL CAROTID            	     6.40	  $238.27	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	35509	ART BYP GRFT CONTRAL CAROTID            	    32.00	 $1191.36	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	35510	ART BYP GRFT CAROTID-BRCHIAL            	    19.74	  $734.92	      ---	  $926.79	004	1	0	0.00	    $0.00	Y	
O	35510	ART BYP GRFT CAROTID-BRCHIAL            	     3.95	  $147.06	      ---	  $185.45	004	1	0	0.00	    $0.00	Y	
O	35511	ART BYP GRFT SUBCLAV-SUBCLAV            	     4.50	  $167.54	      ---	  $211.28	004	1	0	0.00	    $0.00	Y	
K	35511	ART BYP GRFT SUBCLAV-SUBCLAV            	    22.40	  $833.95	      ---	 $1051.68	004	1	0	0.00	    $0.00	Y	
K	35512	ART BYP GRFT SUBCLAV-BRCHIAL            	    19.34	  $720.03	      ---	  $908.01	004	1	0	0.00	    $0.00	Y	
O	35512	ART BYP GRFT SUBCLAV-BRCHIAL            	     3.87	  $144.08	      ---	  $181.70	004	1	0	0.00	    $0.00	Y	
O	35515	ART BYP GRFT SUBCLAV-VERTBRL            	     4.91	  $182.80	      ---	  $230.52	004	1	0	0.00	    $0.00	Y	
K	35515	ART BYP GRFT SUBCLAV-VERTBRL            	    24.42	  $909.16	      ---	 $1146.52	004	1	0	0.00	    $0.00	Y	
K	35516	ART BYP GRFT SUBCLAV-AXILARY            	    30.00	 $1116.90	      ---	 $1408.50	004	1	0	0.00	    $0.00	Y	
O	35516	ART BYP GRFT SUBCLAV-AXILARY            	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
O	35518	ART BYP GRFT AXILLARY-AXILRY            	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
K	35518	ART BYP GRFT AXILLARY-AXILRY            	    30.00	 $1116.90	      ---	 $1408.50	004	1	0	0.00	    $0.00	Y	
K	35521	ART BYP GRFT AXILL-FEMORAL              	    30.00	 $1116.90	      ---	 $1408.50	004	1	0	0.00	    $0.00	Y	
O	35521	ART BYP GRFT AXILL-FEMORAL              	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
O	35522	ART BYP GRFT AXILL-BRACHIAL             	     3.75	  $139.61	      ---	  $176.06	004	1	0	0.00	    $0.00	Y	
K	35522	ART BYP GRFT AXILL-BRACHIAL             	    18.76	  $698.43	      ---	  $880.78	004	1	0	0.00	    $0.00	Y	
K	35523	ART BYP GRFT BRCHL-ULNR-RDL             	    27.06	 $1007.44	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	35523	ART BYP GRFT BRCHL-ULNR-RDL             	     5.41	  $201.41	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	35525	ART BYP GRFT BRACHIAL-BRCHL             	     3.57	  $132.91	      ---	  $167.61	004	1	0	0.00	    $0.00	Y	
K	35525	ART BYP GRFT BRACHIAL-BRCHL             	    17.85	  $664.56	      ---	  $838.06	004	1	0	0.00	    $0.00	Y	
K	35526	ART BYP GRFT AOR/CAROT/INNOM            	    32.00	 $1191.36	      ---	 $1502.40	004	1	0	0.00	    $0.00	Y	
O	35526	ART BYP GRFT AOR/CAROT/INNOM            	     6.40	  $238.27	      ---	  $300.48	004	1	0	0.00	    $0.00	Y	
O	35531	ART BYP GRFT AORCEL/AORMESEN            	     6.61	  $246.09	      ---	  $310.34	004	1	0	0.00	    $0.00	Y	
K	35531	ART BYP GRFT AORCEL/AORMESEN            	    33.06	 $1230.82	      ---	 $1552.17	004	1	0	0.00	    $0.00	Y	
K	35533	ART BYP GRFT AXILL/FEM/FEM              	    30.15	 $1122.48	      ---	 $1415.54	004	1	0	0.00	    $0.00	Y	
O	35533	ART BYP GRFT AXILL/FEM/FEM              	     6.03	  $224.50	      ---	  $283.11	004	1	0	0.00	    $0.00	Y	
O	35535	ART BYP GRFT HEPATORENAL                	     8.00	  $297.84	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	35535	ART BYP GRFT HEPATORENAL                	    39.98	 $1488.46	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	35536	ART BYP GRFT SPLENORENAL                	    32.00	 $1191.36	      ---	 $1502.40	004	1	0	0.00	    $0.00	Y	
O	35536	ART BYP GRFT SPLENORENAL                	     6.40	  $238.27	      ---	  $300.48	004	1	0	0.00	    $0.00	Y	
O	35537	ART BYP GRFT AORTOILIAC                 	    10.24	  $381.24	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	35537	ART BYP GRFT AORTOILIAC                 	    51.19	 $1905.80	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	35538	ART BYP GRFT AORTOBI-ILIAC              	    57.17	 $2128.44	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	35538	ART BYP GRFT AORTOBI-ILIAC              	    11.43	  $425.54	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	35539	ART BYP GRFT AORTOFEMORAL               	    10.75	  $400.22	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	35539	ART BYP GRFT AORTOFEMORAL               	    53.73	 $2000.37	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	35540	ART BYP GRFT AORTBIFEMORAL              	    59.88	 $2229.33	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	35540	ART BYP GRFT AORTBIFEMORAL              	    11.98	  $446.02	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	35556	ART BYP GRFT FEM-POPLITEAL              	     5.69	  $211.84	      ---	  $267.15	004	1	0	0.00	    $0.00	Y	
K	35556	ART BYP GRFT FEM-POPLITEAL              	    28.47	 $1059.94	      ---	 $1336.67	004	1	0	0.00	    $0.00	Y	
K	35558	ART BYP GRFT FEM-FEMORAL                	    28.00	 $1042.44	      ---	 $1314.60	004	1	0	0.00	    $0.00	Y	
O	35558	ART BYP GRFT FEM-FEMORAL                	     5.60	  $208.49	      ---	  $262.92	004	1	0	0.00	    $0.00	Y	
O	35560	ART BYP GRFT AORTORENAL                 	     6.40	  $238.27	      ---	  $300.48	004	1	0	0.00	    $0.00	Y	
K	35560	ART BYP GRFT AORTORENAL                 	    32.00	 $1191.36	      ---	 $1502.40	004	1	0	0.00	    $0.00	Y	
K	35563	ART BYP GRFT ILIOILIAC                  	    32.00	 $1191.36	      ---	 $1502.40	004	1	0	0.00	    $0.00	Y	
O	35563	ART BYP GRFT ILIOILIAC                  	     6.40	  $238.27	      ---	  $300.48	004	1	0	0.00	    $0.00	Y	
O	35565	ART BYP GRFT ILIOFEMORAL                	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
K	35565	ART BYP GRFT ILIOFEMORAL                	    30.00	 $1116.90	      ---	 $1408.50	004	1	0	0.00	    $0.00	Y	
K	35566	ART BYP FEM-ANT-POST TIB/PRL            	    30.13	 $1121.74	      ---	 $1414.60	004	1	0	0.00	    $0.00	Y	
O	35566	ART BYP FEM-ANT-POST TIB/PRL            	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
O	35570	ART BYP TIBIAL-TIB/PERONEAL             	     6.19	  $230.45	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	35570	ART BYP TIBIAL-TIB/PERONEAL             	    30.94	 $1151.90	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	35571	ART BYP POP-TIBL-PRL-OTHER              	    32.00	 $1191.36	      ---	 $1502.40	004	1	0	0.00	    $0.00	Y	
O	35571	ART BYP POP-TIBL-PRL-OTHER              	     6.40	  $238.27	      ---	  $300.48	004	1	0	0.00	    $0.00	Y	
O	35572	HARVEST FEMOROPOPLITEAL VEIN            	     1.16	   $43.19	      ---	   $54.46	004	1	0	0.00	    $0.00	Y	
K	35572	HARVEST FEMOROPOPLITEAL VEIN            	     5.89	  $219.28	      ---	  $276.54	004	1	0	0.00	    $0.00	Y	
K	35583	VEIN BYP GRFT FEM-POPLITEAL             	    30.13	 $1121.74	      ---	 $1414.60	004	1	0	0.00	    $0.00	Y	
O	35583	VEIN BYP GRFT FEM-POPLITEAL             	     6.03	  $224.50	      ---	  $283.11	004	1	0	0.00	    $0.00	Y	
O	35585	VEIN BYP FEM-TIBIAL PERONEAL            	     7.70	  $286.67	      ---	  $361.52	004	1	0	0.00	    $0.00	Y	
K	35585	VEIN BYP FEM-TIBIAL PERONEAL            	    38.51	 $1433.73	      ---	 $1808.04	004	1	0	0.00	    $0.00	Y	
K	35587	VEIN BYP POP-TIBL PERONEAL              	    32.00	 $1191.36	      ---	 $1502.40	004	1	0	0.00	    $0.00	Y	
O	35587	VEIN BYP POP-TIBL PERONEAL              	     6.40	  $238.27	      ---	  $300.48	004	1	0	0.00	    $0.00	Y	
O	35600	OPEN HRV UXTR ART 1 SGM CAB             	     1.28	   $47.65	      ---	   $60.10	004	1	0	0.00	    $0.00	Y	
K	35600	OPEN HRV UXTR ART 1 SGM CAB             	     6.40	  $238.27	      ---	  $300.48	004	1	0	0.00	    $0.00	Y	
K	35601	ART BYP COMMON IPSI CAROTID             	    25.19	  $937.82	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	35601	ART BYP COMMON IPSI CAROTID             	     5.04	  $187.64	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	35606	ART BYP CAROTID-SUBCLAVIAN              	     4.87	  $181.31	      ---	  $228.65	004	1	0	0.00	    $0.00	Y	
K	35606	ART BYP CAROTID-SUBCLAVIAN              	    24.57	  $914.74	      ---	 $1153.56	004	1	0	0.00	    $0.00	Y	
K	35612	ART BYP SUBCLAV-SUBCLAVIAN              	    20.94	  $779.60	      ---	  $983.13	004	1	0	0.00	    $0.00	Y	
O	35612	ART BYP SUBCLAV-SUBCLAVIAN              	     4.17	  $155.25	      ---	  $195.78	004	1	0	0.00	    $0.00	Y	
O	35616	ART BYP SUBCLAV-AXILLARY                	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
K	35616	ART BYP SUBCLAV-AXILLARY                	    30.00	 $1116.90	      ---	 $1408.50	004	1	0	0.00	    $0.00	Y	
K	35621	ART BYP AXILLARY-FEMORAL                	    30.00	 $1116.90	      ---	 $1408.50	004	1	0	0.00	    $0.00	Y	
O	35621	ART BYP AXILLARY-FEMORAL                	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
O	35623	ART BYP AXILLARY-POP-TIBIAL             	     3.84	  $142.96	      ---	  $180.29	004	1	0	0.00	    $0.00	Y	
K	35623	ART BYP AXILLARY-POP-TIBIAL             	    19.22	  $715.56	      ---	  $902.38	004	1	0	0.00	    $0.00	Y	
K	35626	ART BYP AORSUBCL/CAROT/INNOM            	    32.00	 $1191.36	      ---	 $1502.40	004	1	0	0.00	    $0.00	Y	
O	35626	ART BYP AORSUBCL/CAROT/INNOM            	     6.40	  $238.27	      ---	  $300.48	004	1	0	0.00	    $0.00	Y	
O	35631	ART BYP AOR-CELIAC-MSN-RENAL            	     6.40	  $238.27	      ---	  $300.48	004	1	0	0.00	    $0.00	Y	
K	35631	ART BYP AOR-CELIAC-MSN-RENAL            	    32.00	 $1191.36	      ---	 $1502.40	004	1	0	0.00	    $0.00	Y	
K	35632	ART BYP ILIO-CELIAC                     	    37.97	 $1413.62	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	35632	ART BYP ILIO-CELIAC                     	     7.59	  $282.58	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	35633	ART BYP ILIO-MESENTERIC                 	     8.20	  $305.29	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	35633	ART BYP ILIO-MESENTERIC                 	    40.99	 $1526.06	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	35634	ART BYP ILIORENAL                       	    37.16	 $1383.47	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	35634	ART BYP ILIORENAL                       	     7.43	  $276.62	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	35636	ART BYP SPENORENAL                      	     6.40	  $238.27	      ---	  $300.48	004	1	0	0.00	    $0.00	Y	
K	35636	ART BYP SPENORENAL                      	    32.00	 $1191.36	      ---	 $1502.40	004	1	0	0.00	    $0.00	Y	
K	35637	ART BYP AORTOILIAC                      	    40.78	 $1518.24	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	35637	ART BYP AORTOILIAC                      	     8.16	  $303.80	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	35638	ART BYP AORTOBI-ILIAC                   	     8.29	  $308.64	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	35638	ART BYP AORTOBI-ILIAC                   	    41.43	 $1542.44	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	35642	ART BYP CAROTID-VERTEBRAL               	    23.20	  $863.74	      ---	 $1089.24	004	1	0	0.00	    $0.00	Y	
O	35642	ART BYP CAROTID-VERTEBRAL               	     4.60	  $171.26	      ---	  $215.97	004	1	0	0.00	    $0.00	Y	
O	35645	ART BYP SUBCLAV-VERTEBRL                	     4.60	  $171.26	      ---	  $215.97	004	1	0	0.00	    $0.00	Y	
K	35645	ART BYP SUBCLAV-VERTEBRL                	    23.20	  $863.74	      ---	 $1089.24	004	1	0	0.00	    $0.00	Y	
K	35646	ART BYP AORTOBIFEMORAL                  	    33.64	 $1252.42	      ---	 $1579.40	004	1	0	0.00	    $0.00	Y	
O	35646	ART BYP AORTOBIFEMORAL                  	     7.15	  $266.19	      ---	  $335.69	004	1	0	0.00	    $0.00	Y	
O	35647	ART BYP AORTOFEMORAL                    	     6.97	  $259.49	      ---	  $327.24	004	1	0	0.00	    $0.00	Y	
K	35647	ART BYP AORTOFEMORAL                    	    34.87	 $1298.21	      ---	 $1637.15	004	1	0	0.00	    $0.00	Y	
K	35650	ART BYP AXILLARY-AXILLARY               	    30.00	 $1116.90	      ---	 $1408.50	004	1	0	0.00	    $0.00	Y	
O	35650	ART BYP AXILLARY-AXILLARY               	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
O	35654	ART BYP AXILL-FEM-FEMORAL               	     8.00	  $297.84	      ---	  $375.60	004	1	0	0.00	    $0.00	Y	
K	35654	ART BYP AXILL-FEM-FEMORAL               	    40.00	 $1489.20	      ---	 $1878.00	004	1	0	0.00	    $0.00	Y	
K	35656	ART BYP FEMORAL-POPLITEAL               	    21.63	  $805.28	      ---	 $1015.53	004	1	0	0.00	    $0.00	Y	
O	35656	ART BYP FEMORAL-POPLITEAL               	     4.30	  $160.09	      ---	  $201.89	004	1	0	0.00	    $0.00	Y	
O	35661	ART BYP FEMORAL-FEMORAL                 	     3.80	  $141.47	      ---	  $178.41	004	1	0	0.00	    $0.00	Y	
K	35661	ART BYP FEMORAL-FEMORAL                 	    19.10	  $711.09	      ---	  $896.75	004	1	0	0.00	    $0.00	Y	
K	35663	ART BYP ILIOILIAC                       	    24.00	  $893.52	      ---	 $1126.80	004	1	0	0.00	    $0.00	Y	
O	35663	ART BYP ILIOILIAC                       	     4.80	  $178.70	      ---	  $225.36	004	1	0	0.00	    $0.00	Y	
O	35665	ART BYP ILIOFEMORAL                     	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	35665	ART BYP ILIOFEMORAL                     	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	35666	ART BYP FEM-ANT-POST TIB/PRL            	    23.56	  $877.14	      ---	 $1106.14	004	1	0	0.00	    $0.00	Y	
O	35666	ART BYP FEM-ANT-POST TIB/PRL            	     4.77	  $177.59	      ---	  $223.95	004	1	0	0.00	    $0.00	Y	
O	35671	ART BYP POP-TIBL-PRL-OTHER              	     5.20	  $193.60	      ---	  $244.14	004	1	0	0.00	    $0.00	Y	
K	35671	ART BYP POP-TIBL-PRL-OTHER              	    26.00	  $967.98	      ---	 $1220.70	004	1	0	0.00	    $0.00	Y	
K	35681	COMPOSITE BYP GRFT PROS&VEIN            	     5.12	  $190.62	      ---	  $240.38	004	1	0	0.00	    $0.00	Y	
O	35681	COMPOSITE BYP GRFT PROS&VEIN            	     1.02	   $37.97	      ---	   $47.89	004	1	0	0.00	    $0.00	Y	
O	35682	COMPOSITE BYP GRFT 2 VEINS              	     2.02	   $75.20	      ---	   $94.84	004	1	0	0.00	    $0.00	Y	
K	35682	COMPOSITE BYP GRFT 2 VEINS              	    10.10	  $376.02	      ---	  $474.20	004	1	0	0.00	    $0.00	Y	
K	35683	COMPOSITE BYP GRFT 3/> SEGMT            	    11.62	  $432.61	      ---	  $545.56	004	1	0	0.00	    $0.00	Y	
O	35683	COMPOSITE BYP GRFT 3/> SEGMT            	     2.32	   $86.37	      ---	  $108.92	004	1	0	0.00	    $0.00	Y	
O	35685	BYPASS GRAFT PATENCY/PATCH              	     0.97	   $36.11	      ---	   $45.54	004	1	0	0.00	    $0.00	Y	
K	35685	BYPASS GRAFT PATENCY/PATCH              	     4.83	  $179.82	      ---	  $226.77	004	1	0	0.00	    $0.00	Y	
K	35686	BYPASS GRAFT/AV FIST PATENCY            	     3.99	  $148.55	      ---	  $187.33	004	1	0	0.00	    $0.00	Y	
O	35686	BYPASS GRAFT/AV FIST PATENCY            	     0.80	   $29.78	      ---	   $37.56	004	1	0	0.00	    $0.00	Y	
O	35691	ART TRNSPOSJ VERTBRL CAROTID            	     5.51	  $205.14	      ---	  $258.69	004	1	0	0.00	    $0.00	Y	
K	35691	ART TRNSPOSJ VERTBRL CAROTID            	    27.56	 $1026.06	      ---	 $1293.94	004	1	0	0.00	    $0.00	Y	
K	35693	ART TRNSPOSJ SUBCLAVIAN                 	    19.33	  $719.66	      ---	  $907.54	004	1	0	0.00	    $0.00	Y	
O	35693	ART TRNSPOSJ SUBCLAVIAN                 	     3.86	  $143.71	      ---	  $181.23	004	1	0	0.00	    $0.00	Y	
O	35694	ART TRNSPOSJ SUBCLAV CAROTID            	     4.45	  $165.67	      ---	  $208.93	004	1	0	0.00	    $0.00	Y	
K	35694	ART TRNSPOSJ SUBCLAV CAROTID            	    22.28	  $829.48	      ---	 $1046.05	004	1	0	0.00	    $0.00	Y	
K	35695	ART TRNSPOSJ CAROTID SUBCLAV            	    22.28	  $829.48	      ---	 $1046.05	004	1	0	0.00	    $0.00	Y	
O	35695	ART TRNSPOSJ CAROTID SUBCLAV            	     4.45	  $165.67	      ---	  $208.93	004	1	0	0.00	    $0.00	Y	
O	35697	REIMPLANT ARTERY EACH                   	     0.53	   $19.73	      ---	   $24.88	004	1	0	0.00	    $0.00	Y	
K	35697	REIMPLANT ARTERY EACH                   	     2.66	   $99.03	      ---	  $124.89	004	1	0	0.00	    $0.00	Y	
K	35700	REOPERATION BYPASS GRAFT                	     3.85	  $143.34	      ---	  $180.76	004	1	0	0.00	    $0.00	Y	
O	35700	REOPERATION BYPASS GRAFT                	     0.77	   $28.67	      ---	   $36.15	004	1	0	0.00	    $0.00	Y	
O	35701	EXPL N/FLWD SURG NECK ART               	     2.00	   $74.46	      ---	   $93.90	004	1	0	0.00	    $0.00	Y	
K	35701	EXPL N/FLWD SURG NECK ART               	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
K	35702	EXPL N/FLWD SURG UXTR ART               	     9.43	  $351.08	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	35702	EXPL N/FLWD SURG UXTR ART               	     1.88	   $69.99	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	35703	EXPL N/FLWD SURG LXTR ART               	     1.90	   $70.74	      ---	       --	004	0	0	0.00	    $0.00	Y	
P	35703	EXPL N/FLWD SURG LXTR ART               	     9.50	  $353.69	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	35703	EXPL N/FLWD SURG LXTR ART               	     9.50	  $353.69	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	35800	EXPLORE NECK VESSELS                    	    10.66	  $396.87	      ---	  $500.49	004	1	0	0.00	    $0.00	Y	
O	35800	EXPLORE NECK VESSELS                    	     2.13	   $79.30	      ---	  $100.00	004	1	0	0.00	    $0.00	Y	
O	35820	EXPLORE CHEST VESSELS                   	     3.27	  $121.74	      ---	  $153.53	004	1	0	0.00	    $0.00	Y	
K	35820	EXPLORE CHEST VESSELS                   	    16.37	  $609.46	      ---	  $768.57	004	1	0	0.00	    $0.00	Y	
K	35840	EXPLORE ABDOMINAL VESSELS               	    13.51	  $502.98	      ---	  $634.29	004	1	0	0.00	    $0.00	Y	
O	35840	EXPLORE ABDOMINAL VESSELS               	     2.70	  $100.52	      ---	  $126.77	004	1	0	0.00	    $0.00	Y	
O	35860	EXPLORE LIMB VESSELS                    	     1.67	   $62.17	      ---	   $78.41	004	1	0	0.00	    $0.00	Y	
K	35860	EXPLORE LIMB VESSELS                    	     8.35	  $310.87	      ---	  $392.03	004	1	0	0.00	    $0.00	Y	
K	35870	REPAIR VESSEL GRAFT DEFECT              	    29.27	 $1089.72	      ---	 $1374.23	004	1	0	0.00	    $0.00	Y	
O	35870	REPAIR VESSEL GRAFT DEFECT              	     5.85	  $217.80	      ---	  $274.66	004	1	0	0.00	    $0.00	Y	
O	35875	REMOVAL OF CLOT IN GRAFT                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	35875	REMOVAL OF CLOT IN GRAFT                	     7.80	  $290.39	      ---	  $366.21	004	1	0	0.00	    $0.00	Y	
K	35876	REMOVAL OF CLOT IN GRAFT                	    17.36	  $646.31	      ---	  $815.05	004	1	0	0.00	    $0.00	Y	
O	35876	REMOVAL OF CLOT IN GRAFT                	     3.48	  $129.56	      ---	  $163.39	004	1	0	0.00	    $0.00	Y	
O	35879	REVISE GRAFT W/VEIN                     	     3.48	  $129.56	      ---	  $163.39	004	1	0	0.00	    $0.00	Y	
K	35879	REVISE GRAFT W/VEIN                     	    17.41	  $648.17	      ---	  $817.40	004	1	0	0.00	    $0.00	Y	
K	35881	REVISE GRAFT W/VEIN                     	    19.05	  $709.23	      ---	  $894.40	004	1	0	0.00	    $0.00	Y	
O	35881	REVISE GRAFT W/VEIN                     	     3.81	  $141.85	      ---	  $178.88	004	1	0	0.00	    $0.00	Y	
O	35883	REVJ FEM ANAST NONAUTOG GRF             	     5.97	  $222.26	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	35883	REVJ FEM ANAST NONAUTOG GRF             	    29.86	 $1111.69	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	35884	REVJ FEM ANAST AUTOG VN GRF             	    31.70	 $1180.19	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	35884	REVJ FEM ANAST AUTOG VN GRF             	     6.34	  $236.04	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	35901	EXCISION GRAFT NECK                     	     2.47	   $91.96	      ---	  $115.97	004	1	0	0.00	    $0.00	Y	
K	35901	EXCISION GRAFT NECK                     	    12.33	  $459.05	      ---	  $578.89	004	1	0	0.00	    $0.00	Y	
K	35903	EXCISION GRAFT EXTREMITY                	    13.33	  $496.28	      ---	  $625.84	004	1	0	0.00	    $0.00	Y	
O	35903	EXCISION GRAFT EXTREMITY                	     2.66	   $99.03	      ---	  $124.89	004	1	0	0.00	    $0.00	Y	
O	35905	EXCISION GRAFT THORAX                   	     3.84	  $142.96	      ---	  $180.29	004	1	0	0.00	    $0.00	Y	
K	35905	EXCISION GRAFT THORAX                   	    19.19	  $714.44	      ---	  $900.97	004	1	0	0.00	    $0.00	Y	
K	35907	EXCISION GRAFT ABDOMEN                  	    19.75	  $735.29	      ---	  $927.26	004	1	0	0.00	    $0.00	Y	
O	35907	EXCISION GRAFT ABDOMEN                  	     3.95	  $147.06	      ---	  $185.45	004	1	0	0.00	    $0.00	Y	
K	36000	PLACE NEEDLE IN VEIN                    	     0.70	   $26.06	      ---	   $32.87	004	1	1	0.00	    $0.00	Y	
K	36002	PSEUDOANEURYSM INJECTION TRT            	     4.20	  $156.37	      ---	  $197.19	004	1	0	0.00	    $0.00	Y	
O	36002	PSEUDOANEURYSM INJECTION TRT            	     0.84	   $31.27	      ---	   $39.44	004	1	0	0.00	    $0.00	Y	
K	36005	INJECTION EXT VENOGRAPHY                	     7.72	  $287.42	      ---	  $362.45	004	1	0	0.00	    $0.00	Y	
K	36010	PLACE CATHETER IN VEIN                  	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	36011	PLACE CATHETER IN VEIN                  	     2.17	   $80.79	      ---	  $101.88	004	1	0	0.00	    $0.00	Y	
K	36012	PLACE CATHETER IN VEIN                  	     3.05	  $113.55	      ---	  $143.20	004	1	0	0.00	    $0.00	Y	
K	36013	PLACE CATHETER IN ARTERY                	     2.17	   $80.79	      ---	  $101.88	004	1	0	0.00	    $0.00	Y	
K	36014	PLACE CATHETER IN ARTERY                	     2.61	   $97.17	      ---	  $122.54	004	1	0	0.00	    $0.00	Y	
K	36015	PLACE CATHETER IN ARTERY                	     3.05	  $113.55	      ---	  $143.20	004	1	0	0.00	    $0.00	Y	
K	36100	ESTABLISH ACCESS TO ARTERY              	     5.00	  $186.15	      ---	  $234.75	004	1	1	0.00	    $0.00	Y	
K	36140	INTRO NDL ICATH UPR/LXTR ART            	     2.27	   $84.51	      ---	  $106.58	004	1	1	0.00	    $0.00	Y	
K	36160	ESTABLISH ACCESS TO AORTA               	     3.00	  $111.69	      ---	  $140.85	004	1	1	0.00	    $0.00	Y	
K	36200	PLACE CATHETER IN AORTA                 	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
K	36215	PLACE CATHETER IN ARTERY                	     4.84	  $180.19	      ---	  $227.24	004	1	0	0.00	    $0.00	Y	
O	36215	PLACE CATHETER IN ARTERY                	     0.96	   $35.74	      ---	   $45.07	004	1	0	0.00	    $0.00	Y	
O	36216	PLACE CATHETER IN ARTERY                	     1.18	   $43.93	      ---	   $55.40	004	1	0	0.00	    $0.00	Y	
K	36216	PLACE CATHETER IN ARTERY                	     5.88	  $218.91	      ---	  $276.07	004	1	0	0.00	    $0.00	Y	
K	36217	PLACE CATHETER IN ARTERY                	     7.06	  $262.84	      ---	  $331.47	004	1	0	0.00	    $0.00	Y	
O	36217	PLACE CATHETER IN ARTERY                	     1.41	   $52.49	      ---	   $66.20	004	1	0	0.00	    $0.00	Y	
O	36218	PLACE CATHETER IN ARTERY                	     0.23	    $8.56	      ---	   $10.80	004	1	0	0.00	    $0.00	Y	
K	36218	PLACE CATHETER IN ARTERY                	     1.16	   $43.19	      ---	   $54.46	004	1	0	0.00	    $0.00	Y	
K	36221	PLACE CATH THORACIC AORTA               	     4.67	  $173.86	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	36222	PLACE CATH CAROTID/INOM ART             	     6.39	  $237.90	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	36223	PLACE CATH CAROTID/INOM ART             	     6.90	  $256.89	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	36224	PLACE CATH CAROTD ART                   	     7.54	  $280.71	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	36225	PLACE CATH SUBCLAVIAN ART               	     6.87	  $255.77	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	36226	PLACE CATH VERTEBRAL ART                	     7.56	  $281.46	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	36227	PLACE CATH XTRNL CAROTID                	     2.38	   $88.61	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	36228	PLACE CATH INTRACRANIAL ART             	     4.87	  $181.31	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	36245	INS CATH ABD/L-EXT ART 1ST              	     5.45	  $202.90	      ---	  $255.88	004	1	0	0.00	    $0.00	Y	
K	36246	INS CATH ABD/L-EXT ART 2ND              	     6.54	  $243.48	      ---	  $307.05	004	1	0	0.00	    $0.00	Y	
K	36247	INS CATH ABD/L-EXT ART 3RD              	     7.78	  $289.65	      ---	  $365.27	004	1	0	0.00	    $0.00	Y	
K	36248	INS CATH ABD/L-EXT ART ADDL             	     1.24	   $46.17	      ---	   $58.22	004	1	0	0.00	    $0.00	Y	
K	36251	INS CATH REN ART 1ST UNILAT             	     6.12	  $227.85	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	36252	INS CATH REN ART 1ST BILAT              	     7.97	  $296.72	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	36253	INS CATH REN ART 2ND+ UNILAT            	     8.50	  $316.46	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	36254	INS CATH REN ART 2ND+ BILAT             	     9.16	  $341.03	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	36260	INSERTION OF INFUSION PUMP              	    16.00	  $595.68	      ---	  $751.20	004	1	0	0.00	    $0.00	Y	
O	36260	INSERTION OF INFUSION PUMP              	     3.20	  $119.14	      ---	  $150.24	004	1	0	0.00	    $0.00	Y	
O	36261	REVISION OF INFUSION PUMP               	     1.45	   $53.98	      ---	   $68.08	004	1	0	0.00	    $0.00	Y	
K	36261	REVISION OF INFUSION PUMP               	     7.25	  $269.92	      ---	  $340.39	004	1	0	0.00	    $0.00	Y	
K	36262	REMOVAL OF INFUSION PUMP                	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
O	36262	REMOVAL OF INFUSION PUMP                	     1.20	   $44.68	      ---	   $56.34	004	1	0	0.00	    $0.00	Y	
O	36299	UNLISTED PX VASCULAR NJX                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	36299	UNLISTED PX VASCULAR NJX                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	36400	VNPNXR<3YRS PHY/QHP FEM/JUG             	     0.45	   $16.75	      ---	   $21.13	004	1	1	0.00	    $0.00	Y	
K	36405	VNPNXR<3YRS PHY/QHP SCALP VN            	     0.48	   $17.87	      ---	   $22.54	004	1	1	0.00	    $0.00	Y	
K	36406	VNPNXR<3YRS PHY/QHP OTHER VN            	     0.63	   $23.45	      ---	   $29.58	004	1	0	0.00	    $0.00	Y	
K	36410	VNPNXR 3YR/> PHY/QHP DX/THER            	     0.29	   $10.80	      ---	   $13.62	004	1	1	0.00	    $0.00	Y	
X	36410	VNPNXR 3YR/> PHY/QHP DX/THER            	    16.03	   $16.03	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	36420	VENIPUNCTURE CUTDOWN < 1 YR             	     1.13	   $42.07	      ---	   $53.05	004	1	1	0.00	    $0.00	Y	
K	36425	VENIPUNCTURE CUTDOWN 1 YR/>             	     1.61	   $59.94	      ---	   $75.59	004	1	1	0.00	    $0.00	Y	
K	36440	BLD PUSH TFUJ 2 YR/<                    	     0.95	   $35.37	      ---	   $44.60	004	1	0	0.00	    $0.00	Y	
K	36450	BLD EXCHANGE TRUJ NEWBORN               	     3.51	  $130.68	      ---	  $164.79	004	1	0	0.00	    $0.00	Y	
K	36455	BLD EXCHANGE TRUJ OTH THN NB            	     3.11	  $115.79	      ---	  $146.01	004	1	0	0.00	    $0.00	Y	
O	36455	BLD EXCHANGE TRUJ OTH THN NB            	     0.62	   $23.08	      ---	   $29.11	004	1	0	0.00	    $0.00	Y	
O	36456	PRTL EXCHANGE TRANSFUSE NB              	     0.49	   $18.24	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	36456	PRTL EXCHANGE TRANSFUSE NB              	     2.47	   $91.96	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	36460	INTRAUTERINE TRANSFUSION FTL            	     8.32	  $309.75	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	36465	NJX NONCMPND SCLRSNT 1 VEIN             	    39.77	 $1480.64	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	36466	NJX NONCMPND SCLRSNT MLT VN             	    41.46	 $1543.56	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	36470	NJX SCLRSNT 1 INCMPTNT VEIN             	     1.81	   $67.39	      ---	   $84.98	004	1	1	0.00	    $0.00	Y	
K	36471	NJX SCLRSNT MLT INCMPTNT VN             	     2.24	   $83.40	      ---	  $105.17	004	1	1	0.00	    $0.00	Y	
K	36473	ENDOVENOUS MCHNCHEM 1ST VEIN            	    37.09	 $1380.86	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	36474	ENDOVENOUS MCHNCHEM ADD-ON              	     6.63	  $246.83	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	36475	ENDOVENOUS RF 1ST VEIN                  	    53.43	 $1989.20	      ---	 $2508.54	004	1	0	0.00	    $0.00	Y	
O	36475	ENDOVENOUS RF 1ST VEIN                  	    10.69	  $397.99	      ---	  $501.90	004	1	0	0.00	    $0.00	Y	
O	36476	ENDOVENOUS RF VEIN ADD-ON               	     2.05	   $76.32	      ---	   $96.25	004	1	0	0.00	    $0.00	Y	
K	36476	ENDOVENOUS RF VEIN ADD-ON               	    10.25	  $381.61	      ---	  $481.24	004	1	0	0.00	    $0.00	Y	
K	36478	ENDOVENOUS LASER 1ST VEIN               	    49.15	 $1829.85	      ---	 $2307.59	004	1	0	0.00	    $0.00	Y	
O	36478	ENDOVENOUS LASER 1ST VEIN               	     9.83	  $365.97	      ---	  $461.52	004	1	0	0.00	    $0.00	Y	
O	36479	ENDOVENOUS LASER VEIN ADDON             	     2.07	   $77.07	      ---	   $97.19	004	1	0	0.00	    $0.00	Y	
K	36479	ENDOVENOUS LASER VEIN ADDON             	    10.35	  $385.33	      ---	  $485.93	004	1	0	0.00	    $0.00	Y	
K	36481	INSERTION OF CATHETER VEIN              	     7.82	  $291.14	      ---	  $367.15	004	1	0	0.00	    $0.00	Y	
O	36481	INSERTION OF CATHETER VEIN              	     1.56	   $58.08	      ---	   $73.24	004	1	0	0.00	    $0.00	Y	
K	36482	ENDOVEN THER CHEM ADHES 1ST             	    52.88	 $1968.72	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	36483	ENDOVEN THER CHEM ADHES SBSQ            	     3.33	  $123.98	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	36500	INSERTION OF CATHETER VEIN              	     3.06	  $113.92	      ---	  $143.67	004	1	0	0.00	    $0.00	Y	
K	36510	INSERTION OF CATHETER VEIN              	     0.69	   $25.69	      ---	   $32.40	004	1	0	0.00	    $0.00	Y	
K	36511	APHERESIS WBC                           	    26.25	  $977.29	      ---	 $1232.44	004	1	0	0.00	    $0.00	Y	
K	36512	APHERESIS RBC                           	    26.25	  $977.29	      ---	 $1232.44	004	1	0	0.00	    $0.00	Y	
K	36513	APHERESIS PLATELETS                     	     8.05	  $299.70	      ---	  $377.95	004	1	0	0.00	    $0.00	Y	
K	36514	APHERESIS PLASMA                        	    26.25	  $977.29	      ---	 $1232.44	004	1	0	0.00	    $0.00	Y	
K	36516	APHERESIS IMMUNOADS SLCTV               	    79.50	 $2959.79	      ---	 $3732.53	004	1	0	0.00	    $0.00	Y	
K	36522	PHOTOPHERESIS                           	    79.50	 $2959.79	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	36555	INSERT NON-TUNNEL CV CATH               	     2.32	   $86.37	      ---	  $108.92	004	1	0	0.00	    $0.00	Y	
K	36556	INSERT NON-TUNNEL CV CATH               	     1.99	   $74.09	      ---	   $93.43	004	1	0	0.00	    $0.00	Y	
K	36557	INSERT TUNNELED CV CATH                 	     3.72	  $138.50	      ---	  $174.65	004	1	0	0.00	    $0.00	Y	
K	36558	INSERT TUNNELED CV CATH                 	     3.64	  $135.52	      ---	  $170.90	004	1	0	0.00	    $0.00	Y	
K	36560	INSERT TUNNELED CV CATH                 	     7.05	  $262.47	      ---	  $331.00	004	1	0	0.00	    $0.00	Y	
K	36561	INSERT TUNNELED CV CATH                 	     6.98	  $259.87	      ---	  $327.71	004	1	0	0.00	    $0.00	Y	
K	36563	INSERT TUNNELED CV CATH                 	     8.56	  $318.69	      ---	  $401.89	004	1	0	0.00	    $0.00	Y	
K	36565	INSERT TUNNELED CV CATH                 	     5.60	  $208.49	      ---	  $262.92	004	1	0	0.00	    $0.00	Y	
K	36566	INSERT TUNNELED CV CATH                 	     5.85	  $217.80	      ---	  $274.66	004	1	0	0.00	    $0.00	Y	
K	36568	INSJ PICC <5 YR W/O IMAGING             	     1.84	   $68.50	      ---	   $86.39	004	1	0	0.00	    $0.00	Y	
K	36569	INSJ PICC 5 YR+ W/O IMAGING             	     1.54	   $57.33	      ---	   $72.30	004	1	0	0.00	    $0.00	Y	
K	36570	INSERT PICVAD CATH                      	     9.09	  $338.42	      ---	  $426.78	004	1	0	0.00	    $0.00	Y	
K	36571	INSERT PICVAD CATH                      	     8.16	  $303.80	      ---	  $383.11	004	1	0	0.00	    $0.00	Y	
K	36572	INSJ PICC RS&I <5 YR                    	    10.38	  $386.45	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	36573	INSJ PICC RS&I 5 YR+                    	     9.75	  $362.99	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	36575	REPAIR TUNNELED CV CATH                 	     1.23	   $45.79	      ---	   $57.75	004	1	0	0.00	    $0.00	Y	
K	36576	REPAIR TUNNELED CV CATH                 	     3.09	  $115.04	      ---	  $145.08	004	1	0	0.00	    $0.00	Y	
K	36578	REPLACE TUNNELED CV CATH                	     3.95	  $147.06	      ---	  $185.45	004	1	0	0.00	    $0.00	Y	
K	36580	REPLACE CVAD CATH                       	     1.93	   $71.85	      ---	   $90.61	004	1	0	0.00	    $0.00	Y	
K	36581	REPLACE TUNNELED CV CATH                	     4.70	  $174.98	      ---	  $220.67	004	1	0	0.00	    $0.00	Y	
K	36582	REPLACE TUNNELED CV CATH                	     8.87	  $330.23	      ---	  $416.45	004	1	0	0.00	    $0.00	Y	
K	36583	REPLACE TUNNELED CV CATH                	     5.50	  $204.77	      ---	  $258.23	004	1	0	0.00	    $0.00	Y	
K	36584	COMPL RPLCMT PICC RS&I                  	     1.70	   $63.29	      ---	   $79.82	004	1	0	0.00	    $0.00	Y	
K	36585	REPLACE PICVAD CATH                     	    11.22	  $417.72	      ---	  $526.78	004	1	0	0.00	    $0.00	Y	
K	36589	REMOVAL TUNNELED CV CATH                	     3.65	  $135.89	      ---	  $171.37	004	1	0	0.00	    $0.00	Y	
K	36590	REMOVAL TUNNELED CV CATH                	     4.30	  $160.09	      ---	  $201.89	004	1	0	0.00	    $0.00	Y	
K	36593	DECLOT VASCULAR DEVICE                  	     0.90	   $33.51	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	36595	MECH REMOV TUNNELED CV CATH             	    19.55	  $727.85	      ---	  $917.87	004	1	0	0.00	    $0.00	Y	
K	36596	MECH REMOV TUNNELED CV CATH             	     4.49	  $167.16	      ---	  $210.81	004	1	0	0.00	    $0.00	Y	
K	36597	REPOSITION VENOUS CATHETER              	     1.20	   $44.68	      ---	   $56.34	004	1	0	0.00	    $0.00	Y	
K	36598	INJ W/FLUOR EVAL CV DEVICE              	     2.97	  $110.57	      ---	  $139.44	004	1	0	0.00	    $0.00	Y	
K	36600	WITHDRAWAL OF ARTERIAL BLOOD            	     0.34	   $12.66	      ---	   $15.96	004	1	0	0.00	    $0.00	Y	
K	36620	INSERTION CATHETER ARTERY               	     1.13	   $42.07	      ---	   $53.05	004	1	0	0.00	    $0.00	Y	
K	36625	INSERTION CATHETER ARTERY               	     1.59	   $59.20	      ---	   $74.65	004	1	0	0.00	    $0.00	Y	
K	36640	INSERTION CATHETER ARTERY               	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	36660	INSERTION CATHETER ARTERY               	     0.85	   $31.65	      ---	   $39.91	004	1	0	0.00	    $0.00	Y	
K	36680	INSERT NEEDLE BONE CAVITY               	     1.40	   $52.12	      ---	   $65.73	004	1	0	0.00	    $0.00	Y	
K	36800	INSERTION OF CANNULA                    	     3.40	  $126.58	      ---	  $159.63	004	1	0	0.00	    $0.00	Y	
K	36810	INSERTION OF CANNULA                    	     9.00	  $335.07	      ---	  $422.55	004	1	1	0.00	    $0.00	Y	
O	36810	INSERTION OF CANNULA                    	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	36815	INSERTION OF CANNULA                    	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	36815	INSERTION OF CANNULA                    	     6.00	  $223.38	      ---	  $281.70	004	1	1	0.00	    $0.00	Y	
K	36818	AV FUSE UPPR ARM CEPHALIC               	    10.94	  $407.30	      ---	  $513.63	004	1	0	0.00	    $0.00	Y	
O	36818	AV FUSE UPPR ARM CEPHALIC               	     2.19	   $81.53	      ---	  $102.82	004	1	0	0.00	    $0.00	Y	
O	36819	AV FUSE UPPR ARM BASILIC                	     2.92	  $108.71	      ---	  $137.09	004	1	0	0.00	    $0.00	Y	
K	36819	AV FUSE UPPR ARM BASILIC                	    14.61	  $543.93	      ---	  $685.94	004	1	0	0.00	    $0.00	Y	
K	36820	AV FUSION/FOREARM VEIN                  	    17.96	  $668.65	      ---	  $843.22	004	1	0	0.00	    $0.00	Y	
O	36820	AV FUSION/FOREARM VEIN                  	     3.59	  $133.66	      ---	  $168.55	004	1	0	0.00	    $0.00	Y	
O	36821	AV FUSION DIRECT ANY SITE               	     2.38	   $88.61	      ---	  $111.74	004	1	0	0.00	    $0.00	Y	
K	36821	AV FUSION DIRECT ANY SITE               	    11.67	  $434.47	      ---	  $547.91	004	1	0	0.00	    $0.00	Y	
K	36823	INSERTION OF CANNULA(S)                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	36825	ARTERY-VEIN AUTOGRAFT                   	    16.60	  $618.02	      ---	  $779.37	004	1	0	0.00	    $0.00	Y	
O	36825	ARTERY-VEIN AUTOGRAFT                   	     3.30	  $122.86	      ---	  $154.94	004	1	0	0.00	    $0.00	Y	
O	36830	ARTERY-VEIN NONAUTOGRAFT                	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
K	36830	ARTERY-VEIN NONAUTOGRAFT                	    15.63	  $581.90	      ---	  $733.83	004	1	0	0.00	    $0.00	Y	
K	36831	OPEN THROMBECT AV FISTULA               	     9.48	  $352.94	      ---	  $445.09	004	1	0	0.00	    $0.00	Y	
O	36831	OPEN THROMBECT AV FISTULA               	     1.90	   $70.74	      ---	   $89.21	004	1	0	0.00	    $0.00	Y	
O	36832	AV FISTULA REVISION OPEN                	     3.30	  $122.86	      ---	  $154.94	004	1	0	0.00	    $0.00	Y	
K	36832	AV FISTULA REVISION OPEN                	    16.60	  $618.02	      ---	  $779.37	004	1	0	0.00	    $0.00	Y	
K	36833	AV FISTULA REVISION                     	    14.65	  $545.42	      ---	  $687.82	004	1	0	0.00	    $0.00	Y	
O	36833	AV FISTULA REVISION                     	     2.93	  $109.08	      ---	  $137.56	004	1	0	0.00	    $0.00	Y	
O	36835	INSERTION THOMAS SHUNT                  	     3.30	  $122.86	      ---	  $154.94	004	1	0	0.00	    $0.00	Y	
K	36835	INSERTION THOMAS SHUNT                  	    16.60	  $618.02	      ---	  $779.37	004	1	0	0.00	    $0.00	Y	
K	36836	PRQ AV FSTL CRTJ UXTR 1 ACS             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	36836	PRQ AV FSTL CRTJ UXTR 1 ACS             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	36837	PRQ AV FSTL CRT UXTR SEP ACS            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	36837	PRQ AV FSTL CRT UXTR SEP ACS            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	36838	DIST REVAS LIGATION HEMO                	    18.42	  $685.78	      ---	  $864.82	004	1	0	0.00	    $0.00	Y	
O	36838	DIST REVAS LIGATION HEMO                	     3.68	  $137.01	      ---	  $172.78	004	1	0	0.00	    $0.00	Y	
O	36860	EXTERNAL CANNULA DECLOTTING             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	36860	EXTERNAL CANNULA DECLOTTING             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	36861	CANNULA DECLOTTING                      	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	36861	CANNULA DECLOTTING                      	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	36901	INTRO CATH DIALYSIS CIRCUIT             	    13.92	  $518.24	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	36902	INTRO CATH DIALYSIS CIRCUIT             	    29.87	 $1112.06	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	36903	INTRO CATH DIALYSIS CIRCUIT             	   139.00	 $5174.97	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	36904	THRMBC/NFS DIALYSIS CIRCUIT             	    43.48	 $1618.76	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	36905	THRMBC/NFS DIALYSIS CIRCUIT             	    55.66	 $2072.22	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	36906	THRMBC/NFS DIALYSIS CIRCUIT             	   168.14	 $6259.85	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	36907	BALO ANGIOP CTR DIALYSIS SEG            	    17.88	  $665.67	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	36908	STENT PLMT CTR DIALYSIS SEG             	    66.67	 $2482.12	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	36909	DIALYSIS CIRCUIT EMBOLJ                 	    48.51	 $1806.03	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37140	REVISION OF CIRCULATION                 	    32.00	 $1191.36	      ---	 $1502.40	004	1	0	0.00	    $0.00	Y	
O	37140	REVISION OF CIRCULATION                 	     6.40	  $238.27	      ---	  $300.48	004	1	0	0.00	    $0.00	Y	
O	37145	REVISION OF CIRCULATION                 	     6.40	  $238.27	      ---	  $300.48	004	1	0	0.00	    $0.00	Y	
K	37145	REVISION OF CIRCULATION                 	    32.00	 $1191.36	      ---	 $1502.40	004	1	0	0.00	    $0.00	Y	
K	37160	REVISION OF CIRCULATION                 	    32.00	 $1191.36	      ---	 $1502.40	004	1	0	0.00	    $0.00	Y	
O	37160	REVISION OF CIRCULATION                 	     6.40	  $238.27	      ---	  $300.48	004	1	0	0.00	    $0.00	Y	
O	37180	REVISION OF CIRCULATION                 	     6.40	  $238.27	      ---	  $300.48	004	1	0	0.00	    $0.00	Y	
K	37180	REVISION OF CIRCULATION                 	    32.00	 $1191.36	      ---	 $1502.40	004	1	0	0.00	    $0.00	Y	
K	37181	SPLICE SPLEEN/KIDNEY VEINS              	    33.16	 $1234.55	      ---	 $1556.86	004	1	0	0.00	    $0.00	Y	
O	37181	SPLICE SPLEEN/KIDNEY VEINS              	     6.63	  $246.83	      ---	  $311.28	004	1	0	0.00	    $0.00	Y	
O	37182	INSERT HEPATIC SHUNT (TIPS)             	     2.93	  $109.08	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37182	INSERT HEPATIC SHUNT (TIPS)             	    14.64	  $545.05	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37183	REVISION TIPS                           	     6.71	  $249.81	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	37183	REVISION TIPS                           	     1.34	   $49.89	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	37184	PRIM ART M-THRMBC 1ST VSL               	    10.88	  $405.06	      ---	  $510.82	004	1	0	0.00	    $0.00	Y	
K	37184	PRIM ART M-THRMBC 1ST VSL               	    54.44	 $2026.80	      ---	 $2555.96	004	1	0	0.00	    $0.00	Y	
K	37185	PRIM ART M-THRMBC SBSQ VSL              	    23.03	  $857.41	      ---	 $1081.26	004	1	0	0.00	    $0.00	Y	
O	37185	PRIM ART M-THRMBC SBSQ VSL              	     4.61	  $171.63	      ---	  $216.44	004	1	0	0.00	    $0.00	Y	
O	37186	SEC ART THROMBECTOMY ADD-ON             	     9.58	  $356.66	      ---	  $449.78	004	1	0	0.00	    $0.00	Y	
K	37186	SEC ART THROMBECTOMY ADD-ON             	    47.88	 $1782.57	      ---	 $2247.97	004	1	0	0.00	    $0.00	Y	
K	37187	VENOUS MECH THROMBECTOMY                	    68.91	 $2565.52	      ---	 $3235.32	004	1	0	0.00	    $0.00	Y	
O	37187	VENOUS MECH THROMBECTOMY                	    13.78	  $513.03	      ---	  $646.97	004	1	0	0.00	    $0.00	Y	
O	37188	VEN MECHNL THRMBC REPEAT TX             	    11.94	  $444.53	      ---	  $560.58	004	1	0	0.00	    $0.00	Y	
K	37188	VEN MECHNL THRMBC REPEAT TX             	    59.69	 $2222.26	      ---	 $2802.45	004	1	0	0.00	    $0.00	Y	
K	37191	INS ENDOVAS VENA CAVA FILTR             	     5.27	  $196.20	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37192	REDO ENDOVAS VENA CAVA FILTR            	     8.15	  $303.42	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37193	REM ENDOVAS VENA CAVA FILTER            	     8.14	  $303.05	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37195	THROMBOLYTIC THERAPY STROKE             	     6.67	  $248.32	      ---	  $313.16	004	1	0	0.00	    $0.00	Y	
K	37197	REMOVE INTRVAS FOREIGN BODY             	     6.81	  $253.54	      ---	  $319.73	004	1	0	0.00	    $0.00	Y	
K	37200	TRANSCATHETER BIOPSY                    	     3.70	  $137.75	      ---	  $173.72	004	1	0	0.00	    $0.00	Y	
O	37200	TRANSCATHETER BIOPSY                    	     0.74	   $27.55	      ---	   $34.74	004	1	0	0.00	    $0.00	Y	
K	37211	THROMBOLYTIC ART THERAPY                	     8.82	  $328.37	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37212	THROMBOLYTIC VENOUS THERAPY             	     7.76	  $288.90	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37213	THROMBLYTIC ART/VEN THERAPY             	     5.41	  $201.41	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37214	CESSJ THERAPY CATH REMOVAL              	     3.21	  $119.51	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37215	TRANSCATH STENT CCA W/EPS               	    16.45	  $612.43	      ---	  $772.33	004	1	0	0.00	    $0.00	Y	
O	37215	TRANSCATH STENT CCA W/EPS               	     3.29	  $122.49	      ---	  $154.47	004	1	0	0.00	    $0.00	Y	
O	37216	TRANSCATH STENT CCA W/O EPS             	     3.16	  $117.65	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37216	TRANSCATH STENT CCA W/O EPS             	    15.80	  $588.23	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37217	STENT PLACEMT RETRO CAROTID             	    25.48	  $948.62	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	37217	STENT PLACEMT RETRO CAROTID             	     5.10	  $189.87	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	37218	STENT PLACEMT ANTE CAROTID              	     3.80	  $141.47	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37218	STENT PLACEMT ANTE CAROTID              	    19.04	  $708.86	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37220	ILIAC REVASC                            	     9.49	  $353.31	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	37220	ILIAC REVASC                            	     1.90	   $70.74	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	37221	ILIAC REVASC W/STENT                    	     2.32	   $86.37	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37221	ILIAC REVASC W/STENT                    	    11.60	  $431.87	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37222	ILIAC REVASC ADD-ON                     	     4.31	  $160.46	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	37222	ILIAC REVASC ADD-ON                     	     0.86	   $32.02	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	37223	ILIAC REVASC W/STENT ADD-ON             	     0.98	   $36.49	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37223	ILIAC REVASC W/STENT ADD-ON             	     4.90	  $182.43	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37224	FEM/POPL REVAS W/TLA                    	    10.46	  $389.43	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	37224	FEM/POPL REVAS W/TLA                    	     2.09	   $77.81	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	37225	FEM/POPL REVAS W/ATHER                  	     2.81	  $104.62	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37225	FEM/POPL REVAS W/ATHER                  	    14.07	  $523.83	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37226	FEM/POPL REVASC W/STENT                 	    11.85	  $441.18	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	37226	FEM/POPL REVASC W/STENT                 	     2.37	   $88.24	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	37227	FEM/POPL REVASC STNT & ATHER            	     3.40	  $126.58	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37227	FEM/POPL REVASC STNT & ATHER            	    17.00	  $632.91	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37228	TIB/PER REVASC W/TLA                    	    12.77	  $475.43	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	37228	TIB/PER REVASC W/TLA                    	     2.55	   $94.94	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	37229	TIB/PER REVASC W/ATHER                  	     3.29	  $122.49	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37229	TIB/PER REVASC W/ATHER                  	    16.47	  $613.18	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37230	TIB/PER REVASC W/STENT                  	    15.97	  $594.56	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	37230	TIB/PER REVASC W/STENT                  	     3.19	  $118.76	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	37231	TIB/PER REVASC STENT & ATHER            	     3.47	  $129.19	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37231	TIB/PER REVASC STENT & ATHER            	    17.36	  $646.31	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37232	TIB/PER REVASC ADD-ON                   	     4.61	  $171.63	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	37232	TIB/PER REVASC ADD-ON                   	     0.92	   $34.25	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	37233	TIBPER REVASC W/ATHER ADD-ON            	     1.52	   $56.59	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37233	TIBPER REVASC W/ATHER ADD-ON            	     7.60	  $282.95	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37234	REVSC OPN/PRQ TIB/PERO STENT            	     6.33	  $235.67	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	37234	REVSC OPN/PRQ TIB/PERO STENT            	     1.27	   $47.28	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	37235	TIB/PER REVASC STNT & ATHER             	     1.80	   $67.01	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37235	TIB/PER REVASC STNT & ATHER             	     8.98	  $334.33	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37236	OPEN/PERQ PLACE STENT 1ST               	    10.54	  $392.40	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	37236	OPEN/PERQ PLACE STENT 1ST               	     2.11	   $78.56	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	37237	OPEN/PERQ PLACE STENT EA ADD            	     0.98	   $36.49	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37237	OPEN/PERQ PLACE STENT EA ADD            	     4.91	  $182.80	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37238	OPEN/PERQ PLACE STENT SAME              	     7.39	  $275.13	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	37238	OPEN/PERQ PLACE STENT SAME              	     1.48	   $55.10	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	37239	OPEN/PERQ PLACE STENT EA ADD            	     0.68	   $25.32	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37239	OPEN/PERQ PLACE STENT EA ADD            	     3.42	  $127.33	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37241	VASC EMBOLIZE/OCCLUDE VENOUS            	   117.69	 $4381.60	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37242	VASC EMBOLIZE/OCCLUDE ARTERY            	    11.50	  $428.15	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37243	VASC EMBOLIZE/OCCLUDE ORGAN             	    13.70	  $510.05	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37244	VASC EMBOLIZE/OCCLUDE BLEED             	    15.99	  $595.31	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37246	TRLUML BALO ANGIOP 1ST ART              	    52.66	 $1960.53	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37247	TRLUML BALO ANGIOP ADDL ART             	    21.21	  $789.65	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37248	TRLUML BALO ANGIOP 1ST VEIN             	    36.31	 $1351.82	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37249	TRLUML BALO ANGIOP ADDL VEIN            	    15.50	  $577.07	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37252	INTRVASC US NONCORONARY 1ST             	    34.95	 $1301.19	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37253	INTRVASC US NONCORONARY ADDL            	     5.25	  $195.46	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37500	ENDOSCOPY LIGATE PERF VEINS             	     9.10	  $338.79	      ---	  $427.25	004	1	0	0.00	    $0.00	Y	
K	37501	UNLISTED VASC ENDOSCOPY PX              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	37565	LIGATION INT JUGULAR VEIN               	     7.10	  $264.33	      ---	  $333.35	004	1	0	0.00	    $0.00	Y	
O	37565	LIGATION INT JUGULAR VEIN               	     1.42	   $52.87	      ---	   $66.67	004	1	0	0.00	    $0.00	Y	
O	37600	LIGATION XTRNL CAROTID ART              	     2.00	   $74.46	      ---	   $93.90	004	1	0	0.00	    $0.00	Y	
K	37600	LIGATION XTRNL CAROTID ART              	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
K	37605	LIGATION INT/COM CAROTID ART            	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
O	37605	LIGATION INT/COM CAROTID ART            	     2.00	   $74.46	      ---	   $93.90	004	1	0	0.00	    $0.00	Y	
O	37606	LIG INT/COM CAROTID ART OCCL            	     2.00	   $74.46	      ---	   $93.90	004	1	0	0.00	    $0.00	Y	
K	37606	LIG INT/COM CAROTID ART OCCL            	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
K	37607	LIG/BANDING ANGIOACS AV FSTL            	     7.32	  $272.52	      ---	  $343.67	004	1	0	0.00	    $0.00	Y	
O	37607	LIG/BANDING ANGIOACS AV FSTL            	     1.46	   $54.36	      ---	   $68.55	004	1	0	0.00	    $0.00	Y	
O	37609	LIGATION/BX TEMPORAL ARTERY             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	37609	LIGATION/BX TEMPORAL ARTERY             	     4.06	  $151.15	      ---	  $190.62	004	1	0	0.00	    $0.00	Y	
K	37615	LIGATION MAJOR ARTERY NECK              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	37615	LIGATION MAJOR ARTERY NECK              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	37616	LIGATION MAJOR ARTERY CHEST             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	37616	LIGATION MAJOR ARTERY CHEST             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	37617	LIGATION MAJOR ARTERY ABD               	    20.76	  $772.89	      ---	  $974.68	004	1	0	0.00	    $0.00	Y	
O	37617	LIGATION MAJOR ARTERY ABD               	     4.15	  $154.50	      ---	  $194.84	004	1	0	0.00	    $0.00	Y	
O	37618	LIGATION MAJOR ARTERY XTR               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	37618	LIGATION MAJOR ARTERY XTR               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	37619	LIGATION OF INF VENA CAVA               	    35.66	 $1327.62	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	37619	LIGATION OF INF VENA CAVA               	     7.13	  $265.45	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	37650	LIGATION OF FEMORAL VEIN                	     2.80	  $104.24	      ---	  $131.46	004	1	0	0.00	    $0.00	Y	
K	37650	LIGATION OF FEMORAL VEIN                	    14.00	  $521.22	      ---	  $657.30	004	1	0	0.00	    $0.00	Y	
K	37660	LIGATION COMMON ILIAC VEIN              	    16.00	  $595.68	      ---	  $751.20	004	1	0	0.00	    $0.00	Y	
O	37660	LIGATION COMMON ILIAC VEIN              	     3.20	  $119.14	      ---	  $150.24	004	1	0	0.00	    $0.00	Y	
O	37700	LIGATION&DIV LONG SAPH VEIN             	     1.09	   $40.58	      ---	   $51.18	004	1	0	0.00	    $0.00	Y	
K	37700	LIGATION&DIV LONG SAPH VEIN             	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
K	37718	LIG DIV&STRPG SHORT SAPH VN             	     9.10	  $338.79	      ---	  $427.25	004	1	0	0.00	    $0.00	Y	
O	37718	LIG DIV&STRPG SHORT SAPH VN             	     1.82	   $67.76	      ---	   $85.45	004	1	0	0.00	    $0.00	Y	
O	37722	LIG DIV&STRPG LONG SAPH VEIN            	     2.14	   $79.67	      ---	  $100.47	004	1	0	0.00	    $0.00	Y	
K	37722	LIG DIV&STRPG LONG SAPH VEIN            	    10.70	  $398.36	      ---	  $502.37	004	1	0	0.00	    $0.00	Y	
K	37735	LIG&DIV&COMPL STRPG SAPH VN             	    12.01	  $447.13	      ---	  $563.87	004	1	0	0.00	    $0.00	Y	
O	37735	LIG&DIV&COMPL STRPG SAPH VN             	     2.38	   $88.61	      ---	  $111.74	004	1	0	0.00	    $0.00	Y	
O	37760	LIG PRFRATR VN RADICAL 1 LEG            	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	37760	LIG PRFRATR VN RADICAL 1 LEG            	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	37761	LIGATE LEG VEINS OPEN                   	    12.86	  $478.78	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	37761	LIGATE LEG VEINS OPEN                   	     2.57	   $95.68	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37765	STAB PHLEB VEINS XTR 10-20              	     6.19	  $230.45	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37766	PHLEB VEINS - EXTREM 20+                	     7.75	  $288.53	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	37766	PHLEB VEINS - EXTREM 20+                	     1.55	   $57.71	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	37780	REVISION OF LEG VEIN                    	     3.29	  $122.49	      ---	  $154.47	004	1	0	0.00	    $0.00	Y	
K	37785	LIGATE/DIVIDE/EXCISE VEIN               	     5.06	  $188.38	      ---	  $237.57	004	1	0	0.00	    $0.00	Y	
K	37799	UNLISTED PX VASCULAR SURGERY            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	37799	UNLISTED PX VASCULAR SURGERY            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
P	37799	UNLISTED PX VASCULAR SURGERY            	     0.00	    $0.00	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	38100	REMOVAL OF SPLEEN TOTAL                 	     3.28	  $122.11	      ---	  $154.00	004	1	0	0.00	    $0.00	Y	
K	38100	REMOVAL OF SPLEEN TOTAL                 	    16.42	  $611.32	      ---	  $770.92	004	1	0	0.00	    $0.00	Y	
K	38101	REMOVAL OF SPLEEN PARTIAL               	    18.06	  $672.37	      ---	  $847.92	004	1	0	0.00	    $0.00	Y	
O	38101	REMOVAL OF SPLEEN PARTIAL               	     3.61	  $134.40	      ---	  $169.49	004	1	0	0.00	    $0.00	Y	
O	38102	REMOVAL OF SPLEEN TOTAL                 	     1.11	   $41.33	      ---	   $52.11	004	1	0	0.00	    $0.00	Y	
K	38102	REMOVAL OF SPLEEN TOTAL                 	     5.55	  $206.63	      ---	  $260.57	004	1	0	0.00	    $0.00	Y	
K	38115	REPAIR OF RUPTURED SPLEEN               	    18.12	  $674.61	      ---	  $850.73	004	1	0	0.00	    $0.00	Y	
O	38115	REPAIR OF RUPTURED SPLEEN               	     3.62	  $134.77	      ---	  $169.96	004	1	0	0.00	    $0.00	Y	
O	38120	LAPAROSCOPY SPLENECTOMY                 	     2.90	  $107.97	      ---	  $136.16	004	1	0	0.00	    $0.00	Y	
K	38120	LAPAROSCOPY SPLENECTOMY                 	    14.50	  $539.84	      ---	  $680.78	004	1	0	0.00	    $0.00	Y	
K	38129	UNLISTED LAPS PX SPLEEN                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	38129	UNLISTED LAPS PX SPLEEN                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	38200	INJECTION FOR SPLEEN X-RAY              	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	38204	BL DONOR SEARCH MANAGEMENT              	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	38205	HARVEST ALLOGENEIC STEM CELL            	     1.82	   $67.76	      ---	   $85.45	004	1	0	0.00	    $0.00	Y	
K	38206	HARVEST AUTO STEM CELLS                 	     1.85	   $68.88	      ---	   $86.86	004	1	0	0.00	    $0.00	Y	
K	38207	CRYOPRESERVE STEM CELLS                 	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	38208	THAW PRESERVED STEM CELLS               	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	38209	WASH HARVEST STEM CELLS                 	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	38210	T-CELL DEPLETION OF HARVEST             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	38211	TUMOR CELL DEPLETE OF HARVST            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	38212	RBC DEPLETION OF HARVEST                	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	38213	PLATELET DEPLETE OF HARVEST             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	38214	VOLUME DEPLETE OF HARVEST               	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	38215	HARVEST STEM CELL CONCENTRTE            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	38220	DX BONE MARROW ASPIRATIONS              	     4.93	  $183.54	      ---	  $231.46	004	1	0	0.00	    $0.00	Y	
K	38221	DX BONE MARROW BIOPSIES                 	     5.26	  $195.83	      ---	  $246.96	004	1	0	0.00	    $0.00	Y	
K	38222	DX BONE MARROW BX & ASPIR               	     4.14	  $154.13	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	38222	DX BONE MARROW BX & ASPIR               	     0.82	   $30.53	      ---	       --	004	0	0	0.00	    $0.00	Y	
X	38222	DX BONE MARROW BX & ASPIR               	   163.07	  $163.07	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	38230	BONE MARROW HARVEST ALLOGEN             	     1.18	   $43.93	      ---	   $55.40	004	1	0	0.00	    $0.00	Y	
K	38230	BONE MARROW HARVEST ALLOGEN             	     5.94	  $221.15	      ---	  $278.88	004	1	0	0.00	    $0.00	Y	
K	38232	BONE MARROW HARVEST AUTOLOG             	     4.03	  $150.04	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	38232	BONE MARROW HARVEST AUTOLOG             	     0.81	   $30.16	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	38240	TRANSPLT ALLO HCT/DONOR                 	     2.80	  $104.24	      ---	  $131.46	004	1	0	0.00	    $0.00	N	
K	38241	TRANSPLT AUTOL HCT/DONOR                	     2.80	  $104.24	      ---	  $131.46	004	1	0	0.00	    $0.00	N	
K	38242	TRANSPLT ALLO LYMPHOCYTES               	     2.14	   $79.67	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	38243	TRANSPLJ HEMATOPOIETIC BOOST            	     2.64	   $98.29	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	38300	DRAINAGE LYMPH NODE LESION              	     2.52	   $93.82	      ---	  $118.31	004	1	1	0.00	    $0.00	Y	
K	38305	DRAINAGE LYMPH NODE LESION              	   213.95	  $213.95	      ---	       --	042	0	0	0.00	    $0.00	Y	
O	38305	DRAINAGE LYMPH NODE LESION              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	38308	INCISION OF LYMPH CHANNELS              	     1.74	   $64.78	      ---	   $81.69	004	1	0	0.00	    $0.00	Y	
K	38308	INCISION OF LYMPH CHANNELS              	     8.68	  $323.16	      ---	  $407.53	004	1	0	0.00	    $0.00	Y	
K	38380	THORACIC DUCT PROCEDURE                 	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	38380	THORACIC DUCT PROCEDURE                 	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	38381	THORACIC DUCT PROCEDURE                 	     4.46	  $166.05	      ---	  $209.40	004	1	0	0.00	    $0.00	Y	
K	38381	THORACIC DUCT PROCEDURE                 	    22.30	  $830.23	      ---	 $1046.99	004	1	0	0.00	    $0.00	Y	
K	38382	THORACIC DUCT PROCEDURE                 	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
O	38382	THORACIC DUCT PROCEDURE                 	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
K	38500	BIOPSY/REMOVAL LYMPH NODES              	     2.58	   $96.05	      ---	  $121.13	004	1	1	0.00	    $0.00	Y	
K	38505	NEEDLE BIOPSY LYMPH NODES               	     1.90	   $70.74	      ---	   $89.21	004	1	0	0.00	    $0.00	Y	
K	38510	BIOPSY/REMOVAL LYMPH NODES              	     3.88	  $144.45	      ---	  $182.17	004	1	0	0.00	    $0.00	Y	
O	38510	BIOPSY/REMOVAL LYMPH NODES              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	38520	BIOPSY/REMOVAL LYMPH NODES              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	38520	BIOPSY/REMOVAL LYMPH NODES              	     5.66	  $210.72	      ---	  $265.74	004	1	0	0.00	    $0.00	Y	
K	38525	BIOPSY/REMOVAL LYMPH NODES              	     3.97	  $147.80	      ---	  $186.39	004	1	0	0.00	    $0.00	Y	
O	38525	BIOPSY/REMOVAL LYMPH NODES              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	38530	BIOPSY/REMOVAL LYMPH NODES              	     1.59	   $59.20	      ---	   $74.65	004	1	0	0.00	    $0.00	Y	
K	38530	BIOPSY/REMOVAL LYMPH NODES              	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
K	38531	OPEN BX/EXC INGUINOFEM NODES            	    10.11	  $376.40	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	38531	OPEN BX/EXC INGUINOFEM NODES            	     2.02	   $75.20	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	38542	EXPLORE DEEP NODE(S) NECK               	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
K	38542	EXPLORE DEEP NODE(S) NECK               	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
K	38550	REMOVAL NECK/ARMPIT LESION              	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
O	38550	REMOVAL NECK/ARMPIT LESION              	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
O	38555	REMOVAL NECK/ARMPIT LESION              	     3.38	  $125.84	      ---	  $158.69	004	1	0	0.00	    $0.00	Y	
K	38555	REMOVAL NECK/ARMPIT LESION              	    16.88	  $628.44	      ---	  $792.52	004	1	0	0.00	    $0.00	Y	
K	38562	REMOVAL PELVIC LYMPH NODES              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	38562	REMOVAL PELVIC LYMPH NODES              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	38564	REMOVAL ABDOMEN LYMPH NODES             	     3.26	  $121.37	      ---	  $153.06	004	1	0	0.00	    $0.00	Y	
K	38564	REMOVAL ABDOMEN LYMPH NODES             	    16.29	  $606.48	      ---	  $764.82	004	1	0	0.00	    $0.00	Y	
K	38570	LAPAROSCOPY LYMPH NODE BIOP             	    10.29	  $383.10	      ---	  $483.12	004	1	0	0.00	    $0.00	Y	
O	38570	LAPAROSCOPY LYMPH NODE BIOP             	     2.06	   $76.69	      ---	   $96.72	004	1	0	0.00	    $0.00	Y	
O	38571	LAPAROSCOPY LYMPHADENECTOMY             	     2.59	   $96.43	      ---	  $121.60	004	1	0	0.00	    $0.00	Y	
K	38571	LAPAROSCOPY LYMPHADENECTOMY             	    12.94	  $481.76	      ---	  $607.53	004	1	0	0.00	    $0.00	Y	
K	38572	LAPAROSCOPY LYMPHADENECTOMY             	    16.14	  $600.89	      ---	  $757.77	004	1	0	0.00	    $0.00	Y	
O	38572	LAPAROSCOPY LYMPHADENECTOMY             	     3.23	  $120.25	      ---	  $151.65	004	1	0	0.00	    $0.00	Y	
O	38573	LAPS PELVIC LYMPHADEC                   	     5.34	  $198.81	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	38573	LAPS PELVIC LYMPHADEC                   	    26.70	  $994.04	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	38589	UNLISTED LAPS PX LYMPHTC SYS            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	38589	UNLISTED LAPS PX LYMPHTC SYS            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	38700	REMOVAL OF LYMPH NODES NECK             	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	38700	REMOVAL OF LYMPH NODES NECK             	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	38720	REMOVAL OF LYMPH NODES NECK             	    21.52	  $801.19	      ---	 $1010.36	004	1	0	0.00	    $0.00	Y	
O	38720	REMOVAL OF LYMPH NODES NECK             	     4.30	  $160.09	      ---	  $201.89	004	1	0	0.00	    $0.00	Y	
O	38724	REMOVAL OF LYMPH NODES NECK             	     4.30	  $160.09	      ---	  $201.89	004	1	0	0.00	    $0.00	Y	
K	38724	REMOVAL OF LYMPH NODES NECK             	    21.52	  $801.19	      ---	 $1010.36	004	1	0	0.00	    $0.00	Y	
K	38740	REMOVE ARMPIT LYMPH NODES               	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	38740	REMOVE ARMPIT LYMPH NODES               	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
O	38745	REMOVE ARMPIT LYMPH NODES               	     2.80	  $104.24	      ---	  $131.46	004	1	0	0.00	    $0.00	Y	
K	38745	REMOVE ARMPIT LYMPH NODES               	    14.00	  $521.22	      ---	  $657.30	004	1	0	0.00	    $0.00	Y	
K	38746	REMOVE THORACIC LYMPH NODES             	     5.07	  $188.76	      ---	  $238.04	004	1	0	0.00	    $0.00	Y	
O	38746	REMOVE THORACIC LYMPH NODES             	     1.02	   $37.97	      ---	   $47.89	004	1	0	0.00	    $0.00	Y	
O	38747	REMOVE ABDOMINAL LYMPH NODES            	     1.13	   $42.07	      ---	   $53.05	004	1	0	0.00	    $0.00	Y	
K	38747	REMOVE ABDOMINAL LYMPH NODES            	     5.65	  $210.35	      ---	  $265.27	004	1	0	0.00	    $0.00	Y	
K	38760	REMOVE GROIN LYMPH NODES                	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	38760	REMOVE GROIN LYMPH NODES                	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
O	38765	REMOVE GROIN LYMPH NODES                	     4.52	  $168.28	      ---	  $212.21	004	1	0	0.00	    $0.00	Y	
K	38765	REMOVE GROIN LYMPH NODES                	    22.58	  $840.65	      ---	 $1060.13	004	1	0	0.00	    $0.00	Y	
K	38770	REMOVE PELVIS LYMPH NODES               	    17.14	  $638.12	      ---	  $804.72	004	1	0	0.00	    $0.00	Y	
O	38770	REMOVE PELVIS LYMPH NODES               	     3.41	  $126.95	      ---	  $160.10	004	1	0	0.00	    $0.00	Y	
O	38780	REMOVE ABDOMEN LYMPH NODES              	     5.60	  $208.49	      ---	  $262.92	004	1	0	0.00	    $0.00	Y	
K	38780	REMOVE ABDOMEN LYMPH NODES              	    28.00	 $1042.44	      ---	 $1314.60	004	1	0	0.00	    $0.00	Y	
K	38790	INJECT FOR LYMPHATIC X-RAY              	    12.15	  $452.34	      ---	  $570.44	004	1	0	0.00	    $0.00	Y	
K	38792	RA TRACER ID OF SENTINL NODE            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	38794	ACCESS THORACIC LYMPH DUCT              	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
O	38794	ACCESS THORACIC LYMPH DUCT              	     3.40	  $126.58	      ---	  $159.63	004	1	0	0.00	    $0.00	Y	
O	38900	IO MAP OF SENT LYMPH NODE               	     0.60	   $22.34	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	38900	IO MAP OF SENT LYMPH NODE               	     2.99	  $111.32	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	38999	UNLISTD PX HEMIC/LYMPHTC SYS            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	38999	UNLISTD PX HEMIC/LYMPHTC SYS            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	39000	EXPLORATION OF CHEST                    	     1.54	   $57.33	      ---	   $72.30	004	1	0	0.00	    $0.00	Y	
K	39000	EXPLORATION OF CHEST                    	     7.68	  $285.93	      ---	  $360.58	004	1	0	0.00	    $0.00	Y	
K	39010	EXPLORATION OF CHEST                    	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	39010	EXPLORATION OF CHEST                    	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
O	39200	RESECT MEDIASTINAL CYST                 	     4.08	  $151.90	      ---	  $191.56	004	1	0	0.00	    $0.00	Y	
K	39200	RESECT MEDIASTINAL CYST                 	    20.39	  $759.12	      ---	  $957.31	004	1	0	0.00	    $0.00	Y	
K	39220	RESECT MEDIASTINAL TUMOR                	    20.39	  $759.12	      ---	  $957.31	004	1	0	0.00	    $0.00	Y	
O	39220	RESECT MEDIASTINAL TUMOR                	     4.08	  $151.90	      ---	  $191.56	004	1	0	0.00	    $0.00	Y	
K	39401	MEDIASTINOSCPY W/MEDSTNL BX             	     7.15	  $266.19	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	39402	MEDIASTINOSCPY W/LMPH NOD BX            	     9.31	  $346.61	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	39499	UNLISTED PX MEDIASTINUM                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	39499	UNLISTED PX MEDIASTINUM                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	39501	REPAIR DIAPHRAGM LACERATION             	     3.84	  $142.96	      ---	  $180.29	004	1	0	0.00	    $0.00	Y	
K	39501	REPAIR DIAPHRAGM LACERATION             	    19.20	  $714.82	      ---	  $901.44	004	1	0	0.00	    $0.00	Y	
K	39503	REPAIR OF DIAPHRAGM HERNIA              	    24.92	  $927.77	      ---	 $1169.99	004	1	0	0.00	    $0.00	Y	
O	39503	REPAIR OF DIAPHRAGM HERNIA              	     4.98	  $185.41	      ---	  $233.81	004	1	0	0.00	    $0.00	Y	
O	39540	REPAIR OF DIAPHRAGM HERNIA              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	39540	REPAIR OF DIAPHRAGM HERNIA              	   736.98	  $736.98	      ---	       --	042	0	0	0.00	    $0.00	Y	
K	39541	REPAIR OF DIAPHRAGM HERNIA              	    19.25	  $716.68	      ---	  $903.79	004	1	0	0.00	    $0.00	Y	
O	39541	REPAIR OF DIAPHRAGM HERNIA              	     3.85	  $143.34	      ---	  $180.76	004	1	0	0.00	    $0.00	Y	
O	39545	REVISION OF DIAPHRAGM                   	     4.60	  $171.26	      ---	  $215.97	004	1	0	0.00	    $0.00	Y	
K	39545	REVISION OF DIAPHRAGM                   	    23.20	  $863.74	      ---	 $1089.24	004	1	0	0.00	    $0.00	Y	
K	39560	RESECT DIAPHRAGM SIMPLE                 	    14.68	  $546.54	      ---	  $689.23	004	1	0	0.00	    $0.00	Y	
O	39560	RESECT DIAPHRAGM SIMPLE                 	     2.94	  $109.46	      ---	  $138.03	004	1	0	0.00	    $0.00	Y	
O	39561	RESECT DIAPHRAGM COMPLEX                	     4.01	  $149.29	      ---	  $188.27	004	1	0	0.00	    $0.00	Y	
K	39561	RESECT DIAPHRAGM COMPLEX                	    20.04	  $746.09	      ---	  $940.88	004	1	0	0.00	    $0.00	Y	
K	39599	UNLISTED PX DIAPHRAGM                   	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	39599	UNLISTED PX DIAPHRAGM                   	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	40490	BIOPSY OF LIP                           	     1.30	   $48.40	      ---	   $61.04	004	1	1	0.00	    $0.00	Y	
K	40500	PARTIAL EXCISION OF LIP                 	    10.50	  $390.92	      ---	  $492.98	004	1	0	0.00	    $0.00	Y	
O	40500	PARTIAL EXCISION OF LIP                 	     2.10	   $78.18	      ---	   $98.60	004	1	0	0.00	    $0.00	Y	
O	40510	PARTIAL EXCISION OF LIP                 	     2.10	   $78.18	      ---	   $98.60	004	1	0	0.00	    $0.00	Y	
K	40510	PARTIAL EXCISION OF LIP                 	    10.50	  $390.92	      ---	  $492.98	004	1	0	0.00	    $0.00	Y	
K	40520	PARTIAL EXCISION OF LIP                 	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
O	40520	PARTIAL EXCISION OF LIP                 	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
O	40525	RECONSTRUCT LIP WITH FLAP               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	40525	RECONSTRUCT LIP WITH FLAP               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	40527	RECONSTRUCT LIP WITH FLAP               	    15.02	  $559.19	      ---	  $705.19	004	1	0	0.00	    $0.00	Y	
O	40527	RECONSTRUCT LIP WITH FLAP               	     3.00	  $111.69	      ---	  $140.85	004	1	0	0.00	    $0.00	Y	
O	40530	PARTIAL REMOVAL OF LIP                  	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
K	40530	PARTIAL REMOVAL OF LIP                  	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
K	40650	RPR LIP FTH VERMILION ONLY              	     7.15	  $266.19	      ---	  $335.69	004	1	1	0.00	    $0.00	Y	
O	40650	RPR LIP FTH VERMILION ONLY              	     1.43	   $53.24	      ---	   $67.14	004	1	0	0.00	    $0.00	Y	
O	40652	RPR LIP FTH<HALF VER HEIGHT             	     1.73	   $64.41	      ---	   $81.22	004	1	0	0.00	    $0.00	Y	
K	40652	RPR LIP FTH<HALF VER HEIGHT             	     8.67	  $322.78	      ---	  $407.06	004	1	1	0.00	    $0.00	Y	
K	40654	RPR LIP FTH>1HALF VER HT/CPX            	    10.08	  $375.28	      ---	  $473.26	004	1	1	0.00	    $0.00	Y	
O	40654	RPR LIP FTH>1HALF VER HT/CPX            	     2.02	   $75.20	      ---	   $94.84	004	1	0	0.00	    $0.00	Y	
O	40700	REPAIR CLEFT LIP/NASAL                  	     3.62	  $134.77	      ---	  $169.96	004	1	0	0.00	    $0.00	Y	
K	40700	REPAIR CLEFT LIP/NASAL                  	    18.12	  $674.61	      ---	  $850.73	004	1	0	0.00	    $0.00	Y	
K	40701	REPAIR CLEFT LIP/NASAL                  	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
O	40701	REPAIR CLEFT LIP/NASAL                  	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
O	40702	REPAIR CLEFT LIP/NASAL                  	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
K	40702	REPAIR CLEFT LIP/NASAL                  	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
K	40720	REPAIR CLEFT LIP/NASAL                  	    18.12	  $674.61	      ---	  $850.73	004	1	0	0.00	    $0.00	Y	
O	40720	REPAIR CLEFT LIP/NASAL                  	     3.62	  $134.77	      ---	  $169.96	004	1	0	0.00	    $0.00	Y	
O	40761	REPAIR CLEFT LIP/NASAL                  	     5.11	  $190.25	      ---	  $239.91	004	1	0	0.00	    $0.00	Y	
K	40761	REPAIR CLEFT LIP/NASAL                  	    25.56	  $951.60	      ---	 $1200.04	004	1	0	0.00	    $0.00	Y	
K	40799	UNLISTED PROCEDURE LIPS                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	40799	UNLISTED PROCEDURE LIPS                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	40800	DRAINAGE OF MOUTH LESION                	     1.33	   $49.52	      ---	   $62.44	004	1	1	0.00	    $0.00	Y	
K	40801	DRAINAGE OF MOUTH LESION                	     4.12	  $153.39	      ---	  $193.43	004	1	0	0.00	    $0.00	Y	
K	40804	REMOVAL FOREIGN BODY MOUTH              	     1.64	   $61.06	      ---	   $77.00	004	1	1	0.00	    $0.00	Y	
X	40804	REMOVAL FOREIGN BODY MOUTH              	   175.37	  $175.37	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	40805	REMOVAL FOREIGN BODY MOUTH              	   263.93	  $263.93	      ---	       --	009	1	0	0.00	    $0.00	Y	
K	40805	REMOVAL FOREIGN BODY MOUTH              	     2.51	   $93.45	      ---	  $117.84	004	1	0	0.00	    $0.00	Y	
K	40808	BIOPSY OF MOUTH LESION                  	     1.27	   $47.28	      ---	   $59.63	004	1	1	0.00	    $0.00	Y	
K	40812	EXCISE/REPAIR MOUTH LESION              	     2.31	   $86.00	      ---	  $108.45	004	1	1	0.00	    $0.00	Y	
K	40814	EXCISE/REPAIR MOUTH LESION              	     6.37	  $237.16	      ---	  $299.07	004	1	0	0.00	    $0.00	Y	
O	40814	EXCISE/REPAIR MOUTH LESION              	     1.27	   $47.28	      ---	   $59.63	004	1	0	0.00	    $0.00	Y	
K	40816	EXCISION OF MOUTH LESION                	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
K	40818	EXCISE ORAL MUCOSA FOR GRAFT            	     5.42	  $201.79	      ---	  $254.47	004	1	0	0.00	    $0.00	Y	
O	40818	EXCISE ORAL MUCOSA FOR GRAFT            	     1.09	   $40.58	      ---	   $51.18	004	1	0	0.00	    $0.00	Y	
K	40819	EXCISE LIP OR CHEEK FOLD                	     4.90	  $182.43	      ---	  $230.06	004	1	0	0.00	    $0.00	Y	
K	40820	TREATMENT OF MOUTH LESION               	     1.56	   $58.08	      ---	   $73.24	004	1	1	0.00	    $0.00	Y	
K	40830	REPAIR MOUTH LACERATION                 	     1.84	   $68.50	      ---	   $86.39	004	1	1	0.00	    $0.00	Y	
K	40831	REPAIR MOUTH LACERATION                 	     4.11	  $153.02	      ---	  $192.96	004	1	0	0.00	    $0.00	Y	
O	40831	REPAIR MOUTH LACERATION                 	     0.82	   $30.53	      ---	   $38.50	004	1	0	0.00	    $0.00	Y	
O	40840	RECONSTRUCTION OF MOUTH                 	     2.65	   $98.66	      ---	  $124.42	004	1	0	0.00	    $0.00	Y	
K	40840	RECONSTRUCTION OF MOUTH                 	    13.24	  $492.93	      ---	  $621.62	004	1	0	0.00	    $0.00	Y	
K	40842	RECONSTRUCTION OF MOUTH                 	    13.23	  $492.55	      ---	  $621.15	004	1	0	0.00	    $0.00	Y	
O	40842	RECONSTRUCTION OF MOUTH                 	     2.65	   $98.66	      ---	  $124.42	004	1	0	0.00	    $0.00	Y	
O	40843	RECONSTRUCTION OF MOUTH                 	     3.48	  $129.56	      ---	  $163.39	004	1	0	0.00	    $0.00	Y	
K	40843	RECONSTRUCTION OF MOUTH                 	    17.41	  $648.17	      ---	  $817.40	004	1	0	0.00	    $0.00	Y	
K	40844	RECONSTRUCTION OF MOUTH                 	    22.37	  $832.84	      ---	 $1050.27	004	1	0	0.00	    $0.00	Y	
O	40844	RECONSTRUCTION OF MOUTH                 	     4.47	  $166.42	      ---	  $209.87	004	1	0	0.00	    $0.00	Y	
O	40845	RECONSTRUCTION OF MOUTH                 	     5.31	  $197.69	      ---	  $249.30	004	1	0	0.00	    $0.00	Y	
K	40845	RECONSTRUCTION OF MOUTH                 	    26.56	  $988.83	      ---	 $1246.99	004	1	0	0.00	    $0.00	Y	
K	40899	UNLISTED PX VESTIBULE MOUTH             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	40899	UNLISTED PX VESTIBULE MOUTH             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	41000	DRAINAGE OF MOUTH LESION                	     1.54	   $57.33	      ---	   $72.30	004	1	1	0.00	    $0.00	Y	
K	41005	DRAINAGE OF MOUTH LESION                	     1.45	   $53.98	      ---	   $68.08	004	1	1	0.00	    $0.00	Y	
K	41006	DRAINAGE OF MOUTH LESION                	     5.95	  $221.52	      ---	  $279.35	004	1	0	0.00	    $0.00	Y	
O	41006	DRAINAGE OF MOUTH LESION                	     1.19	   $44.30	      ---	   $55.87	004	1	0	0.00	    $0.00	Y	
K	41007	DRAINAGE OF MOUTH LESION                	     5.64	  $209.98	      ---	  $264.80	004	1	0	0.00	    $0.00	Y	
K	41008	DRAINAGE OF MOUTH LESION                	     5.88	  $218.91	      ---	  $276.07	004	1	0	0.00	    $0.00	Y	
K	41009	DRAINAGE OF MOUTH LESION                	     6.16	  $229.34	      ---	  $289.21	004	1	0	0.00	    $0.00	Y	
K	41010	INCISION OF TONGUE FOLD                 	     4.11	  $153.02	      ---	  $192.96	004	1	0	0.00	    $0.00	Y	
K	41015	DRAINAGE OF MOUTH LESION                	     3.60	  $134.03	      ---	  $169.02	004	1	0	0.00	    $0.00	Y	
O	41015	DRAINAGE OF MOUTH LESION                	     0.72	   $26.81	      ---	   $33.80	004	1	0	0.00	    $0.00	Y	
K	41016	DRAINAGE OF MOUTH LESION                	     6.60	  $245.72	      ---	  $309.87	004	1	0	0.00	    $0.00	Y	
K	41017	DRAINAGE OF MOUTH LESION                	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
K	41018	DRAINAGE OF MOUTH LESION                	     8.24	  $306.78	      ---	  $386.87	004	1	0	0.00	    $0.00	Y	
K	41019	PLACE NEEDLES H&N FOR RT                	     9.77	  $363.74	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	41019	PLACE NEEDLES H&N FOR RT                	     1.95	   $72.60	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	41100	BIOPSY OF TONGUE                        	     1.82	   $67.76	      ---	   $85.45	004	1	1	0.00	    $0.00	Y	
K	41105	BIOPSY OF TONGUE                        	     1.62	   $60.31	      ---	   $76.06	004	1	1	0.00	    $0.00	Y	
K	41108	BIOPSY OF FLOOR OF MOUTH                	     2.61	   $97.17	      ---	  $122.54	004	1	0	0.00	    $0.00	Y	
K	41110	EXCISION OF TONGUE LESION               	     3.59	  $133.66	      ---	  $168.55	004	1	0	0.00	    $0.00	Y	
O	41110	EXCISION OF TONGUE LESION               	     0.72	   $26.81	      ---	   $33.80	004	1	0	0.00	    $0.00	Y	
O	41112	EXCISION OF TONGUE LESION               	     1.03	   $38.35	      ---	   $48.36	004	1	0	0.00	    $0.00	Y	
K	41112	EXCISION OF TONGUE LESION               	     5.14	  $191.36	      ---	  $241.32	004	1	0	0.00	    $0.00	Y	
K	41113	EXCISION OF TONGUE LESION               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	41113	EXCISION OF TONGUE LESION               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	41114	EXCISION OF TONGUE LESION               	     2.50	   $93.08	      ---	  $117.38	004	1	0	0.00	    $0.00	Y	
K	41114	EXCISION OF TONGUE LESION               	    12.51	  $465.75	      ---	  $587.34	004	1	0	0.00	    $0.00	Y	
K	41116	EXCISION OF MOUTH LESION                	     4.80	  $178.70	      ---	  $225.36	004	1	0	0.00	    $0.00	Y	
K	41120	PARTIAL REMOVAL OF TONGUE               	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	41120	PARTIAL REMOVAL OF TONGUE               	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
O	41130	PARTIAL REMOVAL OF TONGUE               	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	41130	PARTIAL REMOVAL OF TONGUE               	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	41135	TONGUE AND NECK SURGERY                 	    29.45	 $1096.42	      ---	 $1382.68	004	1	0	0.00	    $0.00	Y	
O	41135	TONGUE AND NECK SURGERY                 	     5.89	  $219.28	      ---	  $276.54	004	1	0	0.00	    $0.00	Y	
O	41140	REMOVAL OF TONGUE                       	     4.08	  $151.90	      ---	  $191.56	004	1	0	0.00	    $0.00	Y	
K	41140	REMOVAL OF TONGUE                       	    20.39	  $759.12	      ---	  $957.31	004	1	0	0.00	    $0.00	Y	
K	41145	TONGUE REMOVAL NECK SURGERY             	    29.45	 $1096.42	      ---	 $1382.68	004	1	0	0.00	    $0.00	Y	
O	41145	TONGUE REMOVAL NECK SURGERY             	     5.89	  $219.28	      ---	  $276.54	004	1	0	0.00	    $0.00	Y	
O	41150	TONGUE MOUTH JAW SURGERY                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	41150	TONGUE MOUTH JAW SURGERY                	    29.61	 $1102.38	      ---	 $1390.19	004	1	0	0.00	    $0.00	Y	
K	41153	TONGUE MOUTH NECK SURGERY               	    39.41	 $1467.23	      ---	 $1850.30	004	1	0	0.00	    $0.00	Y	
O	41153	TONGUE MOUTH NECK SURGERY               	     7.88	  $293.37	      ---	  $369.97	004	1	0	0.00	    $0.00	Y	
O	41155	TONGUE JAW & NECK SURGERY               	     8.20	  $305.29	      ---	  $384.99	004	1	0	0.00	    $0.00	Y	
K	41155	TONGUE JAW & NECK SURGERY               	    40.99	 $1526.06	      ---	 $1924.48	004	1	0	0.00	    $0.00	Y	
K	41250	REPAIR TONGUE LACERATION                	     2.01	   $74.83	      ---	   $94.37	004	1	1	0.00	    $0.00	Y	
K	41251	REPAIR TONGUE LACERATION                	     2.06	   $76.69	      ---	   $96.72	004	1	0	0.00	    $0.00	Y	
K	41252	REPAIR TONGUE LACERATION                	     5.14	  $191.36	      ---	  $241.32	004	1	0	0.00	    $0.00	Y	
O	41252	REPAIR TONGUE LACERATION                	     1.03	   $38.35	      ---	   $48.36	004	1	0	0.00	    $0.00	Y	
O	41510	TONGUE TO LIP SURGERY                   	     2.00	   $74.46	      ---	   $93.90	004	1	0	0.00	    $0.00	Y	
K	41510	TONGUE TO LIP SURGERY                   	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
K	41512	TONGUE SUSPENSION                       	    11.66	  $434.10	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	41512	TONGUE SUSPENSION                       	     2.33	   $86.75	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	41520	RECONSTRUCTION TONGUE FOLD              	     6.30	  $234.55	      ---	  $295.79	004	1	0	0.00	    $0.00	Y	
K	41530	TONGUE BASE VOL REDUCTION               	     7.64	  $284.44	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	41599	UNLISTED PX TONGUE FLR MOUTH            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	41599	UNLISTED PX TONGUE FLR MOUTH            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	41800	DRAINAGE OF GUM LESION                  	     1.34	   $49.89	      ---	   $62.91	004	1	1	0.00	    $0.00	Y	
K	41805	REMOVAL FOREIGN BODY GUM                	     2.56	   $95.31	      ---	  $120.19	004	1	1	0.00	    $0.00	Y	
O	41805	REMOVAL FOREIGN BODY GUM                	     0.51	   $18.99	      ---	   $23.94	004	1	0	0.00	    $0.00	Y	
O	41806	REMOVAL FOREIGN BODY JAWBONE            	     0.88	   $32.76	      ---	   $41.32	004	1	0	0.00	    $0.00	Y	
K	41806	REMOVAL FOREIGN BODY JAWBONE            	     4.42	  $164.56	      ---	  $207.52	004	1	0	0.00	    $0.00	Y	
K	41820	EXCISION GUM EACH QUADRANT              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	41821	EXCISION OF GUM FLAP                    	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	41822	EXCISION OF GUM LESION                  	     4.29	  $159.72	      ---	  $201.42	004	1	0	0.00	    $0.00	Y	
K	41823	EXCISION OF GUM LESION                  	     5.83	  $217.05	      ---	  $273.72	004	1	0	0.00	    $0.00	Y	
K	41825	EXCISION OF GUM LESION                  	     3.00	  $111.69	      ---	  $140.85	004	1	0	0.00	    $0.00	Y	
K	41826	EXCISION OF GUM LESION                  	     4.21	  $156.74	      ---	  $197.66	004	1	0	0.00	    $0.00	Y	
K	41827	EXCISION OF GUM LESION                  	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
O	41827	EXCISION OF GUM LESION                  	     1.20	   $44.68	      ---	   $56.34	004	1	0	0.00	    $0.00	Y	
K	41828	EXCISION OF GUM LESION                  	     5.31	  $197.69	      ---	  $249.30	004	1	0	0.00	    $0.00	Y	
K	41830	REMOVAL OF GUM TISSUE                   	     5.68	  $211.47	      ---	  $266.68	004	1	0	0.00	    $0.00	Y	
K	41850	TREATMENT OF GUM LESION                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	41850	TREATMENT OF GUM LESION                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	41870	PERIODONTAL MUCOSAL GRAFTING            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	41872	GINGIVOPLASTY EACH QUADRANT             	     4.62	  $172.00	      ---	  $216.91	004	1	0	0.00	    $0.00	Y	
K	41874	ALVEOLOPLASTY EACH QUADRANT             	     5.15	  $191.73	      ---	  $241.79	004	1	0	0.00	    $0.00	Y	
K	41899	UNLISTED PX DENTALVLR STRUX             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	41899	UNLISTED PX DENTALVLR STRUX             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	42000	DRAINAGE MOUTH ROOF LESION              	     1.56	   $58.08	      ---	   $73.24	004	1	1	0.00	    $0.00	Y	
K	42100	BIOPSY ROOF OF MOUTH                    	     1.57	   $58.45	      ---	   $73.71	004	1	1	0.00	    $0.00	Y	
K	42104	EXCISION LESION MOUTH ROOF              	     3.25	  $121.00	      ---	  $152.59	004	1	1	0.00	    $0.00	Y	
O	42104	EXCISION LESION MOUTH ROOF              	     0.65	   $24.20	      ---	   $30.52	004	1	0	0.00	    $0.00	Y	
O	42106	EXCISION LESION MOUTH ROOF              	     0.80	   $29.78	      ---	   $37.56	004	1	0	0.00	    $0.00	Y	
K	42106	EXCISION LESION MOUTH ROOF              	     4.00	  $148.92	      ---	  $187.80	004	1	1	0.00	    $0.00	Y	
K	42107	EXCISION LESION MOUTH ROOF              	     7.42	  $276.25	      ---	  $348.37	004	1	1	0.00	    $0.00	Y	
O	42107	EXCISION LESION MOUTH ROOF              	     1.48	   $55.10	      ---	   $69.49	004	1	0	0.00	    $0.00	Y	
O	42120	REMOVE PALATE/LESION                    	     2.03	   $75.58	      ---	   $95.31	004	1	0	0.00	    $0.00	Y	
K	42120	REMOVE PALATE/LESION                    	    10.14	  $377.51	      ---	  $476.07	004	1	0	0.00	    $0.00	Y	
K	42140	EXCISION OF UVULA                       	     2.18	   $81.16	      ---	  $102.35	004	1	0	0.00	    $0.00	Y	
K	42145	REPAIR PALATE PHARYNX/UVULA             	    12.97	  $482.87	      ---	  $608.94	004	1	0	0.00	    $0.00	Y	
O	42145	REPAIR PALATE PHARYNX/UVULA             	     2.59	   $96.43	      ---	  $121.60	004	1	0	0.00	    $0.00	Y	
K	42160	TREATMENT MOUTH ROOF LESION             	     2.03	   $75.58	      ---	   $95.31	004	1	1	0.00	    $0.00	Y	
K	42180	REPAIR LAC PALATE<2 CM                  	     4.21	  $156.74	      ---	  $197.66	004	1	1	0.00	    $0.00	Y	
K	42182	REPAIR PALATE                           	     5.73	  $213.33	      ---	  $269.02	004	1	0	0.00	    $0.00	Y	
O	42182	REPAIR PALATE                           	     1.15	   $42.81	      ---	   $53.99	004	1	0	0.00	    $0.00	Y	
O	42200	RECONSTRUCT CLEFT PALATE                	     3.62	  $134.77	      ---	  $169.96	004	1	0	0.00	    $0.00	Y	
K	42200	RECONSTRUCT CLEFT PALATE                	    18.12	  $674.61	      ---	  $850.73	004	1	0	0.00	    $0.00	Y	
K	42205	RECONSTRUCT CLEFT PALATE                	    20.00	  $744.60	      ---	  $939.00	004	1	1	0.00	    $0.00	Y	
O	42205	RECONSTRUCT CLEFT PALATE                	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
O	42210	RECONSTRUCT CLEFT PALATE                	     4.40	  $163.81	      ---	  $206.58	004	1	0	0.00	    $0.00	Y	
K	42210	RECONSTRUCT CLEFT PALATE                	    22.00	  $819.06	      ---	 $1032.90	004	1	0	0.00	    $0.00	Y	
K	42215	RECONSTRUCT CLEFT PALATE                	    16.00	  $595.68	      ---	  $751.20	004	1	0	0.00	    $0.00	Y	
O	42215	RECONSTRUCT CLEFT PALATE                	     3.20	  $119.14	      ---	  $150.24	004	1	0	0.00	    $0.00	Y	
O	42220	RECONSTRUCT CLEFT PALATE                	     3.40	  $126.58	      ---	  $159.63	004	1	0	0.00	    $0.00	Y	
K	42220	RECONSTRUCT CLEFT PALATE                	    17.00	  $632.91	      ---	  $798.15	004	1	0	0.00	    $0.00	Y	
K	42225	RECONSTRUCT CLEFT PALATE                	    17.00	  $632.91	      ---	  $798.15	004	1	0	0.00	    $0.00	Y	
O	42225	RECONSTRUCT CLEFT PALATE                	     3.40	  $126.58	      ---	  $159.63	004	1	0	0.00	    $0.00	Y	
O	42226	LENGTHENING OF PALATE                   	     3.40	  $126.58	      ---	  $159.63	004	1	0	0.00	    $0.00	Y	
K	42226	LENGTHENING OF PALATE                   	    17.00	  $632.91	      ---	  $798.15	004	1	0	0.00	    $0.00	Y	
K	42227	LENGTHENING OF PALATE                   	    17.00	  $632.91	      ---	  $798.15	004	1	0	0.00	    $0.00	Y	
O	42227	LENGTHENING OF PALATE                   	     3.40	  $126.58	      ---	  $159.63	004	1	0	0.00	    $0.00	Y	
O	42235	REPAIR PALATE                           	     3.20	  $119.14	      ---	  $150.24	004	1	0	0.00	    $0.00	Y	
K	42235	REPAIR PALATE                           	    16.00	  $595.68	      ---	  $751.20	004	1	0	0.00	    $0.00	Y	
K	42260	REPAIR NOSE TO LIP FISTULA              	    14.60	  $543.56	      ---	  $685.47	004	1	1	0.00	    $0.00	Y	
O	42260	REPAIR NOSE TO LIP FISTULA              	     2.92	  $108.71	      ---	  $137.09	004	1	0	0.00	    $0.00	Y	
K	42280	PREPARATION PALATE MOLD                 	     2.56	   $95.31	      ---	  $120.19	004	1	1	0.00	    $0.00	Y	
K	42281	INSERTION PALATE PROSTHESIS             	     3.02	  $112.43	      ---	  $141.79	004	1	1	0.00	    $0.00	Y	
K	42299	UNLISTED PX PALATE UVULA                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	42299	UNLISTED PX PALATE UVULA                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	42300	DRAINAGE OF SALIVARY GLAND              	     1.99	   $74.09	      ---	   $93.43	004	1	1	0.00	    $0.00	Y	
K	42305	DRAINAGE OF SALIVARY GLAND              	    11.01	  $409.90	      ---	  $516.92	004	1	0	0.00	    $0.00	Y	
O	42305	DRAINAGE OF SALIVARY GLAND              	     2.20	   $81.91	      ---	  $103.29	004	1	0	0.00	    $0.00	Y	
K	42310	DRAINAGE OF SALIVARY GLAND              	     1.73	   $64.41	      ---	   $81.22	004	1	1	0.00	    $0.00	Y	
K	42320	DRAINAGE OF SALIVARY GLAND              	     2.38	   $88.61	      ---	  $111.74	004	1	0	0.00	    $0.00	Y	
K	42330	REMOVAL OF SALIVARY STONE               	     2.19	   $81.53	      ---	  $102.82	004	1	1	0.00	    $0.00	Y	
K	42335	REMOVAL OF SALIVARY STONE               	     3.09	  $115.04	      ---	  $145.08	004	1	0	0.00	    $0.00	Y	
K	42340	REMOVAL OF SALIVARY STONE               	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
O	42340	REMOVAL OF SALIVARY STONE               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	42400	BIOPSY OF SALIVARY GLAND                	     1.35	   $50.26	      ---	   $63.38	004	1	1	0.00	    $0.00	Y	
K	42405	BIOPSY OF SALIVARY GLAND                	     2.95	  $109.83	      ---	  $138.50	004	1	0	0.00	    $0.00	Y	
K	42408	EXCISION OF SALIVARY CYST               	     7.32	  $272.52	      ---	  $343.67	004	1	0	0.00	    $0.00	Y	
O	42408	EXCISION OF SALIVARY CYST               	     1.46	   $54.36	      ---	   $68.55	004	1	0	0.00	    $0.00	Y	
O	42409	DRAINAGE OF SALIVARY CYST               	     1.02	   $37.97	      ---	   $47.89	004	1	0	0.00	    $0.00	Y	
K	42409	DRAINAGE OF SALIVARY CYST               	     5.11	  $190.25	      ---	  $239.91	004	1	0	0.00	    $0.00	Y	
K	42410	EXCISE PAROTID GLAND/LESION             	     7.81	  $290.77	      ---	  $366.68	004	1	0	0.00	    $0.00	Y	
O	42410	EXCISE PAROTID GLAND/LESION             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	42415	EXCISE PAROTID GLAND/LESION             	     3.28	  $122.11	      ---	  $154.00	004	1	0	0.00	    $0.00	Y	
K	42415	EXCISE PAROTID GLAND/LESION             	    16.42	  $611.32	      ---	  $770.92	004	1	0	0.00	    $0.00	Y	
K	42420	EXCISE PAROTID GLAND/LESION             	    20.39	  $759.12	      ---	  $957.31	004	1	0	0.00	    $0.00	Y	
O	42420	EXCISE PAROTID GLAND/LESION             	     4.08	  $151.90	      ---	  $191.56	004	1	0	0.00	    $0.00	Y	
O	42425	EXCISE PAROTID GLAND/LESION             	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	42425	EXCISE PAROTID GLAND/LESION             	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	42426	EXCISE PAROTID GLAND/LESION             	    31.18	 $1160.83	      ---	 $1463.90	004	1	0	0.00	    $0.00	Y	
O	42426	EXCISE PAROTID GLAND/LESION             	     6.21	  $231.20	      ---	  $291.56	004	1	0	0.00	    $0.00	Y	
O	42440	EXCISE SUBMAXILLARY GLAND               	     2.18	   $81.16	      ---	  $102.35	004	1	0	0.00	    $0.00	Y	
K	42440	EXCISE SUBMAXILLARY GLAND               	    10.91	  $406.18	      ---	  $512.22	004	1	0	0.00	    $0.00	Y	
K	42450	EXCISE SUBLINGUAL GLAND                 	     6.23	  $231.94	      ---	  $292.50	004	1	0	0.00	    $0.00	Y	
O	42450	EXCISE SUBLINGUAL GLAND                 	     1.25	   $46.54	      ---	   $58.69	004	1	0	0.00	    $0.00	Y	
O	42500	REPAIR SALIVARY DUCT                    	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	42500	REPAIR SALIVARY DUCT                    	     7.51	  $279.60	      ---	  $352.59	004	1	0	0.00	    $0.00	Y	
K	42505	REPAIR SALIVARY DUCT                    	    10.39	  $386.82	      ---	  $487.81	004	1	0	0.00	    $0.00	Y	
O	42505	REPAIR SALIVARY DUCT                    	     2.08	   $77.44	      ---	   $97.66	004	1	0	0.00	    $0.00	Y	
O	42507	PAROTID DUCT DIVERSION                  	     2.34	   $87.12	      ---	  $109.86	004	1	0	0.00	    $0.00	Y	
K	42507	PAROTID DUCT DIVERSION                  	    11.68	  $434.85	      ---	  $548.38	004	1	0	0.00	    $0.00	Y	
K	42509	PAROTID DUCT DIVERSION                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	42509	PAROTID DUCT DIVERSION                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	42510	PAROTID DUCT DIVERSION                  	     2.54	   $94.56	      ---	  $119.25	004	1	0	0.00	    $0.00	Y	
K	42510	PAROTID DUCT DIVERSION                  	    12.69	  $472.45	      ---	  $595.80	004	1	0	0.00	    $0.00	Y	
K	42550	INJECTION FOR SALIVARY X-RAY            	     5.87	  $218.54	      ---	  $275.60	004	1	0	0.00	    $0.00	Y	
K	42600	CLOSURE OF SALIVARY FISTULA             	     9.19	  $342.14	      ---	  $431.47	004	1	0	0.00	    $0.00	Y	
O	42600	CLOSURE OF SALIVARY FISTULA             	     1.84	   $68.50	      ---	   $86.39	004	1	0	0.00	    $0.00	Y	
K	42650	DILATION OF SALIVARY DUCT               	     0.81	   $30.16	      ---	   $38.03	004	1	1	0.00	    $0.00	Y	
K	42660	DILATION OF SALIVARY DUCT               	     1.05	   $39.09	      ---	   $49.30	004	1	1	0.00	    $0.00	Y	
K	42665	LIGATION OF SALIVARY DUCT               	     5.22	  $194.34	      ---	  $245.08	004	1	0	0.00	    $0.00	Y	
O	42665	LIGATION OF SALIVARY DUCT               	     1.04	   $38.72	      ---	   $48.83	004	1	0	0.00	    $0.00	Y	
O	42699	UNLISTED PX SALIVRY GLND/DUX            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	42699	UNLISTED PX SALIVRY GLND/DUX            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	42700	DRAINAGE OF TONSIL ABSCESS              	     1.96	   $72.97	      ---	   $92.02	004	1	0	0.00	    $0.00	Y	
K	42720	DRAINAGE OF THROAT ABSCESS              	     4.66	  $173.49	      ---	  $218.79	004	1	0	0.00	    $0.00	Y	
K	42725	DRAINAGE OF THROAT ABSCESS              	    16.45	  $612.43	      ---	  $772.33	004	1	0	0.00	    $0.00	Y	
O	42725	DRAINAGE OF THROAT ABSCESS              	     3.29	  $122.49	      ---	  $154.47	004	1	0	0.00	    $0.00	Y	
K	42800	BIOPSY OF THROAT                        	     1.78	   $66.27	      ---	   $83.57	004	1	1	0.00	    $0.00	Y	
K	42804	BIOPSY OF UPPER NOSE/THROAT             	     1.68	   $62.55	      ---	   $78.88	004	1	0	0.00	    $0.00	Y	
K	42806	BIOPSY OF UPPER NOSE/THROAT             	     3.74	  $139.24	      ---	  $175.59	004	1	1	0.00	    $0.00	Y	
O	42806	BIOPSY OF UPPER NOSE/THROAT             	     0.75	   $27.92	      ---	   $35.21	004	1	0	0.00	    $0.00	Y	
O	42808	EXCISE PHARYNX LESION                   	     1.06	   $39.46	      ---	   $49.77	004	1	0	0.00	    $0.00	Y	
K	42808	EXCISE PHARYNX LESION                   	     5.30	  $197.32	      ---	  $248.84	004	1	0	0.00	    $0.00	Y	
K	42809	REMOVE PHARYNX FOREIGN BODY             	     3.99	  $148.55	      ---	  $187.33	004	1	0	0.00	    $0.00	Y	
K	42810	EXCISION OF NECK CYST                   	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	42815	EXCISION OF NECK CYST                   	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	42815	EXCISION OF NECK CYST                   	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	42820	REMOVE TONSILS AND ADENOIDS             	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	42821	REMOVE TONSILS AND ADENOIDS             	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
K	42825	REMOVAL OF TONSILS                      	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	42826	REMOVAL OF TONSILS                      	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
K	42830	REMOVAL OF ADENOIDS                     	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
K	42831	REMOVAL OF ADENOIDS                     	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
K	42835	REMOVAL OF ADENOIDS                     	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
K	42836	REMOVAL OF ADENOIDS                     	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
K	42842	EXTENSIVE SURGERY OF THROAT             	    13.84	  $515.26	      ---	  $649.79	004	1	0	0.00	    $0.00	Y	
O	42842	EXTENSIVE SURGERY OF THROAT             	     2.77	  $103.13	      ---	  $130.05	004	1	0	0.00	    $0.00	Y	
O	42844	EXTENSIVE SURGERY OF THROAT             	     4.74	  $176.47	      ---	  $222.54	004	1	0	0.00	    $0.00	Y	
K	42844	EXTENSIVE SURGERY OF THROAT             	    23.72	  $883.10	      ---	 $1113.65	004	1	0	0.00	    $0.00	Y	
K	42845	EXTENSIVE SURGERY OF THROAT             	    39.31	 $1463.51	      ---	 $1845.60	004	1	0	0.00	    $0.00	Y	
O	42845	EXTENSIVE SURGERY OF THROAT             	     7.86	  $292.63	      ---	  $369.03	004	1	0	0.00	    $0.00	Y	
K	42860	EXCISION OF TONSIL TAGS                 	     3.17	  $118.02	      ---	  $148.83	004	1	1	0.00	    $0.00	Y	
K	42870	EXCISION OF LINGUAL TONSIL              	     5.44	  $202.53	      ---	  $255.41	004	1	1	0.00	    $0.00	Y	
K	42890	LIMITED PHARYNGECTOMY                   	    20.08	  $747.58	      ---	  $942.76	004	1	0	0.00	    $0.00	Y	
O	42890	LIMITED PHARYNGECTOMY                   	     4.02	  $149.66	      ---	  $188.74	004	1	0	0.00	    $0.00	Y	
O	42892	REVISION OF PHARYNGEAL WALLS            	     4.78	  $177.96	      ---	  $224.42	004	1	0	0.00	    $0.00	Y	
K	42892	REVISION OF PHARYNGEAL WALLS            	    23.90	  $889.80	      ---	 $1122.11	004	1	0	0.00	    $0.00	Y	
K	42894	REVISION OF PHARYNGEAL WALLS            	    37.16	 $1383.47	      ---	 $1744.66	004	1	0	0.00	    $0.00	Y	
O	42894	REVISION OF PHARYNGEAL WALLS            	     7.43	  $276.62	      ---	  $348.84	004	1	0	0.00	    $0.00	Y	
O	42900	REPAIR THROAT WOUND                     	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	42900	REPAIR THROAT WOUND                     	     4.15	  $154.50	      ---	  $194.84	004	1	0	0.00	    $0.00	Y	
K	42950	RECONSTRUCTION OF THROAT                	     6.98	  $259.87	      ---	  $327.71	004	1	0	0.00	    $0.00	Y	
O	42950	RECONSTRUCTION OF THROAT                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	42953	REPAIR THROAT ESOPHAGUS                 	     3.33	  $123.98	      ---	  $156.34	004	1	0	0.00	    $0.00	Y	
K	42953	REPAIR THROAT ESOPHAGUS                 	    16.65	  $619.88	      ---	  $781.72	004	1	0	0.00	    $0.00	Y	
K	42955	SURGICAL OPENING OF THROAT              	    12.99	  $483.62	      ---	  $609.88	004	1	0	0.00	    $0.00	Y	
O	42955	SURGICAL OPENING OF THROAT              	     2.60	   $96.80	      ---	  $122.07	004	1	0	0.00	    $0.00	Y	
K	42960	CONTROL THROAT BLEEDING                 	     1.99	   $74.09	      ---	   $93.43	004	1	0	0.00	    $0.00	Y	
K	42961	CONTROL THROAT BLEEDING                 	     9.02	  $335.81	      ---	  $423.49	004	1	0	0.00	    $0.00	Y	
O	42961	CONTROL THROAT BLEEDING                 	     1.80	   $67.01	      ---	   $84.51	004	1	0	0.00	    $0.00	Y	
K	42962	CONTROL THROAT BLEEDING                 	    11.08	  $412.51	      ---	  $520.21	004	1	0	0.00	    $0.00	Y	
K	42970	CONTROL NOSE/THROAT BLEEDING            	     4.14	  $154.13	      ---	  $194.37	004	1	0	0.00	    $0.00	Y	
K	42971	CONTROL NOSE/THROAT BLEEDING            	    11.18	  $416.23	      ---	  $524.90	004	1	0	0.00	    $0.00	Y	
O	42971	CONTROL NOSE/THROAT BLEEDING            	     2.24	   $83.40	      ---	  $105.17	004	1	0	0.00	    $0.00	Y	
K	42972	CONTROL NOSE/THROAT BLEEDING            	    12.22	  $454.95	      ---	  $573.73	004	1	0	0.00	    $0.00	Y	
K	42975	DISE EVAL SLP DO BRTH FLX DX            	     2.60	   $96.80	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	42999	UNLISTED PX PHRNX ADND/TNSL             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	42999	UNLISTED PX PHRNX ADND/TNSL             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	43020	INCISION OF ESOPHAGUS                   	     2.80	  $104.24	      ---	  $131.46	004	1	0	0.00	    $0.00	Y	
K	43020	INCISION OF ESOPHAGUS                   	    14.00	  $521.22	      ---	  $657.30	004	1	0	0.00	    $0.00	Y	
K	43030	CRICOPHARYNGEAL MYOTOMY                 	    14.00	  $521.22	      ---	  $657.30	004	1	0	0.00	    $0.00	Y	
O	43030	CRICOPHARYNGEAL MYOTOMY                 	     2.80	  $104.24	      ---	  $131.46	004	1	0	0.00	    $0.00	Y	
O	43045	ESOPHAGOTOMY THRC RMVL FB               	     4.30	  $160.09	      ---	  $201.89	004	1	0	0.00	    $0.00	Y	
K	43045	ESOPHAGOTOMY THRC RMVL FB               	    21.52	  $801.19	      ---	 $1010.36	004	1	0	0.00	    $0.00	Y	
K	43100	EXCISION OF ESOPHAGUS LESION            	    19.00	  $707.37	      ---	  $892.05	004	1	0	0.00	    $0.00	Y	
O	43100	EXCISION OF ESOPHAGUS LESION            	     3.80	  $141.47	      ---	  $178.41	004	1	0	0.00	    $0.00	Y	
O	43101	EXCISION OF ESOPHAGUS LESION            	     4.30	  $160.09	      ---	  $201.89	004	1	0	0.00	    $0.00	Y	
K	43101	EXCISION OF ESOPHAGUS LESION            	    21.52	  $801.19	      ---	 $1010.36	004	1	0	0.00	    $0.00	Y	
K	43107	REMOVAL OF ESOPHAGUS                    	    45.54	 $1695.45	      ---	 $2138.10	004	1	0	0.00	    $0.00	Y	
O	43107	REMOVAL OF ESOPHAGUS                    	     9.11	  $339.17	      ---	  $427.71	004	1	0	0.00	    $0.00	Y	
O	43108	REMOVAL OF ESOPHAGUS                    	    10.55	  $392.78	      ---	  $495.32	004	1	0	0.00	    $0.00	Y	
K	43108	REMOVAL OF ESOPHAGUS                    	    52.77	 $1964.63	      ---	 $2477.55	004	1	0	0.00	    $0.00	Y	
K	43112	ESPHG TOT W/THRCM                       	    46.70	 $1738.64	      ---	 $2192.57	004	1	0	0.00	    $0.00	Y	
O	43112	ESPHG TOT W/THRCM                       	     9.34	  $347.73	      ---	  $438.51	004	1	0	0.00	    $0.00	Y	
O	43113	REMOVAL OF ESOPHAGUS                    	    10.72	  $399.11	      ---	  $503.30	004	1	0	0.00	    $0.00	Y	
K	43113	REMOVAL OF ESOPHAGUS                    	    53.59	 $1995.16	      ---	 $2516.05	004	1	0	0.00	    $0.00	Y	
K	43116	PARTIAL REMOVAL OF ESOPHAGUS            	    50.32	 $1873.41	      ---	 $2362.52	004	1	0	0.00	    $0.00	Y	
O	43116	PARTIAL REMOVAL OF ESOPHAGUS            	    10.06	  $374.53	      ---	  $472.32	004	1	0	0.00	    $0.00	Y	
O	43117	PARTIAL REMOVAL OF ESOPHAGUS            	     9.86	  $367.09	      ---	  $462.93	004	1	0	0.00	    $0.00	Y	
K	43117	PARTIAL REMOVAL OF ESOPHAGUS            	    49.32	 $1836.18	      ---	 $2315.57	004	1	0	0.00	    $0.00	Y	
K	43118	PARTIAL REMOVAL OF ESOPHAGUS            	    51.96	 $1934.47	      ---	 $2439.52	004	1	0	0.00	    $0.00	Y	
O	43118	PARTIAL REMOVAL OF ESOPHAGUS            	    10.39	  $386.82	      ---	  $487.81	004	1	0	0.00	    $0.00	Y	
O	43121	PARTIAL REMOVAL OF ESOPHAGUS            	     8.96	  $333.58	      ---	  $420.67	004	1	0	0.00	    $0.00	Y	
K	43121	PARTIAL REMOVAL OF ESOPHAGUS            	    44.78	 $1667.16	      ---	 $2102.42	004	1	0	0.00	    $0.00	Y	
K	43122	PARTIAL REMOVAL OF ESOPHAGUS            	    44.78	 $1667.16	      ---	 $2102.42	004	1	0	0.00	    $0.00	Y	
O	43122	PARTIAL REMOVAL OF ESOPHAGUS            	     8.96	  $333.58	      ---	  $420.67	004	1	0	0.00	    $0.00	Y	
O	43123	PARTIAL REMOVAL OF ESOPHAGUS            	    10.39	  $386.82	      ---	  $487.81	004	1	0	0.00	    $0.00	Y	
K	43123	PARTIAL REMOVAL OF ESOPHAGUS            	    51.96	 $1934.47	      ---	 $2439.52	004	1	0	0.00	    $0.00	Y	
K	43124	REMOVAL OF ESOPHAGUS                    	    43.50	 $1619.51	      ---	 $2042.33	004	1	0	0.00	    $0.00	Y	
O	43124	REMOVAL OF ESOPHAGUS                    	     8.70	  $323.90	      ---	  $408.47	004	1	0	0.00	    $0.00	Y	
O	43130	REMOVAL OF ESOPHAGUS POUCH              	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
K	43130	REMOVAL OF ESOPHAGUS POUCH              	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
K	43135	REMOVAL OF ESOPHAGUS POUCH              	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
O	43135	REMOVAL OF ESOPHAGUS POUCH              	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	43180	ESOPHAGOSCOPY RIGID TRNSO               	    13.05	  $485.85	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43191	ESOPHAGOSCOPY RIGID TRNSO DX            	     2.97	  $110.57	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43192	ESOPHAGOSCP RIG TRNSO INJECT            	     3.53	  $131.42	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43193	ESOPHAGOSCP RIG TRNSO BIOPSY            	     4.20	  $156.37	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43194	ESOPHAGOSCP RIG TRNSO REM FB            	     3.77	  $140.36	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43195	ESOPHAGOSCOPY RIGID BALLOON             	     4.21	  $156.74	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43196	ESOPHAGOSCP GUIDE WIRE DILAT            	     4.59	  $170.89	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43197	ESOPHAGOSCOPY FLEX DX BRUSH             	     1.86	   $69.25	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43198	ESOPHAGOSC FLEX TRNSN BIOPSY            	     2.21	   $82.28	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43200	ESOPHAGOSCOPY FLEXIBLE BRUSH            	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	43201	ESOPH SCOPE W/SUBMUCOUS INJ             	     5.63	  $209.60	      ---	  $264.33	004	1	0	0.00	    $0.00	Y	
K	43202	ESOPHAGOSCOPY FLEX BIOPSY               	     4.87	  $181.31	      ---	  $228.65	004	1	0	0.00	    $0.00	Y	
K	43204	ESOPH SCOPE W/SCLEROSIS INJ             	     7.50	  $279.23	      ---	  $352.13	004	1	0	0.00	    $0.00	Y	
K	43205	ESOPHAGUS ENDOSCOPY/LIGATION            	     4.76	  $177.21	      ---	  $223.48	004	1	0	0.00	    $0.00	Y	
K	43206	ESOPH OPTICAL ENDOMICROSCOPY            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43210	EGD ESOPHAGOGASTRC FNDOPLSTY            	    10.01	  $372.67	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43211	ESOPHAGOSCOP MUCOSAL RESECT             	     5.67	  $211.09	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43212	ESOPHAGOSCOP STENT PLACEMENT            	     4.44	  $165.30	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43213	ESOPHAGOSCOPY RETRO BALLOON             	     6.29	  $234.18	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43214	ESOPHAGOSC DILATE BALLOON 30            	     4.56	  $169.77	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43215	ESOPHAGOSCOPY FLEX REMOVE FB            	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
K	43216	ESOPHAGOSCOPY LESION REMOVAL            	     5.32	  $198.06	      ---	  $249.77	004	1	0	0.00	    $0.00	Y	
K	43217	ESOPHAGOSCOPY SNARE LES REMV            	     3.82	  $142.22	      ---	  $179.35	004	1	0	0.00	    $0.00	Y	
K	43220	ESOPHAGOSCOPY BALLOON <30MM             	     4.80	  $178.70	      ---	  $225.36	004	1	0	0.00	    $0.00	Y	
K	43226	ESOPH ENDOSCOPY DILATION                	     4.80	  $178.70	      ---	  $225.36	004	1	0	0.00	    $0.00	Y	
K	43227	ESOPHAGOSCOPY CONTROL BLEED             	     4.63	  $172.37	      ---	  $217.38	004	1	0	0.00	    $0.00	Y	
K	43229	ESOPHAGOSCOPY LESION ABLATE             	     4.81	  $179.08	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43231	ESOPHAGOSCOP ULTRASOUND EXAM            	     5.34	  $198.81	      ---	  $250.71	004	1	0	0.00	    $0.00	Y	
K	43232	ESOPHAGOSCOPY W/US NEEDLE BX            	     6.21	  $231.20	      ---	  $291.56	004	1	0	0.00	    $0.00	Y	
K	43233	EGD BALLOON DIL ESOPH30 MM/>            	     5.41	  $201.41	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43235	EGD DIAGNOSTIC BRUSH WASH               	     6.02	  $224.12	      ---	  $282.64	004	1	0	0.00	    $0.00	Y	
K	43236	UPPR GI SCOPE W/SUBMUC INJ              	     6.53	  $243.11	      ---	  $306.58	004	1	0	0.00	    $0.00	Y	
K	43237	ENDOSCOPIC US EXAM ESOPH                	     3.36	  $125.09	      ---	  $157.75	004	1	0	0.00	    $0.00	Y	
K	43239	EGD BIOPSY SINGLE/MULTIPLE              	     6.29	  $234.18	      ---	  $295.32	004	1	0	0.00	    $0.00	Y	
K	43240	EGD W/TRANSMURAL DRAIN CYST             	     9.40	  $349.96	      ---	  $441.33	004	1	0	0.00	    $0.00	Y	
K	43241	EGD TUBE/CATH INSERTION                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	43242	EGD US FINE NEEDLE BX/ASPIR             	     6.74	  $250.93	      ---	  $316.44	004	1	0	0.00	    $0.00	Y	
K	43243	EGD INJECTION VARICES                   	     8.20	  $305.29	      ---	  $384.99	004	1	0	0.00	    $0.00	Y	
K	43244	EGD VARICES LIGATION                    	     5.77	  $214.82	      ---	  $270.90	004	1	0	0.00	    $0.00	Y	
K	43245	EGD DILATE STRICTURE                    	     6.50	  $242.00	      ---	  $305.18	004	1	0	0.00	    $0.00	Y	
K	43246	EGD PLACE GASTROSTOMY TUBE              	     6.50	  $242.00	      ---	  $305.18	004	1	0	0.00	    $0.00	Y	
K	43247	EGD REMOVE FOREIGN BODY                 	     6.86	  $255.40	      ---	  $322.08	004	1	0	0.00	    $0.00	Y	
O	43247	EGD REMOVE FOREIGN BODY                 	     1.37	   $51.01	      ---	   $64.32	004	1	0	0.00	    $0.00	Y	
K	43248	EGD GUIDE WIRE INSERTION                	     3.97	  $147.80	      ---	  $186.39	004	1	0	0.00	    $0.00	Y	
K	43249	ESOPH EGD DILATION <30 MM               	     5.99	  $223.01	      ---	  $281.23	004	1	0	0.00	    $0.00	Y	
O	43249	ESOPH EGD DILATION <30 MM               	     1.20	   $44.68	      ---	   $56.34	004	1	0	0.00	    $0.00	Y	
K	43250	EGD CAUTERY TUMOR POLYP                 	     6.58	  $244.97	      ---	  $308.93	004	1	0	0.00	    $0.00	Y	
K	43251	EGD REMOVE LESION SNARE                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	43252	EGD OPTICAL ENDOMICROSCOPY              	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43253	EGD US TRANSMURAL INJXN/MARK            	     6.27	  $233.43	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43254	EGD ENDO MUCOSAL RESECTION              	     6.50	  $242.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43255	EGD CONTROL BLEEDING ANY                	     7.73	  $287.79	      ---	  $362.92	004	1	0	0.00	    $0.00	Y	
O	43255	EGD CONTROL BLEEDING ANY                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	43257	EGD W/THRML TXMNT GERD                  	     0.97	   $36.11	      ---	   $45.54	004	1	0	0.00	    $0.00	Y	
K	43257	EGD W/THRML TXMNT GERD                  	     4.86	  $180.94	      ---	  $228.18	004	1	0	0.00	    $0.00	Y	
K	43259	EGD US EXAM DUODENUM/JEJUNUM            	     5.58	  $207.74	      ---	  $261.98	004	1	0	0.00	    $0.00	Y	
K	43260	ERCP W/SPECIMEN COLLECTION              	     8.30	  $309.01	      ---	  $389.69	004	1	0	0.00	    $0.00	Y	
O	43260	ERCP W/SPECIMEN COLLECTION              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	43261	ENDO CHOLANGIOPANCREATOGRAPH            	     9.16	  $341.03	      ---	  $430.06	004	1	0	0.00	    $0.00	Y	
K	43262	ENDO CHOLANGIOPANCREATOGRAPH            	     9.95	  $370.44	      ---	  $467.15	004	1	0	0.00	    $0.00	Y	
K	43263	ERCP SPHINCTER PRESSURE MEAS            	     7.17	  $266.94	      ---	  $336.63	004	1	0	0.00	    $0.00	Y	
K	43264	ERCP REMOVE DUCT CALCULI                	    10.31	  $383.84	      ---	  $484.05	004	1	0	0.00	    $0.00	Y	
K	43266	EGD ENDOSCOPIC STENT PLACE              	     5.38	  $200.30	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43270	EGD LESION ABLATION                     	     5.66	  $210.72	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43273	ENDOSCOPIC PANCREATOSCOPY               	     2.51	   $93.45	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43274	ERCP DUCT STENT PLACEMENT               	    11.14	  $414.74	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43275	ERCP REMOVE FORGN BODY DUCT             	     9.19	  $342.14	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43276	ERCP STENT EXCHANGE W/DILATE            	    11.59	  $431.50	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43277	ERCP EA DUCT/AMPULLA DILATE             	     9.24	  $344.01	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43278	ERCP LESION ABLATE W/DILATE             	    10.51	  $391.29	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43279	LAP MYOTOMY HELLER                      	    23.12	  $860.76	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	43279	LAP MYOTOMY HELLER                      	     4.62	  $172.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	43280	LAPAROSCOPY FUNDOPLASTY                 	     4.30	  $160.09	      ---	  $201.89	004	1	0	0.00	    $0.00	Y	
K	43280	LAPAROSCOPY FUNDOPLASTY                 	    21.52	  $801.19	      ---	 $1010.36	004	1	0	0.00	    $0.00	Y	
K	43281	LAP PARAESOPHAG HERN REPAIR             	    34.18	 $1272.52	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	43281	LAP PARAESOPHAG HERN REPAIR             	     6.84	  $254.65	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	43282	LAP PARAESOPH HER RPR W/MESH            	     7.68	  $285.93	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43282	LAP PARAESOPH HER RPR W/MESH            	    38.41	 $1430.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43283	LAP ESOPH LENGTHENING                   	     3.59	  $133.66	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	43283	LAP ESOPH LENGTHENING                   	     0.72	   $26.81	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	43284	LAPS ESOPHGL SPHNCTR AGMNTJ             	     2.97	  $110.57	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43284	LAPS ESOPHGL SPHNCTR AGMNTJ             	    14.89	  $554.35	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43285	RMVL ESOPHGL SPHNCTR DEV                	    15.03	  $559.57	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	43285	RMVL ESOPHGL SPHNCTR DEV                	     3.00	  $111.69	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	43286	ESPHG TOT W/LAPS MOBLJ                  	    14.35	  $534.25	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43286	ESPHG TOT W/LAPS MOBLJ                  	    71.77	 $2672.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43287	ESPHG DSTL 2/3 W/LAPS MOBLJ             	    81.71	 $3042.06	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	43287	ESPHG DSTL 2/3 W/LAPS MOBLJ             	    16.34	  $608.34	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	43288	ESPHG THRSC MOBLJ                       	    17.09	  $636.26	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43288	ESPHG THRSC MOBLJ                       	    85.48	 $3182.42	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43289	UNLISTED LAPS PX ESOPH                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	43289	UNLISTED LAPS PX ESOPH                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	43290	EGD FLX TRNSORL DPLMNT BALO             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43291	EGD FLX TRNSORL RMVL BALO               	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43300	REPAIR OF ESOPHAGUS                     	    15.62	  $581.53	      ---	  $733.36	004	1	0	0.00	    $0.00	Y	
O	43300	REPAIR OF ESOPHAGUS                     	     3.12	  $116.16	      ---	  $146.48	004	1	0	0.00	    $0.00	Y	
O	43305	REPAIR ESOPHAGUS AND FISTULA            	     4.98	  $185.41	      ---	  $233.81	004	1	0	0.00	    $0.00	Y	
K	43305	REPAIR ESOPHAGUS AND FISTULA            	    24.92	  $927.77	      ---	 $1169.99	004	1	0	0.00	    $0.00	Y	
K	43310	REPAIR OF ESOPHAGUS                     	    29.11	 $1083.77	      ---	 $1366.71	004	1	0	0.00	    $0.00	Y	
O	43310	REPAIR OF ESOPHAGUS                     	     5.78	  $215.19	      ---	  $271.37	004	1	0	0.00	    $0.00	Y	
O	43312	REPAIR ESOPHAGUS AND FISTULA            	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
K	43312	REPAIR ESOPHAGUS AND FISTULA            	    33.98	 $1265.08	      ---	 $1595.36	004	1	0	0.00	    $0.00	Y	
K	43313	ESOPHAGOPLASTY CONGENITAL               	    59.10	 $2200.29	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	43313	ESOPHAGOPLASTY CONGENITAL               	    11.82	  $440.06	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	43314	TRACHEO-ESOPHAGOPLASTY CONG             	    12.99	  $483.62	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43314	TRACHEO-ESOPHAGOPLASTY CONG             	    64.97	 $2418.83	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43320	FUSE ESOPHAGUS & STOMACH                	    23.77	  $884.96	      ---	 $1116.00	004	1	0	0.00	    $0.00	Y	
O	43320	FUSE ESOPHAGUS & STOMACH                	     4.75	  $176.84	      ---	  $223.01	004	1	0	0.00	    $0.00	Y	
O	43325	REVISE ESOPHAGUS & STOMACH              	     4.19	  $155.99	      ---	  $196.72	004	1	0	0.00	    $0.00	Y	
K	43325	REVISE ESOPHAGUS & STOMACH              	    20.73	  $771.78	      ---	  $973.27	004	1	0	0.00	    $0.00	Y	
K	43327	ESOPH FUNDOPLASTY LAP                   	    18.32	  $682.05	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	43327	ESOPH FUNDOPLASTY LAP                   	     3.66	  $136.26	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	43328	ESOPH FUNDOPLASTY THOR                  	     5.31	  $197.69	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43328	ESOPH FUNDOPLASTY THOR                  	    26.55	  $988.46	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43330	ESOPHAGOMYOTOMY ABDOMINAL               	    21.52	  $801.19	      ---	 $1010.36	004	1	0	0.00	    $0.00	Y	
O	43330	ESOPHAGOMYOTOMY ABDOMINAL               	     4.30	  $160.09	      ---	  $201.89	004	1	0	0.00	    $0.00	Y	
O	43331	ESOPHAGOMYOTOMY THORACIC                	     4.30	  $160.09	      ---	  $201.89	004	1	0	0.00	    $0.00	Y	
K	43331	ESOPHAGOMYOTOMY THORACIC                	    21.52	  $801.19	      ---	 $1010.36	004	1	0	0.00	    $0.00	Y	
K	43332	TRANSAB ESOPH HIAT HERN RPR             	    26.14	  $973.19	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	43332	TRANSAB ESOPH HIAT HERN RPR             	     5.23	  $194.71	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	43333	TRANSAB ESOPH HIAT HERN RPR             	     5.67	  $211.09	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43333	TRANSAB ESOPH HIAT HERN RPR             	    28.37	 $1056.22	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43334	TRANSTHOR DIAPHRAG HERN RPR             	    28.59	 $1064.41	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	43334	TRANSTHOR DIAPHRAG HERN RPR             	     5.72	  $212.96	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	43335	TRANSTHOR DIAPHRAG HERN RPR             	     6.16	  $229.34	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43335	TRANSTHOR DIAPHRAG HERN RPR             	    30.78	 $1145.94	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43336	THORABD DIAPHR HERN REPAIR              	    33.66	 $1253.16	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	43336	THORABD DIAPHR HERN REPAIR              	     6.73	  $250.56	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	43337	THORABD DIAPHR HERN REPAIR              	     7.37	  $274.39	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43337	THORABD DIAPHR HERN REPAIR              	    36.84	 $1371.55	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43338	ESOPH LENGTHENING                       	     3.01	  $112.06	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	43338	ESOPH LENGTHENING                       	     0.60	   $22.34	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	43340	FUSE ESOPHAGUS & INTESTINE              	     4.80	  $178.70	      ---	  $225.36	004	1	0	0.00	    $0.00	Y	
K	43340	FUSE ESOPHAGUS & INTESTINE              	    24.00	  $893.52	      ---	 $1126.80	004	1	0	0.00	    $0.00	Y	
K	43341	FUSE ESOPHAGUS & INTESTINE              	    27.18	 $1011.91	      ---	 $1276.10	004	1	0	0.00	    $0.00	Y	
O	43341	FUSE ESOPHAGUS & INTESTINE              	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
O	43351	SURGICAL OPENING ESOPHAGUS              	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
K	43351	SURGICAL OPENING ESOPHAGUS              	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
K	43352	SURGICAL OPENING ESOPHAGUS              	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
O	43352	SURGICAL OPENING ESOPHAGUS              	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
O	43360	GASTROINTESTINAL REPAIR                 	     8.69	  $323.53	      ---	  $408.00	004	1	0	0.00	    $0.00	Y	
K	43360	GASTROINTESTINAL REPAIR                 	    43.43	 $1616.90	      ---	 $2039.04	004	1	0	0.00	    $0.00	Y	
K	43361	GASTROINTESTINAL REPAIR                 	    50.32	 $1873.41	      ---	 $2362.52	004	1	0	0.00	    $0.00	Y	
O	43361	GASTROINTESTINAL REPAIR                 	    10.06	  $374.53	      ---	  $472.32	004	1	0	0.00	    $0.00	Y	
O	43400	LIGATE ESOPHAGUS VEINS                  	     4.49	  $167.16	      ---	  $210.81	004	1	0	0.00	    $0.00	Y	
K	43400	LIGATE ESOPHAGUS VEINS                  	    22.45	  $835.81	      ---	 $1054.03	004	1	0	0.00	    $0.00	Y	
K	43405	LIGATE/STAPLE ESOPHAGUS                 	    26.86	 $1000.00	      ---	 $1261.08	004	1	0	0.00	    $0.00	Y	
O	43405	LIGATE/STAPLE ESOPHAGUS                 	     5.37	  $199.93	      ---	  $252.12	004	1	0	0.00	    $0.00	Y	
O	43410	REPAIR ESOPHAGUS WOUND                  	     3.74	  $139.24	      ---	  $175.59	004	1	0	0.00	    $0.00	Y	
K	43410	REPAIR ESOPHAGUS WOUND                  	    18.72	  $696.95	      ---	  $878.90	004	1	0	0.00	    $0.00	Y	
K	43415	REPAIR ESOPHAGUS WOUND                  	    21.52	  $801.19	      ---	 $1010.36	004	1	0	0.00	    $0.00	Y	
O	43415	REPAIR ESOPHAGUS WOUND                  	     4.30	  $160.09	      ---	  $201.89	004	1	0	0.00	    $0.00	Y	
O	43420	REPAIR ESOPHAGUS OPENING                	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
K	43420	REPAIR ESOPHAGUS OPENING                	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
K	43425	REPAIR ESOPHAGUS OPENING                	    26.00	  $967.98	      ---	 $1220.70	004	1	0	0.00	    $0.00	Y	
O	43425	REPAIR ESOPHAGUS OPENING                	     5.20	  $193.60	      ---	  $244.14	004	1	0	0.00	    $0.00	Y	
K	43450	DILATE ESOPHAGUS 1/MULT PASS            	     1.25	   $46.54	      ---	   $58.69	004	1	1	0.00	    $0.00	Y	
K	43453	DILATE ESOPHAGUS                        	     2.70	  $100.52	      ---	  $126.77	004	1	1	0.00	    $0.00	Y	
K	43460	PRESSURE TREATMENT ESOPHAGUS            	     2.47	   $91.96	      ---	  $115.97	004	1	0	0.00	    $0.00	Y	
K	43496	FREE JEJUNUM FLAP MICROVASC             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	43496	FREE JEJUNUM FLAP MICROVASC             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	43497	TRANSORL LWR ESOPHGL MYOTOMY            	    18.32	  $682.05	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43499	UNLISTED PROCEDURE ESOPHAGUS            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	43499	UNLISTED PROCEDURE ESOPHAGUS            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	43500	SURGICAL OPENING OF STOMACH             	     2.34	   $87.12	      ---	  $109.86	004	1	0	0.00	    $0.00	Y	
K	43500	SURGICAL OPENING OF STOMACH             	    11.69	  $435.22	      ---	  $548.85	004	1	0	0.00	    $0.00	Y	
K	43501	SURGICAL REPAIR OF STOMACH              	    19.85	  $739.02	      ---	  $931.96	004	1	0	0.00	    $0.00	Y	
O	43501	SURGICAL REPAIR OF STOMACH              	     3.97	  $147.80	      ---	  $186.39	004	1	0	0.00	    $0.00	Y	
O	43502	SURGICAL REPAIR OF STOMACH              	     4.61	  $171.63	      ---	  $216.44	004	1	0	0.00	    $0.00	Y	
K	43502	SURGICAL REPAIR OF STOMACH              	    23.01	  $856.66	      ---	 $1080.32	004	1	0	0.00	    $0.00	Y	
K	43510	SURGICAL OPENING OF STOMACH             	    14.69	  $546.91	      ---	  $689.70	004	1	0	0.00	    $0.00	Y	
O	43510	SURGICAL OPENING OF STOMACH             	     2.94	  $109.46	      ---	  $138.03	004	1	0	0.00	    $0.00	Y	
O	43520	INCISION OF PYLORIC MUSCLE              	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	43520	INCISION OF PYLORIC MUSCLE              	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	43605	BIOPSY OF STOMACH                       	    12.15	  $452.34	      ---	  $570.44	004	1	0	0.00	    $0.00	Y	
O	43605	BIOPSY OF STOMACH                       	     2.43	   $90.47	      ---	  $114.09	004	1	0	0.00	    $0.00	Y	
O	43610	EXCISION OF STOMACH LESION              	     2.97	  $110.57	      ---	  $139.44	004	1	0	0.00	    $0.00	Y	
K	43610	EXCISION OF STOMACH LESION              	    14.85	  $552.87	      ---	  $697.21	004	1	0	0.00	    $0.00	Y	
K	43611	EXCISION OF STOMACH LESION              	    17.90	  $666.42	      ---	  $840.41	004	1	0	0.00	    $0.00	Y	
O	43611	EXCISION OF STOMACH LESION              	     3.58	  $133.28	      ---	  $168.08	004	1	0	0.00	    $0.00	Y	
O	43620	REMOVAL OF STOMACH                      	     5.83	  $217.05	      ---	  $273.72	004	1	0	0.00	    $0.00	Y	
K	43620	REMOVAL OF STOMACH                      	    29.15	 $1085.25	      ---	 $1368.59	004	1	0	0.00	    $0.00	Y	
K	43621	REMOVAL OF STOMACH                      	    29.69	 $1105.36	      ---	 $1393.95	004	1	0	0.00	    $0.00	Y	
O	43621	REMOVAL OF STOMACH                      	     5.93	  $220.77	      ---	  $278.41	004	1	0	0.00	    $0.00	Y	
O	43622	REMOVAL OF STOMACH                      	     6.29	  $234.18	      ---	  $295.32	004	1	0	0.00	    $0.00	Y	
K	43622	REMOVAL OF STOMACH                      	    31.46	 $1171.26	      ---	 $1477.05	004	1	0	0.00	    $0.00	Y	
K	43631	REMOVAL OF STOMACH PARTIAL              	    25.15	  $936.33	      ---	 $1180.79	004	1	0	0.00	    $0.00	Y	
O	43631	REMOVAL OF STOMACH PARTIAL              	     5.03	  $187.27	      ---	  $236.16	004	1	0	0.00	    $0.00	Y	
O	43632	REMOVAL OF STOMACH PARTIAL              	     5.02	  $186.89	      ---	  $235.69	004	1	0	0.00	    $0.00	Y	
K	43632	REMOVAL OF STOMACH PARTIAL              	    25.09	  $934.10	      ---	 $1177.98	004	1	0	0.00	    $0.00	Y	
K	43633	REMOVAL OF STOMACH PARTIAL              	    25.61	  $953.46	      ---	 $1202.39	004	1	0	0.00	    $0.00	Y	
O	43633	REMOVAL OF STOMACH PARTIAL              	     5.12	  $190.62	      ---	  $240.38	004	1	0	0.00	    $0.00	Y	
O	43634	REMOVAL OF STOMACH PARTIAL              	     6.68	  $248.70	      ---	  $313.63	004	1	0	0.00	    $0.00	Y	
K	43634	REMOVAL OF STOMACH PARTIAL              	    33.42	 $1244.23	      ---	 $1569.07	004	1	0	0.00	    $0.00	Y	
K	43635	REMOVAL OF STOMACH PARTIAL              	    21.00	  $781.83	      ---	  $985.95	004	1	0	0.00	    $0.00	Y	
O	43635	REMOVAL OF STOMACH PARTIAL              	     4.20	  $156.37	      ---	  $197.19	004	1	0	0.00	    $0.00	Y	
O	43640	VAGOTOMY & PYLORUS REPAIR               	     3.85	  $143.34	      ---	  $180.76	004	1	0	0.00	    $0.00	Y	
K	43640	VAGOTOMY & PYLORUS REPAIR               	    19.25	  $716.68	      ---	  $903.79	004	1	0	0.00	    $0.00	Y	
K	43641	VAGOTOMY & PYLORUS REPAIR               	    21.35	  $794.86	      ---	 $1002.38	004	1	0	0.00	    $0.00	Y	
O	43641	VAGOTOMY & PYLORUS REPAIR               	     4.27	  $158.97	      ---	  $200.48	004	1	0	0.00	    $0.00	Y	
O	43644	LAP GASTRIC BYPASS/ROUX-EN-Y            	     5.09	  $189.50	      ---	  $238.98	004	1	0	0.00	    $0.00	Y	
K	43644	LAP GASTRIC BYPASS/ROUX-EN-Y            	    25.47	  $948.25	      ---	 $1195.82	004	1	0	0.00	    $0.00	Y	
K	43645	LAP GASTR BYPASS INCL SMLL I            	    27.52	 $1024.57	      ---	 $1292.06	004	1	0	0.00	    $0.00	Y	
O	43645	LAP GASTR BYPASS INCL SMLL I            	     5.50	  $204.77	      ---	  $258.23	004	1	0	0.00	    $0.00	Y	
O	43651	LAPAROSCOPY VAGUS NERVE                 	     1.93	   $71.85	      ---	   $90.61	004	1	0	0.00	    $0.00	Y	
K	43651	LAPAROSCOPY VAGUS NERVE                 	     9.67	  $360.01	      ---	  $454.01	004	1	0	0.00	    $0.00	Y	
K	43652	LAPAROSCOPY VAGUS NERVE                 	    11.61	  $432.24	      ---	  $545.09	004	1	0	0.00	    $0.00	Y	
O	43652	LAPAROSCOPY VAGUS NERVE                 	     2.32	   $86.37	      ---	  $108.92	004	1	0	0.00	    $0.00	Y	
O	43653	LAPAROSCOPY GASTROSTOMY                 	     2.06	   $76.69	      ---	   $96.72	004	1	0	0.00	    $0.00	Y	
K	43653	LAPAROSCOPY GASTROSTOMY                 	    10.30	  $383.47	      ---	  $483.59	004	1	0	0.00	    $0.00	Y	
K	43659	UNLISTED LAPS PX STOMACH                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	43659	UNLISTED LAPS PX STOMACH                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	43752	NASAL/OROGASTRIC W/TUBE PLMT            	     3.49	  $129.93	      ---	  $163.86	004	1	0	0.00	    $0.00	Y	
K	43753	TX GASTRO INTUB W/ASP                   	     0.46	   $17.13	      ---	   $21.60	004	1	0	0.00	    $0.00	Y	
O	43753	TX GASTRO INTUB W/ASP                   	     0.09	    $3.35	      ---	    $4.23	004	1	0	0.00	    $0.00	Y	
O	43754	DX GASTR INTUB W/ASP SPEC               	     0.15	    $5.58	      ---	    $7.04	004	1	0	0.00	    $0.00	Y	
K	43754	DX GASTR INTUB W/ASP SPEC               	     0.74	   $27.55	      ---	   $34.74	004	1	0	0.00	    $0.00	Y	
K	43755	DX GASTR INTUB W/ASP SPECS              	     1.33	   $49.52	      ---	   $62.44	004	1	0	0.00	    $0.00	Y	
O	43755	DX GASTR INTUB W/ASP SPECS              	     0.27	   $10.05	      ---	   $12.68	004	1	0	0.00	    $0.00	Y	
O	43756	DX DUOD INTUB W/ASP SPEC                	     0.24	    $8.94	      ---	   $11.27	004	1	0	0.00	    $0.00	Y	
K	43756	DX DUOD INTUB W/ASP SPEC                	     1.21	   $45.05	      ---	   $56.81	004	1	0	0.00	    $0.00	Y	
K	43757	DX DUOD INTUB W/ASP SPECS               	     1.73	   $64.41	      ---	   $81.22	004	1	0	0.00	    $0.00	Y	
O	43757	DX DUOD INTUB W/ASP SPECS               	     0.35	   $13.03	      ---	   $16.43	004	1	0	0.00	    $0.00	Y	
K	43761	REPOSITION GASTROSTOMY TUBE             	     2.13	   $79.30	      ---	  $100.00	004	1	0	0.00	    $0.00	Y	
K	43762	RPLC GTUBE NO REVJ TRC                  	     5.51	  $205.14	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	43762	RPLC GTUBE NO REVJ TRC                  	     1.10	   $40.95	      ---	       --	004	0	0	0.00	    $0.00	Y	
X	43762	RPLC GTUBE NO REVJ TRC                  	   216.09	  $216.09	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	43763	RPLC GTUBE REVJ GSTRST TRC              	     1.62	   $60.31	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43763	RPLC GTUBE REVJ GSTRST TRC              	     8.14	  $303.05	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43770	LAP PLACE GASTR ADJ DEVICE              	    21.62	  $804.91	      ---	 $1015.06	004	1	0	0.00	    $0.00	Y	
O	43770	LAP PLACE GASTR ADJ DEVICE              	     4.32	  $160.83	      ---	  $202.82	004	1	0	0.00	    $0.00	Y	
O	43771	LAP REVISE GASTR ADJ DEVICE             	     4.97	  $185.03	      ---	  $233.34	004	1	0	0.00	    $0.00	Y	
K	43771	LAP REVISE GASTR ADJ DEVICE             	    24.86	  $925.54	      ---	 $1167.18	004	1	0	0.00	    $0.00	Y	
K	43772	LAP RMVL GASTR ADJ DEVICE               	    18.94	  $705.14	      ---	  $889.23	004	1	0	0.00	    $0.00	Y	
O	43772	LAP RMVL GASTR ADJ DEVICE               	     3.79	  $141.10	      ---	  $177.94	004	1	0	0.00	    $0.00	Y	
O	43773	LAP REPLACE GASTR ADJ DEVICE            	     4.97	  $185.03	      ---	  $233.34	004	1	0	0.00	    $0.00	Y	
K	43773	LAP REPLACE GASTR ADJ DEVICE            	    24.87	  $925.91	      ---	 $1167.65	004	1	0	0.00	    $0.00	Y	
K	43774	LAP RMVL GASTR ADJ ALL PARTS            	    19.01	  $707.74	      ---	  $892.52	004	1	0	0.00	    $0.00	Y	
O	43774	LAP RMVL GASTR ADJ ALL PARTS            	     3.80	  $141.47	      ---	  $178.41	004	1	0	0.00	    $0.00	Y	
O	43775	LAP SLEEVE GASTRECTOMY                  	     5.77	  $214.82	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43775	LAP SLEEVE GASTRECTOMY                  	    28.83	 $1073.34	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	43800	PYLOROPLASTY                            	    14.15	  $526.80	      ---	  $664.34	004	1	0	0.00	    $0.00	Y	
O	43800	PYLOROPLASTY                            	     2.83	  $105.36	      ---	  $132.87	004	1	0	0.00	    $0.00	Y	
O	43810	GASTRODUODENOSTOMY                      	     2.96	  $110.20	      ---	  $138.97	004	1	0	0.00	    $0.00	Y	
K	43810	GASTRODUODENOSTOMY                      	    14.79	  $550.63	      ---	  $694.39	004	1	0	0.00	    $0.00	Y	
K	43820	GASTROJEJUNOSTOMY WO VAGOTMY            	    15.53	  $578.18	      ---	  $729.13	004	1	0	0.00	    $0.00	Y	
O	43820	GASTROJEJUNOSTOMY WO VAGOTMY            	     3.11	  $115.79	      ---	  $146.01	004	1	0	0.00	    $0.00	Y	
O	43825	GASTROJEJUNOSTOMY W/VAGOTOMY            	     3.81	  $141.85	      ---	  $178.88	004	1	0	0.00	    $0.00	Y	
K	43825	GASTROJEJUNOSTOMY W/VAGOTOMY            	    19.05	  $709.23	      ---	  $894.40	004	1	0	0.00	    $0.00	Y	
K	43830	GSTRST OPEN WO CONSTJ TUBE              	    13.00	  $483.99	      ---	  $610.35	004	1	0	0.00	    $0.00	Y	
O	43830	GSTRST OPEN WO CONSTJ TUBE              	     2.60	   $96.80	      ---	  $122.07	004	1	0	0.00	    $0.00	Y	
O	43831	GASTROSTOMY OPEN NEONATAL               	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
K	43831	GASTROSTOMY OPEN NEONATAL               	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
K	43832	GSTRST OPEN W/CONSTJ TUBE               	    16.04	  $597.17	      ---	  $753.08	004	1	0	0.00	    $0.00	Y	
O	43832	GSTRST OPEN W/CONSTJ TUBE               	     3.21	  $119.51	      ---	  $150.71	004	1	0	0.00	    $0.00	Y	
O	43840	REPAIR OF STOMACH LESION                	     2.94	  $109.46	      ---	  $138.03	004	1	0	0.00	    $0.00	Y	
K	43840	REPAIR OF STOMACH LESION                	    14.72	  $548.03	      ---	  $691.10	004	1	0	0.00	    $0.00	Y	
K	43842	V-BAND GASTROPLASTY                     	    21.77	  $810.50	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	43842	V-BAND GASTROPLASTY                     	     4.36	  $162.32	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	43843	GASTROPLASTY W/O V-BAND                 	     4.25	  $158.23	      ---	  $199.54	004	1	0	0.00	    $0.00	Y	
K	43843	GASTROPLASTY W/O V-BAND                 	    21.24	  $790.77	      ---	  $997.22	004	1	0	0.00	    $0.00	Y	
K	43845	GASTROPLASTY DUODENAL SWITCH            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	43845	GASTROPLASTY DUODENAL SWITCH            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	43846	GASTRIC BYPASS FOR OBESITY              	     5.61	  $208.86	      ---	  $263.39	004	1	0	0.00	    $0.00	Y	
K	43846	GASTRIC BYPASS FOR OBESITY              	    28.03	 $1043.56	      ---	 $1316.01	004	1	0	0.00	    $0.00	Y	
K	43847	GASTRIC BYPASS INCL SMALL I             	    27.33	 $1017.50	      ---	 $1283.14	004	1	0	0.00	    $0.00	Y	
O	43847	GASTRIC BYPASS INCL SMALL I             	     5.47	  $203.65	      ---	  $256.82	004	1	0	0.00	    $0.00	Y	
O	43848	REVISION GASTROPLASTY                   	     7.29	  $271.41	      ---	  $342.27	004	1	0	0.00	    $0.00	Y	
K	43848	REVISION GASTROPLASTY                   	    36.46	 $1357.41	      ---	 $1711.80	004	1	0	0.00	    $0.00	Y	
K	43860	REVISE STOMACH-BOWEL FUSION             	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
O	43860	REVISE STOMACH-BOWEL FUSION             	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
O	43865	REVISE STOMACH-BOWEL FUSION             	     5.21	  $193.97	      ---	  $244.61	004	1	0	0.00	    $0.00	Y	
K	43865	REVISE STOMACH-BOWEL FUSION             	    26.05	  $969.84	      ---	 $1223.05	004	1	0	0.00	    $0.00	Y	
K	43870	REPAIR STOMACH OPENING                  	    12.00	  $446.76	      ---	  $563.40	004	1	0	0.00	    $0.00	Y	
O	43870	REPAIR STOMACH OPENING                  	     2.40	   $89.35	      ---	  $112.68	004	1	0	0.00	    $0.00	Y	
O	43880	REPAIR STOMACH-BOWEL FISTULA            	     5.53	  $205.88	      ---	  $259.63	004	1	0	0.00	    $0.00	Y	
K	43880	REPAIR STOMACH-BOWEL FISTULA            	    27.65	 $1029.41	      ---	 $1298.17	004	1	0	0.00	    $0.00	Y	
K	43886	REVISE GASTRIC PORT OPEN                	     6.14	  $228.59	      ---	  $288.27	004	1	0	0.00	    $0.00	Y	
O	43886	REVISE GASTRIC PORT OPEN                	     1.23	   $45.79	      ---	   $57.75	004	1	0	0.00	    $0.00	Y	
O	43887	REMOVE GASTRIC PORT OPEN                	     1.19	   $44.30	      ---	   $55.87	004	1	0	0.00	    $0.00	Y	
K	43887	REMOVE GASTRIC PORT OPEN                	     5.95	  $221.52	      ---	  $279.35	004	1	0	0.00	    $0.00	Y	
K	43888	CHANGE GASTRIC PORT OPEN                	     8.43	  $313.85	      ---	  $395.79	004	1	0	0.00	    $0.00	Y	
O	43888	CHANGE GASTRIC PORT OPEN                	     1.69	   $62.92	      ---	   $79.35	004	1	0	0.00	    $0.00	Y	
O	43999	UNLISTED PROCEDURE STOMACH              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	43999	UNLISTED PROCEDURE STOMACH              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	44005	FREEING OF BOWEL ADHESION               	    16.42	  $611.32	      ---	  $770.92	004	1	0	0.00	    $0.00	Y	
O	44005	FREEING OF BOWEL ADHESION               	     3.28	  $122.11	      ---	  $154.00	004	1	0	0.00	    $0.00	Y	
O	44010	INCISION OF SMALL BOWEL                 	     2.90	  $107.97	      ---	  $136.16	004	1	0	0.00	    $0.00	Y	
K	44010	INCISION OF SMALL BOWEL                 	    14.51	  $540.21	      ---	  $681.24	004	1	0	0.00	    $0.00	Y	
K	44015	INSERT NEEDLE CATH BOWEL                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	44015	INSERT NEEDLE CATH BOWEL                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	44020	EXPLORE SMALL INTESTINE                 	     3.13	  $116.53	      ---	  $146.95	004	1	0	0.00	    $0.00	Y	
K	44020	EXPLORE SMALL INTESTINE                 	    15.64	  $582.28	      ---	  $734.30	004	1	0	0.00	    $0.00	Y	
K	44021	DECOMPRESS SMALL BOWEL                  	    16.18	  $602.38	      ---	  $759.65	004	1	0	0.00	    $0.00	Y	
O	44021	DECOMPRESS SMALL BOWEL                  	     3.24	  $120.63	      ---	  $152.12	004	1	0	0.00	    $0.00	Y	
O	44025	INCISION OF LARGE BOWEL                 	     3.19	  $118.76	      ---	  $149.77	004	1	0	0.00	    $0.00	Y	
K	44025	INCISION OF LARGE BOWEL                 	    15.97	  $594.56	      ---	  $749.79	004	1	0	0.00	    $0.00	Y	
K	44050	REDUCE BOWEL OBSTRUCTION                	    15.03	  $559.57	      ---	  $705.66	004	1	0	0.00	    $0.00	Y	
O	44050	REDUCE BOWEL OBSTRUCTION                	     3.01	  $112.06	      ---	  $141.32	004	1	0	0.00	    $0.00	Y	
O	44055	CORRECT MALROTATION OF BOWEL            	     3.43	  $127.70	      ---	  $161.04	004	1	0	0.00	    $0.00	Y	
K	44055	CORRECT MALROTATION OF BOWEL            	    17.13	  $637.75	      ---	  $804.25	004	1	0	0.00	    $0.00	Y	
K	44100	BIOPSY OF BOWEL                         	     3.00	  $111.69	      ---	  $140.85	004	1	0	0.00	    $0.00	Y	
K	44110	EXCISE INTESTINE LESION(S)              	    16.00	  $595.68	      ---	  $751.20	004	1	0	0.00	    $0.00	Y	
O	44110	EXCISE INTESTINE LESION(S)              	     3.20	  $119.14	      ---	  $150.24	004	1	0	0.00	    $0.00	Y	
O	44111	EXCISION OF BOWEL LESION(S)             	     3.29	  $122.49	      ---	  $154.47	004	1	0	0.00	    $0.00	Y	
K	44111	EXCISION OF BOWEL LESION(S)             	    16.47	  $613.18	      ---	  $773.27	004	1	0	0.00	    $0.00	Y	
K	44120	REMOVAL OF SMALL INTESTINE              	    18.77	  $698.81	      ---	  $881.25	004	1	0	0.00	    $0.00	Y	
O	44120	REMOVAL OF SMALL INTESTINE              	     3.75	  $139.61	      ---	  $176.06	004	1	0	0.00	    $0.00	Y	
O	44121	REMOVAL OF SMALL INTESTINE              	     1.08	   $40.21	      ---	   $50.71	004	1	0	0.00	    $0.00	Y	
K	44121	REMOVAL OF SMALL INTESTINE              	     5.39	  $200.67	      ---	  $253.06	004	1	0	0.00	    $0.00	Y	
K	44125	REMOVAL OF SMALL INTESTINE              	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
O	44125	REMOVAL OF SMALL INTESTINE              	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
O	44126	ENTERECTOMY W/O TAPER CONG              	     8.90	  $331.35	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	44126	ENTERECTOMY W/O TAPER CONG              	    44.48	 $1655.99	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	44127	ENTERECTOMY W/TAPER CONG                	    51.13	 $1903.57	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	44127	ENTERECTOMY W/TAPER CONG                	    10.23	  $380.86	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	44128	ENTERECTOMY CONG ADD-ON                 	     1.08	   $40.21	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	44128	ENTERECTOMY CONG ADD-ON                 	     5.42	  $201.79	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	44130	BOWEL TO BOWEL FUSION                   	    16.19	  $602.75	      ---	  $760.12	004	1	0	0.00	    $0.00	Y	
O	44130	BOWEL TO BOWEL FUSION                   	     3.24	  $120.63	      ---	  $152.12	004	1	0	0.00	    $0.00	Y	
O	44135	INTESTINE TRANSPLNT CADAVER             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	44135	INTESTINE TRANSPLNT CADAVER             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	44139	MOBILIZATION OF COLON                   	     2.70	  $100.52	      ---	  $126.77	004	1	0	0.00	    $0.00	Y	
O	44139	MOBILIZATION OF COLON                   	     0.54	   $20.10	      ---	   $25.35	004	1	0	0.00	    $0.00	Y	
O	44140	PARTIAL REMOVAL OF COLON                	     4.08	  $151.90	      ---	  $191.56	004	1	0	0.00	    $0.00	Y	
K	44140	PARTIAL REMOVAL OF COLON                	    20.39	  $759.12	      ---	  $957.31	004	1	0	0.00	    $0.00	Y	
K	44141	PARTIAL REMOVAL OF COLON                	    25.37	  $944.53	      ---	 $1191.12	004	1	0	0.00	    $0.00	Y	
O	44141	PARTIAL REMOVAL OF COLON                	     5.10	  $189.87	      ---	  $239.45	004	1	0	0.00	    $0.00	Y	
O	44143	PARTIAL REMOVAL OF COLON                	     4.76	  $177.21	      ---	  $223.48	004	1	0	0.00	    $0.00	Y	
K	44143	PARTIAL REMOVAL OF COLON                	    23.56	  $877.14	      ---	 $1106.14	004	1	0	0.00	    $0.00	Y	
K	44144	PARTIAL REMOVAL OF COLON                	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
O	44144	PARTIAL REMOVAL OF COLON                	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
O	44145	PARTIAL REMOVAL OF COLON                	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
K	44145	PARTIAL REMOVAL OF COLON                	    27.18	 $1011.91	      ---	 $1276.10	004	1	0	0.00	    $0.00	Y	
K	44146	PARTIAL REMOVAL OF COLON                	    31.03	 $1155.25	      ---	 $1456.86	004	1	0	0.00	    $0.00	Y	
O	44146	PARTIAL REMOVAL OF COLON                	     6.23	  $231.94	      ---	  $292.50	004	1	0	0.00	    $0.00	Y	
O	44147	PARTIAL REMOVAL OF COLON                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	44147	PARTIAL REMOVAL OF COLON                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	44150	REMOVAL OF COLON                        	    29.45	 $1096.42	      ---	 $1382.68	004	1	0	0.00	    $0.00	Y	
O	44150	REMOVAL OF COLON                        	     5.89	  $219.28	      ---	  $276.54	004	1	0	0.00	    $0.00	Y	
O	44151	REMOVAL OF COLON/ILEOSTOMY              	     5.83	  $217.05	      ---	  $273.72	004	1	0	0.00	    $0.00	Y	
K	44151	REMOVAL OF COLON/ILEOSTOMY              	    29.13	 $1084.51	      ---	 $1367.65	004	1	0	0.00	    $0.00	Y	
K	44155	REMOVAL OF COLON/ILEOSTOMY              	    33.98	 $1265.08	      ---	 $1595.36	004	1	0	0.00	    $0.00	Y	
O	44155	REMOVAL OF COLON/ILEOSTOMY              	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
O	44156	REMOVAL OF COLON/ILEOSTOMY              	     6.64	  $247.21	      ---	  $311.75	004	1	0	0.00	    $0.00	Y	
K	44156	REMOVAL OF COLON/ILEOSTOMY              	    33.20	 $1236.04	      ---	 $1558.74	004	1	0	0.00	    $0.00	Y	
K	44157	COLECTOMY W/ILEOANAL ANAST              	    47.07	 $1752.42	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	44157	COLECTOMY W/ILEOANAL ANAST              	     9.41	  $350.33	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	44158	COLECTOMY W/NEO-RECTUM POUCH            	     9.65	  $359.27	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	44158	COLECTOMY W/NEO-RECTUM POUCH            	    48.27	 $1797.09	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	44160	REMOVAL OF COLON                        	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	44160	REMOVAL OF COLON                        	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	44180	LAP ENTEROLYSIS                         	     3.65	  $135.89	      ---	  $171.37	004	1	0	0.00	    $0.00	Y	
K	44180	LAP ENTEROLYSIS                         	    18.26	  $679.82	      ---	  $857.31	004	1	0	0.00	    $0.00	Y	
K	44186	LAP JEJUNOSTOMY                         	    12.88	  $479.52	      ---	  $604.72	004	1	0	0.00	    $0.00	Y	
O	44186	LAP JEJUNOSTOMY                         	     2.58	   $96.05	      ---	  $121.13	004	1	0	0.00	    $0.00	Y	
O	44187	LAP ILEO/JEJUNO-STOMY                   	     4.27	  $158.97	      ---	  $200.48	004	1	0	0.00	    $0.00	Y	
K	44187	LAP ILEO/JEJUNO-STOMY                   	    21.34	  $794.49	      ---	 $1001.91	004	1	0	0.00	    $0.00	Y	
K	44188	LAP COLOSTOMY                           	    23.38	  $870.44	      ---	 $1097.69	004	1	0	0.00	    $0.00	Y	
O	44188	LAP COLOSTOMY                           	     4.68	  $174.24	      ---	  $219.73	004	1	0	0.00	    $0.00	Y	
O	44202	LAP ENTERECTOMY                         	     5.16	  $192.11	      ---	  $242.26	004	1	0	0.00	    $0.00	Y	
K	44202	LAP ENTERECTOMY                         	    25.81	  $960.91	      ---	 $1211.78	004	1	0	0.00	    $0.00	Y	
K	44203	LAP RESECT S/INTESTINE ADDL             	     5.26	  $195.83	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	44203	LAP RESECT S/INTESTINE ADDL             	     1.05	   $39.09	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	44204	LAPARO PARTIAL COLECTOMY                	     5.86	  $218.17	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	44204	LAPARO PARTIAL COLECTOMY                	    31.11	 $1158.23	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	44205	LAP COLECTOMY PART W/ILEUM              	    26.99	 $1004.84	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	44205	LAP COLECTOMY PART W/ILEUM              	     5.40	  $201.04	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	44206	LAP PART COLECTOMY W/STOMA              	     5.58	  $207.74	      ---	  $261.98	004	1	0	0.00	    $0.00	Y	
K	44206	LAP PART COLECTOMY W/STOMA              	    27.91	 $1039.09	      ---	 $1310.37	004	1	0	0.00	    $0.00	Y	
K	44207	L COLECTOMY/COLOPROCTOSTOMY             	    33.96	 $1264.33	      ---	 $1594.42	004	1	0	0.00	    $0.00	Y	
O	44207	L COLECTOMY/COLOPROCTOSTOMY             	     6.40	  $238.27	      ---	  $300.48	004	1	0	0.00	    $0.00	Y	
O	44208	L COLECTOMY/COLOPROCTOSTOMY             	     5.43	  $202.16	      ---	  $254.94	004	1	0	0.00	    $0.00	Y	
K	44208	L COLECTOMY/COLOPROCTOSTOMY             	    27.16	 $1011.17	      ---	 $1275.16	004	1	0	0.00	    $0.00	Y	
K	44210	LAPARO TOTAL PROCTOCOLECTOMY            	    23.84	  $887.56	      ---	 $1119.29	004	1	0	0.00	    $0.00	Y	
O	44210	LAPARO TOTAL PROCTOCOLECTOMY            	     4.77	  $177.59	      ---	  $223.95	004	1	0	0.00	    $0.00	Y	
O	44211	LAP COLECTOMY W/PROCTECTOMY             	     5.93	  $220.77	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	44211	LAP COLECTOMY W/PROCTECTOMY             	    29.65	 $1103.87	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	44212	LAPARO TOTAL PROCTOCOLECTOMY            	    27.60	 $1027.55	      ---	 $1295.82	004	1	0	0.00	    $0.00	Y	
O	44212	LAPARO TOTAL PROCTOCOLECTOMY            	     5.52	  $205.51	      ---	  $259.16	004	1	0	0.00	    $0.00	Y	
O	44213	LAP MOBIL SPLENIC FL ADD-ON             	     0.83	   $30.90	      ---	   $38.97	004	1	0	0.00	    $0.00	Y	
K	44213	LAP MOBIL SPLENIC FL ADD-ON             	     4.17	  $155.25	      ---	  $195.78	004	1	0	0.00	    $0.00	Y	
K	44227	LAP CLOSE ENTEROSTOMY                   	    32.81	 $1221.52	      ---	 $1540.43	004	1	0	0.00	    $0.00	Y	
O	44227	LAP CLOSE ENTEROSTOMY                   	     6.56	  $244.23	      ---	  $307.99	004	1	0	0.00	    $0.00	Y	
O	44238	UNLISTED LAPS PX INTESTINE              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	44238	UNLISTED LAPS PX INTESTINE              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	44300	OPEN BOWEL TO SKIN                      	     9.63	  $358.52	      ---	  $452.13	004	1	0	0.00	    $0.00	Y	
O	44300	OPEN BOWEL TO SKIN                      	     1.93	   $71.85	      ---	   $90.61	004	1	0	0.00	    $0.00	Y	
O	44310	ILEOSTOMY/JEJUNOSTOMY                   	     3.28	  $122.11	      ---	  $154.00	004	1	0	0.00	    $0.00	Y	
K	44310	ILEOSTOMY/JEJUNOSTOMY                   	    16.42	  $611.32	      ---	  $770.92	004	1	0	0.00	    $0.00	Y	
K	44312	REVISION OF ILEOSTOMY                   	     9.07	  $337.68	      ---	  $425.84	004	1	0	0.00	    $0.00	Y	
O	44312	REVISION OF ILEOSTOMY                   	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
O	44314	REVISION OF ILEOSTOMY                   	     3.55	  $132.17	      ---	  $166.67	004	1	0	0.00	    $0.00	Y	
K	44314	REVISION OF ILEOSTOMY                   	    17.76	  $661.20	      ---	  $833.83	004	1	0	0.00	    $0.00	Y	
K	44316	DEVISE BOWEL POUCH                      	    25.70	  $956.81	      ---	 $1206.62	004	1	0	0.00	    $0.00	Y	
O	44316	DEVISE BOWEL POUCH                      	     5.14	  $191.36	      ---	  $241.32	004	1	0	0.00	    $0.00	Y	
O	44320	COLOSTOMY                               	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	44320	COLOSTOMY                               	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	44322	COLOSTOMY WITH BIOPSIES                 	    19.38	  $721.52	      ---	  $909.89	004	1	0	0.00	    $0.00	Y	
O	44322	COLOSTOMY WITH BIOPSIES                 	     3.88	  $144.45	      ---	  $182.17	004	1	0	0.00	    $0.00	Y	
K	44340	REVISION OF COLOSTOMY                   	     4.59	  $170.89	      ---	  $215.50	004	1	0	0.00	    $0.00	Y	
K	44345	REVISION OF COLOSTOMY                   	     8.66	  $322.41	      ---	  $406.59	004	1	0	0.00	    $0.00	Y	
O	44345	REVISION OF COLOSTOMY                   	     1.73	   $64.41	      ---	   $81.22	004	1	0	0.00	    $0.00	Y	
O	44346	REVISION OF COLOSTOMY                   	     3.49	  $129.93	      ---	  $163.86	004	1	0	0.00	    $0.00	Y	
K	44346	REVISION OF COLOSTOMY                   	    17.44	  $649.29	      ---	  $818.81	004	1	0	0.00	    $0.00	Y	
K	44360	SMALL BOWEL ENDOSCOPY                   	     4.09	  $152.27	      ---	  $192.03	004	1	0	0.00	    $0.00	Y	
K	44361	SMALL BOWEL ENDOSCOPY/BIOPSY            	     4.80	  $178.70	      ---	  $225.36	004	1	0	0.00	    $0.00	Y	
K	44363	SMALL BOWEL ENDOSCOPY                   	     4.54	  $169.02	      ---	  $213.15	004	1	0	0.00	    $0.00	Y	
K	44364	SMALL BOWEL ENDOSCOPY                   	     5.45	  $202.90	      ---	  $255.88	004	1	0	0.00	    $0.00	Y	
K	44365	SMALL BOWEL ENDOSCOPY                   	     6.98	  $259.87	      ---	  $327.71	004	1	0	0.00	    $0.00	Y	
K	44366	SMALL BOWEL ENDOSCOPY                   	     6.31	  $234.92	      ---	  $296.25	004	1	0	0.00	    $0.00	Y	
K	44369	SMALL BOWEL ENDOSCOPY                   	     7.08	  $263.59	      ---	  $332.41	004	1	0	0.00	    $0.00	Y	
K	44370	SMALL BOWEL ENDOSCOPY/STENT             	     5.30	  $197.32	      ---	  $248.84	004	1	0	0.00	    $0.00	Y	
K	44372	SMALL BOWEL ENDOSCOPY                   	     6.44	  $239.76	      ---	  $302.36	004	1	0	0.00	    $0.00	Y	
K	44373	SMALL BOWEL ENDOSCOPY                   	     5.69	  $211.84	      ---	  $267.15	004	1	0	0.00	    $0.00	Y	
K	44376	SMALL BOWEL ENDOSCOPY                   	     6.78	  $252.42	      ---	  $318.32	004	1	0	0.00	    $0.00	Y	
K	44377	SMALL BOWEL ENDOSCOPY/BIOPSY            	     7.17	  $266.94	      ---	  $336.63	004	1	0	0.00	    $0.00	Y	
K	44378	SMALL BOWEL ENDOSCOPY                   	     9.35	  $348.10	      ---	  $438.98	004	1	0	0.00	    $0.00	Y	
K	44379	S BOWEL ENDOSCOPE W/STENT               	     8.64	  $321.67	      ---	  $405.65	004	1	0	0.00	    $0.00	Y	
K	44380	SMALL BOWEL ENDOSCOPY BR/WA             	     2.26	   $84.14	      ---	  $106.11	004	1	0	0.00	    $0.00	Y	
K	44381	SMALL BOWEL ENDOSCOPY BR/WA             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	44382	SMALL BOWEL ENDOSCOPY                   	     2.93	  $109.08	      ---	  $137.56	004	1	0	0.00	    $0.00	Y	
K	44384	SMALL BOWEL ENDOSCOPY                   	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	44385	ENDOSCOPY OF BOWEL POUCH                	     3.23	  $120.25	      ---	  $151.65	004	1	0	0.00	    $0.00	Y	
K	44386	ENDOSCOPY BOWEL POUCH/BIOP              	     3.27	  $121.74	      ---	  $153.53	004	1	0	0.00	    $0.00	Y	
K	44388	COLONOSCOPY THRU STOMA SPX              	     4.30	  $160.09	      ---	  $201.89	004	1	0	0.00	    $0.00	Y	
K	44389	COLONOSCOPY WITH BIOPSY                 	     4.86	  $180.94	      ---	  $228.18	004	1	0	0.00	    $0.00	Y	
K	44390	COLONOSCOPY FOR FOREIGN BODY            	     4.72	  $175.73	      ---	  $221.60	004	1	0	0.00	    $0.00	Y	
K	44391	COLONOSCOPY FOR BLEEDING                	     6.22	  $231.57	      ---	  $292.03	004	1	0	0.00	    $0.00	Y	
K	44392	COLONOSCOPY & POLYPECTOMY               	     6.42	  $239.02	      ---	  $301.42	004	1	0	0.00	    $0.00	Y	
K	44394	COLONOSCOPY W/SNARE                     	     8.34	  $310.50	      ---	  $391.56	004	1	0	0.00	    $0.00	Y	
K	44401	COLONOSCOPY WITH ABLATION               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	44402	COLONOSCOPY W/STENT PLCMT               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	44403	COLONOSCOPY W/RESECTION                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	44404	COLONOSCOPY W/INJECTION                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	44405	COLONOSCOPY W/DILATION                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	44406	COLONOSCOPY W/ULTRASOUND                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	44407	COLONOSCOPY W/NDL ASPIR/BX              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	44408	COLONOSCOPY W/DECOMPRESSION             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	44500	INTRO GASTROINTESTINAL TUBE             	     0.52	   $19.36	      ---	   $24.41	004	1	0	0.00	    $0.00	Y	
K	44602	SUTURE SMALL INTESTINE                  	    14.10	  $524.94	      ---	  $662.00	004	1	0	0.00	    $0.00	Y	
O	44602	SUTURE SMALL INTESTINE                  	     2.82	  $104.99	      ---	  $132.40	004	1	0	0.00	    $0.00	Y	
O	44603	SUTURE SMALL INTESTINE                  	     3.63	  $135.14	      ---	  $170.43	004	1	0	0.00	    $0.00	Y	
K	44603	SUTURE SMALL INTESTINE                  	    18.20	  $677.59	      ---	  $854.49	004	1	0	0.00	    $0.00	Y	
K	44604	SUTURE LARGE INTESTINE                  	    18.38	  $684.29	      ---	  $862.94	004	1	0	0.00	    $0.00	Y	
O	44604	SUTURE LARGE INTESTINE                  	     3.68	  $137.01	      ---	  $172.78	004	1	0	0.00	    $0.00	Y	
O	44605	REPAIR OF BOWEL LESION                  	     3.62	  $134.77	      ---	  $169.96	004	1	0	0.00	    $0.00	Y	
K	44605	REPAIR OF BOWEL LESION                  	    18.12	  $674.61	      ---	  $850.73	004	1	0	0.00	    $0.00	Y	
K	44615	INTESTINAL STRICTUROPLASTY              	    15.21	  $566.27	      ---	  $714.11	004	1	0	0.00	    $0.00	Y	
O	44615	INTESTINAL STRICTUROPLASTY              	     3.05	  $113.55	      ---	  $143.20	004	1	0	0.00	    $0.00	Y	
O	44620	REPAIR BOWEL OPENING                    	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	44620	REPAIR BOWEL OPENING                    	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	44625	REPAIR BOWEL OPENING                    	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
O	44625	REPAIR BOWEL OPENING                    	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
O	44626	REPAIR BOWEL OPENING                    	     5.56	  $207.00	      ---	  $261.04	004	1	0	0.00	    $0.00	Y	
K	44626	REPAIR BOWEL OPENING                    	    27.83	 $1036.11	      ---	 $1306.62	004	1	0	0.00	    $0.00	Y	
K	44640	REPAIR BOWEL-SKIN FISTULA               	    16.12	  $600.15	      ---	  $756.83	004	1	0	0.00	    $0.00	Y	
O	44640	REPAIR BOWEL-SKIN FISTULA               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	44650	REPAIR BOWEL FISTULA                    	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
K	44650	REPAIR BOWEL FISTULA                    	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
K	44660	REPAIR BOWEL-BLADDER FISTULA            	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
O	44660	REPAIR BOWEL-BLADDER FISTULA            	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
O	44661	REPAIR BOWEL-BLADDER FISTULA            	     4.38	  $163.07	      ---	  $205.64	004	1	0	0.00	    $0.00	Y	
K	44661	REPAIR BOWEL-BLADDER FISTULA            	    21.92	  $816.08	      ---	 $1029.14	004	1	0	0.00	    $0.00	Y	
K	44680	SURGICAL REVISION INTESTINE             	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
O	44680	SURGICAL REVISION INTESTINE             	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
O	44700	SUSPEND BOWEL W/PROSTHESIS              	     3.83	  $142.59	      ---	  $179.82	004	1	0	0.00	    $0.00	Y	
K	44700	SUSPEND BOWEL W/PROSTHESIS              	    19.16	  $713.33	      ---	  $899.56	004	1	0	0.00	    $0.00	Y	
K	44701	INTRAOP COLON LAVAGE ADD-ON             	     3.29	  $122.49	      ---	  $154.47	004	1	0	0.00	    $0.00	Y	
O	44701	INTRAOP COLON LAVAGE ADD-ON             	     0.66	   $24.57	      ---	   $30.99	004	1	0	0.00	    $0.00	Y	
K	44705	PREPARE FECAL MICROBIOTA                	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	44799	UNLISTED PX SMALL INTESTINE             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	44799	UNLISTED PX SMALL INTESTINE             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	44800	EXCISION OF BOWEL POUCH                 	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	44800	EXCISION OF BOWEL POUCH                 	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	44820	EXCISION OF MESENTERY LESION            	    14.92	  $555.47	      ---	  $700.49	004	1	0	0.00	    $0.00	Y	
O	44820	EXCISION OF MESENTERY LESION            	     2.98	  $110.95	      ---	  $139.91	004	1	0	0.00	    $0.00	Y	
O	44850	REPAIR OF MESENTERY                     	     2.60	   $96.80	      ---	  $122.07	004	1	0	0.00	    $0.00	Y	
K	44850	REPAIR OF MESENTERY                     	    13.00	  $483.99	      ---	  $610.35	004	1	0	0.00	    $0.00	Y	
K	44899	UNLISTED PX MECKEL'S DVRTCLM            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	44899	UNLISTED PX MECKEL'S DVRTCLM            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	44900	DRAIN APPENDIX ABSCESS OPEN             	     1.59	   $59.20	      ---	   $74.65	004	1	0	0.00	    $0.00	Y	
K	44900	DRAIN APPENDIX ABSCESS OPEN             	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
K	44950	APPENDECTOMY                            	    10.76	  $400.59	      ---	  $505.18	004	1	0	0.00	    $0.00	Y	
O	44950	APPENDECTOMY                            	     2.15	   $80.04	      ---	  $100.94	004	1	0	0.00	    $0.00	Y	
O	44955	APPENDECTOMY ADD-ON                     	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	44955	APPENDECTOMY ADD-ON                     	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	44960	APPENDECTOMY                            	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	44960	APPENDECTOMY                            	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
O	44970	LAPAROSCOPY APPENDECTOMY                	     1.47	   $54.73	      ---	   $69.02	004	1	0	0.00	    $0.00	Y	
K	44970	LAPAROSCOPY APPENDECTOMY                	     7.34	  $273.27	      ---	  $344.61	004	1	0	0.00	    $0.00	Y	
K	44979	UNLISTED LAPS PX APPENDIX               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	44979	UNLISTED LAPS PX APPENDIX               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	45000	DRAINAGE OF PELVIC ABSCESS              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	45000	DRAINAGE OF PELVIC ABSCESS              	     3.74	  $139.24	      ---	  $175.59	004	1	0	0.00	    $0.00	Y	
K	45005	DRAINAGE OF RECTAL ABSCESS              	     3.40	  $126.58	      ---	  $159.63	004	1	0	0.00	    $0.00	Y	
K	45020	DRAINAGE OF RECTAL ABSCESS              	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
O	45020	DRAINAGE OF RECTAL ABSCESS              	     1.09	   $40.58	      ---	   $51.18	004	1	0	0.00	    $0.00	Y	
K	45100	BIOPSY OF RECTUM                        	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	45108	ANORECTAL MYOMECTOMY                    	     9.22	  $343.26	      ---	  $432.88	004	1	0	0.00	    $0.00	Y	
O	45108	ANORECTAL MYOMECTOMY                    	     1.84	   $68.50	      ---	   $86.39	004	1	0	0.00	    $0.00	Y	
O	45110	REMOVAL OF RECTUM                       	     5.89	  $219.28	      ---	  $276.54	004	1	0	0.00	    $0.00	Y	
K	45110	REMOVAL OF RECTUM                       	    29.45	 $1096.42	      ---	 $1382.68	004	1	0	0.00	    $0.00	Y	
K	45111	PARTIAL REMOVAL OF RECTUM               	    22.19	  $826.13	      ---	 $1041.82	004	1	0	0.00	    $0.00	Y	
O	45111	PARTIAL REMOVAL OF RECTUM               	     4.44	  $165.30	      ---	  $208.46	004	1	0	0.00	    $0.00	Y	
O	45112	REMOVAL OF RECTUM                       	     5.89	  $219.28	      ---	  $276.54	004	1	0	0.00	    $0.00	Y	
K	45112	REMOVAL OF RECTUM                       	    29.45	 $1096.42	      ---	 $1382.68	004	1	0	0.00	    $0.00	Y	
K	45113	PARTIAL PROCTECTOMY                     	    37.18	 $1384.21	      ---	 $1745.60	004	1	0	0.00	    $0.00	Y	
O	45113	PARTIAL PROCTECTOMY                     	     7.44	  $276.99	      ---	  $349.31	004	1	0	0.00	    $0.00	Y	
O	45114	PARTIAL REMOVAL OF RECTUM               	     6.63	  $246.83	      ---	  $311.28	004	1	0	0.00	    $0.00	Y	
K	45114	PARTIAL REMOVAL OF RECTUM               	    33.16	 $1234.55	      ---	 $1556.86	004	1	0	0.00	    $0.00	Y	
K	45116	PARTIAL REMOVAL OF RECTUM               	    29.25	 $1088.98	      ---	 $1373.29	004	1	0	0.00	    $0.00	Y	
O	45116	PARTIAL REMOVAL OF RECTUM               	     5.85	  $217.80	      ---	  $274.66	004	1	0	0.00	    $0.00	Y	
O	45119	REMOVE RECTUM W/RESERVOIR               	     6.70	  $249.44	      ---	  $314.57	004	1	0	0.00	    $0.00	Y	
K	45119	REMOVE RECTUM W/RESERVOIR               	    33.48	 $1246.46	      ---	 $1571.89	004	1	0	0.00	    $0.00	Y	
K	45120	REMOVAL OF RECTUM                       	    29.45	 $1096.42	      ---	 $1382.68	004	1	0	0.00	    $0.00	Y	
O	45120	REMOVAL OF RECTUM                       	     5.89	  $219.28	      ---	  $276.54	004	1	0	0.00	    $0.00	Y	
O	45121	REMOVAL OF RECTUM AND COLON             	     5.89	  $219.28	      ---	  $276.54	004	1	0	0.00	    $0.00	Y	
K	45121	REMOVAL OF RECTUM AND COLON             	    29.45	 $1096.42	      ---	 $1382.68	004	1	0	0.00	    $0.00	Y	
K	45123	PARTIAL PROCTECTOMY                     	    23.25	  $865.60	      ---	 $1091.59	004	1	0	0.00	    $0.00	Y	
O	45123	PARTIAL PROCTECTOMY                     	     4.65	  $173.12	      ---	  $218.32	004	1	0	0.00	    $0.00	Y	
O	45126	PELVIC EXENTERATION                     	     9.38	  $349.22	      ---	  $440.39	004	1	0	0.00	    $0.00	Y	
K	45126	PELVIC EXENTERATION                     	    46.90	 $1746.09	      ---	 $2201.96	004	1	0	0.00	    $0.00	Y	
K	45130	EXCISION OF RECTAL PROLAPSE             	    16.42	  $611.32	      ---	  $770.92	004	1	0	0.00	    $0.00	Y	
O	45130	EXCISION OF RECTAL PROLAPSE             	     3.28	  $122.11	      ---	  $154.00	004	1	0	0.00	    $0.00	Y	
O	45135	EXCISION OF RECTAL PROLAPSE             	     5.20	  $193.60	      ---	  $244.14	004	1	0	0.00	    $0.00	Y	
K	45135	EXCISION OF RECTAL PROLAPSE             	    26.00	  $967.98	      ---	 $1220.70	004	1	0	0.00	    $0.00	Y	
K	45136	EXCISE ILEOANAL RESERVIOR               	    34.39	 $1280.34	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	45136	EXCISE ILEOANAL RESERVIOR               	     6.88	  $256.14	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	45150	EXCISION OF RECTAL STRICTURE            	     1.97	   $73.34	      ---	   $92.49	004	1	0	0.00	    $0.00	Y	
K	45150	EXCISION OF RECTAL STRICTURE            	     9.83	  $365.97	      ---	  $461.52	004	1	0	0.00	    $0.00	Y	
K	45160	EXCISION OF RECTAL LESION               	    18.61	  $692.85	      ---	  $873.74	004	1	0	0.00	    $0.00	Y	
O	45160	EXCISION OF RECTAL LESION               	     3.72	  $138.50	      ---	  $174.65	004	1	0	0.00	    $0.00	Y	
O	45171	EXC RECT TUM TRANSANAL PART             	     2.66	   $99.03	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	45171	EXC RECT TUM TRANSANAL PART             	    13.28	  $494.41	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	45172	EXC RECT TUM TRANSANAL FULL             	    18.08	  $673.12	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	45172	EXC RECT TUM TRANSANAL FULL             	     3.62	  $134.77	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	45190	DESTRUCTION RECTAL TUMOR                	     2.37	   $88.24	      ---	  $111.27	004	1	0	0.00	    $0.00	Y	
K	45190	DESTRUCTION RECTAL TUMOR                	    11.85	  $441.18	      ---	  $556.36	004	1	0	0.00	    $0.00	Y	
K	45300	PROCTOSIGMOIDOSCOPY DX                  	     0.97	   $36.11	      ---	   $45.54	004	1	1	0.00	    $0.00	Y	
K	45303	PROCTOSIGMOIDOSCOPY DILATE              	     1.10	   $40.95	      ---	   $51.65	004	1	1	0.00	    $0.00	Y	
K	45305	PROCTOSIGMOIDOSCOPY W/BX                	     1.36	   $50.63	      ---	   $63.85	004	1	1	0.00	    $0.00	Y	
K	45307	PROCTOSIGMOIDOSCOPY FB                  	     2.08	   $77.44	      ---	   $97.66	004	1	1	0.00	    $0.00	Y	
K	45308	PROCTOSIGMOIDOSCOPY REMOVAL             	     2.64	   $98.29	      ---	  $123.95	004	1	0	0.00	    $0.00	Y	
K	45309	PROCTOSIGMOIDOSCOPY REMOVAL             	     2.64	   $98.29	      ---	  $123.95	004	1	0	0.00	    $0.00	Y	
K	45315	PROCTOSIGMOIDOSCOPY REMOVAL             	     2.51	   $93.45	      ---	  $117.84	004	1	1	0.00	    $0.00	Y	
K	45317	PROCTOSIGMOIDOSCOPY BLEED               	     2.31	   $86.00	      ---	  $108.45	004	1	1	0.00	    $0.00	Y	
O	45317	PROCTOSIGMOIDOSCOPY BLEED               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	45320	PROCTOSIGMOIDOSCOPY ABLATE              	     2.70	  $100.52	      ---	  $126.77	004	1	0	0.00	    $0.00	Y	
K	45321	PROCTOSIGMOIDOSCOPY VOLVUL              	     2.34	   $87.12	      ---	  $109.86	004	1	1	0.00	    $0.00	Y	
K	45327	PROCTOSIGMOIDOSCOPY W/STENT             	     2.09	   $77.81	      ---	   $98.13	004	1	0	0.00	    $0.00	Y	
K	45330	DIAGNOSTIC SIGMOIDOSCOPY                	     1.47	   $54.73	      ---	   $69.02	004	1	1	0.00	    $0.00	Y	
K	45331	SIGMOIDOSCOPY AND BIOPSY                	     1.94	   $72.23	      ---	   $91.08	004	1	1	0.00	    $0.00	Y	
K	45332	SIGMOIDOSCOPY W/FB REMOVAL              	     2.52	   $93.82	      ---	  $118.31	004	1	1	0.00	    $0.00	Y	
K	45333	SIGMOIDOSCOPY & POLYPECTOMY             	     2.85	  $106.11	      ---	  $133.81	004	1	1	0.00	    $0.00	Y	
K	45334	SIGMOIDOSCOPY FOR BLEEDING              	     3.31	  $123.23	      ---	  $155.40	004	1	1	0.00	    $0.00	Y	
K	45335	SIGMOIDOSCOPY W/SUBMUC INJ              	     4.12	  $153.39	      ---	  $193.43	004	1	1	0.00	    $0.00	Y	
K	45337	SIGMOIDOSCOPY & DECOMPRESS              	     3.35	  $124.72	      ---	  $157.28	004	1	0	0.00	    $0.00	Y	
K	45338	SIGMOIDOSCOPY W/TUMR REMOVE             	     3.85	  $143.34	      ---	  $180.76	004	1	0	0.00	    $0.00	Y	
K	45340	SIG W/TNDSC BALLOON DILATION            	     9.55	  $355.55	      ---	  $448.37	004	1	1	0.00	    $0.00	Y	
K	45341	SIGMOIDOSCOPY W/ULTRASOUND              	     4.64	  $172.75	      ---	  $217.85	004	1	0	0.00	    $0.00	Y	
K	45342	SIGMOIDOSCOPY W/US GUIDE BX             	     5.33	  $198.44	      ---	  $250.24	004	1	0	0.00	    $0.00	Y	
K	45346	SIGMOIDOSCOPY W/ABLATION                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	45347	SIGMOIDOSCOPY W/PLCMT STENT             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	45349	SIGMOIDOSCOPY W/RESECTION               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	45350	SGMDSC W/BAND LIGATION                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	45378	DIAGNOSTIC COLONOSCOPY                  	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
K	45379	COLONOSCOPY W/FB REMOVAL                	     9.87	  $367.46	      ---	  $463.40	004	1	0	0.00	    $0.00	Y	
K	45380	COLONOSCOPY AND BIOPSY                  	     8.87	  $330.23	      ---	  $416.45	004	1	0	0.00	    $0.00	Y	
K	45381	COLONOSCOPY SUBMUCOUS NJX               	    11.09	  $412.88	      ---	  $520.68	004	1	0	0.00	    $0.00	Y	
K	45382	COLONOSCOPY W/CONTROL BLEED             	    11.16	  $415.49	      ---	  $523.96	004	1	0	0.00	    $0.00	Y	
K	45384	COLONOSCOPY W/LESION REMOVAL            	    10.07	  $374.91	      ---	  $472.79	004	1	0	0.00	    $0.00	Y	
K	45385	COLONOSCOPY W/LESION REMOVAL            	    10.75	  $400.22	      ---	  $504.71	004	1	0	0.00	    $0.00	Y	
K	45386	COLONOSCOPY W/BALLOON DILAT             	    21.42	  $797.47	      ---	 $1005.67	004	1	0	0.00	    $0.00	Y	
K	45388	COLONOSCOPY W/ABLATION                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	45389	COLONOSCOPY W/STENT PLCMT               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	45390	COLONOSCOPY W/RESECTION                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	45391	COLONOSCOPY W/ENDOSCOPE US              	     4.56	  $169.77	      ---	  $214.09	004	1	0	0.00	    $0.00	Y	
K	45392	COLONOSCOPY W/ENDOSCOPIC FNB            	     5.77	  $214.82	      ---	  $270.90	004	1	0	0.00	    $0.00	Y	
K	45393	COLONOSCOPY W/DECOMPRESSION             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	45395	LAP REMOVAL OF RECTUM                   	    38.88	 $1447.50	      ---	 $1825.42	004	1	0	0.00	    $0.00	Y	
O	45395	LAP REMOVAL OF RECTUM                   	     7.78	  $289.65	      ---	  $365.27	004	1	0	0.00	    $0.00	Y	
O	45397	LAP REMOVE RECTUM W/POUCH               	     8.45	  $314.59	      ---	  $396.73	004	1	0	0.00	    $0.00	Y	
K	45397	LAP REMOVE RECTUM W/POUCH               	    42.23	 $1572.22	      ---	 $1982.70	004	1	0	0.00	    $0.00	Y	
K	45398	COLONOSCOPY W/BAND LIGATION             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	45399	UNLISTED PROCEDURE COLON                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	45399	UNLISTED PROCEDURE COLON                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	45400	LAPAROSCOPIC PROC                       	     4.54	  $169.02	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	45400	LAPAROSCOPIC PROC                       	    22.70	  $845.12	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	45402	LAP PROCTOPEXY W/SIG RESECT             	    30.71	 $1143.33	      ---	 $1441.83	004	1	0	0.00	    $0.00	Y	
O	45402	LAP PROCTOPEXY W/SIG RESECT             	     6.14	  $228.59	      ---	  $288.27	004	1	0	0.00	    $0.00	Y	
O	45499	LAPAROSCOPE PROC RECTUM                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	45499	LAPAROSCOPE PROC RECTUM                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	45500	REPAIR OF RECTUM                        	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
O	45500	REPAIR OF RECTUM                        	     2.00	   $74.46	      ---	   $93.90	004	1	0	0.00	    $0.00	Y	
O	45505	REPAIR OF RECTUM                        	     2.20	   $81.91	      ---	  $103.29	004	1	0	0.00	    $0.00	Y	
K	45505	REPAIR OF RECTUM                        	    11.00	  $409.53	      ---	  $516.45	004	1	0	0.00	    $0.00	Y	
K	45520	TREATMENT OF RECTAL PROLAPSE            	     1.08	   $40.21	      ---	   $50.71	004	1	0	0.00	    $0.00	Y	
K	45540	CORRECT RECTAL PROLAPSE                 	    18.00	  $670.14	      ---	  $845.10	004	1	0	0.00	    $0.00	Y	
O	45540	CORRECT RECTAL PROLAPSE                 	     3.60	  $134.03	      ---	  $169.02	004	1	0	0.00	    $0.00	Y	
O	45541	CORRECT RECTAL PROLAPSE                 	     3.60	  $134.03	      ---	  $169.02	004	1	0	0.00	    $0.00	Y	
K	45541	CORRECT RECTAL PROLAPSE                 	    18.00	  $670.14	      ---	  $845.10	004	1	0	0.00	    $0.00	Y	
K	45550	REPAIR RECTUM/REMOVE SIGMOID            	    23.77	  $884.96	      ---	 $1116.00	004	1	0	0.00	    $0.00	Y	
O	45550	REPAIR RECTUM/REMOVE SIGMOID            	     4.75	  $176.84	      ---	  $223.01	004	1	0	0.00	    $0.00	Y	
O	45560	REPAIR OF RECTOCELE                     	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	45560	REPAIR OF RECTOCELE                     	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	45562	EXPLORATION/REPAIR OF RECTUM            	    17.58	  $654.50	      ---	  $825.38	004	1	0	0.00	    $0.00	Y	
O	45562	EXPLORATION/REPAIR OF RECTUM            	     3.52	  $131.05	      ---	  $165.26	004	1	0	0.00	    $0.00	Y	
O	45563	EXPLORATION/REPAIR OF RECTUM            	     5.55	  $206.63	      ---	  $260.57	004	1	0	0.00	    $0.00	Y	
K	45563	EXPLORATION/REPAIR OF RECTUM            	    27.74	 $1032.76	      ---	 $1302.39	004	1	0	0.00	    $0.00	Y	
K	45800	REPAIR RECT/BLADDER FISTULA             	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
O	45800	REPAIR RECT/BLADDER FISTULA             	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
O	45805	REPAIR FISTULA W/COLOSTOMY              	     4.40	  $163.81	      ---	  $206.58	004	1	0	0.00	    $0.00	Y	
K	45805	REPAIR FISTULA W/COLOSTOMY              	    22.00	  $819.06	      ---	 $1032.90	004	1	0	0.00	    $0.00	Y	
K	45820	REPAIR RECTOURETHRAL FISTULA            	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
O	45820	REPAIR RECTOURETHRAL FISTULA            	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
O	45825	REPAIR FISTULA W/COLOSTOMY              	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	45825	REPAIR FISTULA W/COLOSTOMY              	    22.64	  $842.89	      ---	 $1062.95	004	1	0	0.00	    $0.00	Y	
K	45900	REDUCTION OF RECTAL PROLAPSE            	     1.23	   $45.79	      ---	   $57.75	004	1	1	0.00	    $0.00	Y	
K	45905	DILATION OF ANAL SPHINCTER              	     4.05	  $150.78	      ---	  $190.15	004	1	0	0.00	    $0.00	Y	
K	45910	DILATION OF RECTAL NARROWING            	     2.84	  $105.73	      ---	  $133.34	004	1	0	0.00	    $0.00	Y	
K	45915	REMOVE RECTAL OBSTRUCTION               	     5.53	  $205.88	      ---	  $259.63	004	1	0	0.00	    $0.00	Y	
K	45990	SURG DX EXAM ANORECTAL                  	     2.25	   $83.77	      ---	  $105.64	004	1	0	0.00	    $0.00	Y	
O	45990	SURG DX EXAM ANORECTAL                  	     0.45	   $16.75	      ---	   $21.13	004	1	0	0.00	    $0.00	Y	
O	45999	UNLISTED PROCEDURE RECTUM               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	45999	UNLISTED PROCEDURE RECTUM               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	46020	PLACEMENT OF SETON                      	     5.17	  $192.48	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	46030	REMOVAL ANAL SETON OTH MRK              	     1.89	   $70.36	      ---	   $88.74	004	1	1	0.00	    $0.00	Y	
K	46040	INCISION OF RECTAL ABSCESS              	     4.80	  $178.70	      ---	  $225.36	004	1	1	0.00	    $0.00	Y	
K	46045	INCISION OF RECTAL ABSCESS              	     3.32	  $123.60	      ---	  $155.87	004	1	0	0.00	    $0.00	Y	
K	46050	INCISION OF ANAL ABSCESS                	     2.14	   $79.67	      ---	  $100.47	004	1	1	0.00	    $0.00	Y	
K	46060	INCISION OF RECTAL ABSCESS              	     9.50	  $353.69	      ---	  $446.03	004	1	0	0.00	    $0.00	Y	
O	46060	INCISION OF RECTAL ABSCESS              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	46070	INCISION ANAL SEPTUM INFANT             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	46070	INCISION ANAL SEPTUM INFANT             	     2.52	   $93.82	      ---	  $118.31	004	1	0	0.00	    $0.00	Y	
K	46080	INCISION OF ANAL SPHINCTER              	     2.80	  $104.24	      ---	  $131.46	004	1	0	0.00	    $0.00	Y	
K	46083	INCISE EXTERNAL HEMORRHOID              	     5.13	  $190.99	      ---	  $240.85	004	1	1	0.00	    $0.00	Y	
O	46083	INCISE EXTERNAL HEMORRHOID              	     1.03	   $38.35	      ---	   $48.36	004	1	0	0.00	    $0.00	Y	
O	46200	REMOVAL OF ANAL FISSURE                 	     1.09	   $40.58	      ---	   $51.18	004	1	0	0.00	    $0.00	Y	
K	46200	REMOVAL OF ANAL FISSURE                 	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
K	46220	EXCISE ANAL EXT TAG/PAPILLA             	     1.34	   $49.89	      ---	   $62.91	004	1	1	0.00	    $0.00	Y	
K	46221	LIGATION OF HEMORRHOID(S)               	     2.07	   $77.07	      ---	   $97.19	004	1	1	0.00	    $0.00	Y	
K	46230	REMOVAL OF ANAL TAGS                    	     3.13	  $116.53	      ---	  $146.95	004	1	1	0.00	    $0.00	Y	
K	46250	REMOVE EXT HEM GROUPS 2+                	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
K	46255	REMOVE INT/EXT HEM 1 GROUP              	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
O	46255	REMOVE INT/EXT HEM 1 GROUP              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	46257	REMOVE IN/EX HEM GRP & FISS             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	46257	REMOVE IN/EX HEM GRP & FISS             	     8.53	  $317.57	      ---	  $400.48	004	1	0	0.00	    $0.00	Y	
K	46258	REMOVE IN/EX HEM GRP W/FISTU            	     8.94	  $332.84	      ---	  $419.73	004	1	0	0.00	    $0.00	Y	
O	46258	REMOVE IN/EX HEM GRP W/FISTU            	     1.79	   $66.64	      ---	   $84.04	004	1	0	0.00	    $0.00	Y	
O	46260	REMOVE IN/EX HEM GROUPS 2+              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	46260	REMOVE IN/EX HEM GROUPS 2+              	    10.27	  $382.35	      ---	  $482.18	004	1	0	0.00	    $0.00	Y	
K	46261	REMOVE IN/EX HEM GRPS & FISS            	    11.19	  $416.60	      ---	  $525.37	004	1	0	0.00	    $0.00	Y	
O	46261	REMOVE IN/EX HEM GRPS & FISS            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	46262	REMOVE IN/EX HEM GRPS W/FIST            	     2.36	   $87.86	      ---	  $110.80	004	1	0	0.00	    $0.00	Y	
K	46262	REMOVE IN/EX HEM GRPS W/FIST            	    11.82	  $440.06	      ---	  $554.95	004	1	0	0.00	    $0.00	Y	
K	46270	REMOVE ANAL FIST SUBQ                   	     4.04	  $150.41	      ---	  $189.68	004	1	0	0.00	    $0.00	Y	
K	46275	REMOVE ANAL FIST INTER                  	     9.50	  $353.69	      ---	  $446.03	004	1	0	0.00	    $0.00	Y	
O	46275	REMOVE ANAL FIST INTER                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	46280	REMOVE ANAL FIST COMPLEX                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	46280	REMOVE ANAL FIST COMPLEX                	    10.45	  $389.05	      ---	  $490.63	004	1	0	0.00	    $0.00	Y	
K	46285	REMOVE ANAL FIST 2 STAGE                	     3.72	  $138.50	      ---	  $174.65	004	1	0	0.00	    $0.00	Y	
K	46288	REPAIR ANAL FISTULA                     	     8.03	  $298.96	      ---	  $377.01	004	1	0	0.00	    $0.00	Y	
O	46288	REPAIR ANAL FISTULA                     	     1.61	   $59.94	      ---	   $75.59	004	1	0	0.00	    $0.00	Y	
K	46320	REMOVAL OF HEMORRHOID CLOT              	     2.49	   $92.70	      ---	  $116.91	004	1	1	0.00	    $0.00	Y	
K	46500	INJECTION INTO HEMORRHOID(S)            	     1.96	   $72.97	      ---	   $92.02	004	1	1	0.00	    $0.00	Y	
K	46505	CHEMODENERVATION ANAL MUSC              	     5.08	  $189.13	      ---	  $238.51	004	1	0	0.00	    $0.00	Y	
K	46600	DIAGNOSTIC ANOSCOPY SPX                 	     0.59	   $21.97	      ---	   $27.70	004	1	1	0.00	    $0.00	Y	
X	46600	DIAGNOSTIC ANOSCOPY SPX                 	   112.75	  $112.75	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	46601	DIAGNOSTIC ANOSCOPY                     	     0.00	    $0.00	      ---	       --	004	1	1	0.00	    $0.00	Y	
K	46604	ANOSCOPY AND DILATION                   	     1.06	   $39.46	      ---	   $49.77	004	1	1	0.00	    $0.00	Y	
K	46606	ANOSCOPY AND BIOPSY                     	     0.78	   $29.04	      ---	   $36.62	004	1	1	0.00	    $0.00	Y	
K	46607	DIAGNOSTIC ANOSCOPY & BIOPSY            	     0.00	    $0.00	      ---	       --	004	1	1	0.00	    $0.00	Y	
K	46608	ANOSCOPY REMOVE FOR BODY                	     2.90	  $107.97	      ---	  $136.16	004	1	1	0.00	    $0.00	Y	
K	46610	ANOSCOPY REMOVE LESION                  	     2.44	   $90.84	      ---	  $114.56	004	1	1	0.00	    $0.00	Y	
K	46611	ANOSCOPY                                	     2.05	   $76.32	      ---	   $96.25	004	1	0	0.00	    $0.00	Y	
K	46612	ANOSCOPY REMOVE LESIONS                 	     4.10	  $152.64	      ---	  $192.50	004	1	1	0.00	    $0.00	Y	
K	46614	ANOSCOPY CONTROL BLEEDING               	     3.21	  $119.51	      ---	  $150.71	004	1	1	0.00	    $0.00	Y	
K	46615	ANOSCOPY                                	     3.66	  $136.26	      ---	  $171.84	004	1	0	0.00	    $0.00	Y	
K	46700	REPAIR OF ANAL STRICTURE                	     9.88	  $367.83	      ---	  $463.87	004	1	1	0.00	    $0.00	Y	
O	46700	REPAIR OF ANAL STRICTURE                	     1.98	   $73.72	      ---	   $92.96	004	1	0	0.00	    $0.00	Y	
O	46705	REPAIR OF ANAL STRICTURE                	     2.01	   $74.83	      ---	   $94.37	004	1	0	0.00	    $0.00	Y	
K	46705	REPAIR OF ANAL STRICTURE                	    10.03	  $373.42	      ---	  $470.91	004	1	0	0.00	    $0.00	Y	
K	46706	REPR OF ANAL FISTULA W/GLUE             	     2.03	   $75.58	      ---	   $95.31	004	1	0	0.00	    $0.00	Y	
O	46706	REPR OF ANAL FISTULA W/GLUE             	     0.41	   $15.26	      ---	   $19.25	004	1	0	0.00	    $0.00	Y	
K	46707	REPAIR ANORECTAL FIST W/PLUG            	    10.20	  $379.75	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	46710	REPR PER/VAG POUCH SNGL PROC            	    20.57	  $765.82	      ---	  $965.76	004	1	0	0.00	    $0.00	Y	
O	46710	REPR PER/VAG POUCH SNGL PROC            	     4.11	  $153.02	      ---	  $192.96	004	1	0	0.00	    $0.00	Y	
O	46712	REPR PER/VAG POUCH DBL PROC             	     8.58	  $319.43	      ---	  $402.83	004	1	0	0.00	    $0.00	Y	
K	46712	REPR PER/VAG POUCH DBL PROC             	    42.92	 $1597.91	      ---	 $2015.09	004	1	0	0.00	    $0.00	Y	
K	46715	REP PERF ANOPER FISTU                   	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	46715	REP PERF ANOPER FISTU                   	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	46716	REP PERF ANOPER/VESTIB FISTU            	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	46716	REP PERF ANOPER/VESTIB FISTU            	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	46730	CONSTRUCTION OF ABSENT ANUS             	    18.12	  $674.61	      ---	  $850.73	004	1	0	0.00	    $0.00	Y	
O	46730	CONSTRUCTION OF ABSENT ANUS             	     3.62	  $134.77	      ---	  $169.96	004	1	0	0.00	    $0.00	Y	
O	46735	CONSTRUCTION OF ABSENT ANUS             	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	46735	CONSTRUCTION OF ABSENT ANUS             	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
K	46740	CONSTRUCTION OF ABSENT ANUS             	    24.92	  $927.77	      ---	 $1169.99	004	1	0	0.00	    $0.00	Y	
O	46740	CONSTRUCTION OF ABSENT ANUS             	     4.98	  $185.41	      ---	  $233.81	004	1	0	0.00	    $0.00	Y	
O	46742	REPAIR OF IMPERFORATED ANUS             	     7.85	  $292.26	      ---	  $368.56	004	1	0	0.00	    $0.00	Y	
K	46742	REPAIR OF IMPERFORATED ANUS             	    39.23	 $1460.53	      ---	 $1841.85	004	1	0	0.00	    $0.00	Y	
K	46744	REPAIR OF CLOACAL ANOMALY               	    41.13	 $1531.27	      ---	 $1931.05	004	1	0	0.00	    $0.00	Y	
O	46744	REPAIR OF CLOACAL ANOMALY               	     8.23	  $306.40	      ---	  $386.40	004	1	0	0.00	    $0.00	Y	
O	46746	REPAIR OF CLOACAL ANOMALY               	     9.51	  $354.06	      ---	  $446.49	004	1	0	0.00	    $0.00	Y	
K	46746	REPAIR OF CLOACAL ANOMALY               	    47.56	 $1770.66	      ---	 $2232.94	004	1	0	0.00	    $0.00	Y	
K	46748	REPAIR OF CLOACAL ANOMALY               	    51.17	 $1905.06	      ---	 $2402.43	004	1	0	0.00	    $0.00	Y	
O	46748	REPAIR OF CLOACAL ANOMALY               	    10.24	  $381.24	      ---	  $480.77	004	1	0	0.00	    $0.00	Y	
O	46750	REPAIR OF ANAL SPHINCTER                	     2.24	   $83.40	      ---	  $105.17	004	1	0	0.00	    $0.00	Y	
K	46750	REPAIR OF ANAL SPHINCTER                	    11.20	  $416.98	      ---	  $525.84	004	1	0	0.00	    $0.00	Y	
K	46751	REPAIR OF ANAL SPHINCTER                	    12.59	  $468.73	      ---	  $591.10	004	1	0	0.00	    $0.00	Y	
O	46751	REPAIR OF ANAL SPHINCTER                	     2.52	   $93.82	      ---	  $118.31	004	1	0	0.00	    $0.00	Y	
O	46753	RECONSTRUCTION OF ANUS                  	     1.88	   $69.99	      ---	   $88.27	004	1	0	0.00	    $0.00	Y	
K	46753	RECONSTRUCTION OF ANUS                  	     9.42	  $350.71	      ---	  $442.27	004	1	0	0.00	    $0.00	Y	
K	46754	REMOVAL OF SUTURE FROM ANUS             	     5.57	  $207.37	      ---	  $261.51	004	1	0	0.00	    $0.00	Y	
O	46754	REMOVAL OF SUTURE FROM ANUS             	     1.11	   $41.33	      ---	   $52.11	004	1	0	0.00	    $0.00	Y	
O	46760	REPAIR OF ANAL SPHINCTER                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	46760	REPAIR OF ANAL SPHINCTER                	     8.23	  $306.40	      ---	  $386.40	004	1	0	0.00	    $0.00	Y	
K	46761	REPAIR OF ANAL SPHINCTER                	     8.22	  $306.03	      ---	  $385.93	004	1	0	0.00	    $0.00	Y	
O	46761	REPAIR OF ANAL SPHINCTER                	     1.70	   $63.29	      ---	   $79.82	004	1	0	0.00	    $0.00	Y	
K	46900	DESTRUCTION ANAL LESION(S)              	     2.45	   $91.21	      ---	  $115.03	004	1	1	0.00	    $0.00	Y	
K	46910	DESTRUCTION ANAL LESION(S)              	     2.53	   $94.19	      ---	  $118.78	004	1	1	0.00	    $0.00	Y	
K	46916	CRYOSURGERY ANAL LESION(S)              	     2.39	   $88.98	      ---	  $112.21	004	1	1	0.00	    $0.00	Y	
K	46917	LASER SURGERY ANAL LESIONS              	     2.89	  $107.59	      ---	  $135.69	004	1	1	0.00	    $0.00	Y	
K	46922	EXCISION OF ANAL LESION(S)              	     2.56	   $95.31	      ---	  $120.19	004	1	1	0.00	    $0.00	Y	
K	46924	DESTRUCTION ANAL LESION(S)              	     6.34	  $236.04	      ---	  $297.66	004	1	0	0.00	    $0.00	Y	
K	46930	DESTROY INTERNAL HEMORRHOIDS            	     2.83	  $105.36	      ---	  $132.87	004	1	0	0.00	    $0.00	Y	
K	46940	TREATMENT OF ANAL FISSURE               	     4.55	  $169.40	      ---	  $213.62	004	1	1	0.00	    $0.00	Y	
K	46942	TREATMENT OF ANAL FISSURE               	     4.03	  $150.04	      ---	  $189.21	004	1	1	0.00	    $0.00	Y	
K	46945	INT HRHC LIG 1 HROID W/O IMG            	     2.76	  $102.75	      ---	  $129.58	004	1	1	0.00	    $0.00	Y	
K	46946	INT HRHC LIG 2+HROID W/O IMG            	     6.80	  $253.16	      ---	  $319.26	004	1	1	0.00	    $0.00	Y	
K	46947	HEMORRHOIDOPEXY BY STAPLING             	     4.87	  $181.31	      ---	  $228.65	004	1	0	0.00	    $0.00	Y	
K	46948	INT HRHC TRANAL DARTLZJ 2+              	    10.48	  $390.17	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	46999	UNLISTED PROCEDURE ANUS                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	46999	UNLISTED PROCEDURE ANUS                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	47000	NEEDLE BIOPSY OF LIVER PERQ             	     4.52	  $168.28	      ---	  $212.21	004	1	1	0.00	    $0.00	Y	
K	47001	NDL BIOPSY LVR TM OTH MAJ PX            	     1.31	   $48.77	      ---	   $61.50	004	1	0	0.00	    $0.00	Y	
O	47001	NDL BIOPSY LVR TM OTH MAJ PX            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	47010	HEPATOT OPN DRG ABSC/CST 1/2            	     2.96	  $110.20	      ---	  $138.97	004	1	0	0.00	    $0.00	Y	
K	47010	HEPATOT OPN DRG ABSC/CST 1/2            	    14.81	  $551.38	      ---	  $695.33	004	1	0	0.00	    $0.00	Y	
K	47015	LAPT ASPIR&/NJX HEP PRST CST            	    13.50	  $502.61	      ---	  $633.83	004	1	0	0.00	    $0.00	Y	
O	47015	LAPT ASPIR&/NJX HEP PRST CST            	     2.70	  $100.52	      ---	  $126.77	004	1	0	0.00	    $0.00	Y	
O	47100	WEDGE BIOPSY OF LIVER                   	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	47100	WEDGE BIOPSY OF LIVER                   	    10.97	  $408.41	      ---	  $515.04	004	1	0	0.00	    $0.00	Y	
K	47120	PARTIAL REMOVAL OF LIVER                	    21.52	  $801.19	      ---	 $1010.36	004	1	0	0.00	    $0.00	Y	
O	47120	PARTIAL REMOVAL OF LIVER                	     4.30	  $160.09	      ---	  $201.89	004	1	0	0.00	    $0.00	Y	
O	47122	EXTENSIVE REMOVAL OF LIVER              	     5.00	  $186.15	      ---	  $234.75	004	1	0	0.00	    $0.00	Y	
K	47122	EXTENSIVE REMOVAL OF LIVER              	    24.99	  $930.38	      ---	 $1173.28	004	1	0	0.00	    $0.00	Y	
K	47125	PARTIAL REMOVAL OF LIVER                	    26.31	  $979.52	      ---	 $1235.25	004	1	0	0.00	    $0.00	Y	
O	47125	PARTIAL REMOVAL OF LIVER                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	47130	PARTIAL REMOVAL OF LIVER                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	47130	PARTIAL REMOVAL OF LIVER                	    25.00	  $930.75	      ---	 $1173.75	004	1	0	0.00	    $0.00	Y	
K	47135	TRANSPLANTATION OF LIVER                	 11326.00	$11326.00	      ---	       --	042	0	0	0.00	    $0.00	Y	
O	47135	TRANSPLANTATION OF LIVER                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	47140	PARTIAL REMOVAL DONOR LIVER             	     9.41	  $350.33	      ---	  $441.80	004	1	0	0.00	    $0.00	Y	
K	47140	PARTIAL REMOVAL DONOR LIVER             	    47.07	 $1752.42	      ---	 $2209.94	004	1	0	0.00	    $0.00	Y	
K	47141	PARTIAL REMOVAL DONOR LIVER             	    57.06	 $2124.34	      ---	 $2678.97	004	1	0	0.00	    $0.00	Y	
O	47141	PARTIAL REMOVAL DONOR LIVER             	    11.41	  $424.79	      ---	  $535.70	004	1	0	0.00	    $0.00	Y	
O	47142	PARTIAL REMOVAL DONOR LIVER             	    12.61	  $469.47	      ---	  $592.04	004	1	0	0.00	    $0.00	Y	
K	47142	PARTIAL REMOVAL DONOR LIVER             	    63.05	 $2347.35	      ---	 $2960.20	004	1	0	0.00	    $0.00	Y	
K	47300	SURGERY FOR LIVER LESION                	    14.50	  $539.84	      ---	  $680.78	004	1	0	0.00	    $0.00	Y	
O	47300	SURGERY FOR LIVER LESION                	     2.90	  $107.97	      ---	  $136.16	004	1	0	0.00	    $0.00	Y	
O	47350	REPAIR LIVER WOUND                      	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
K	47350	REPAIR LIVER WOUND                      	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
K	47360	REPAIR LIVER WOUND                      	    23.56	  $877.14	      ---	 $1106.14	004	1	0	0.00	    $0.00	Y	
O	47360	REPAIR LIVER WOUND                      	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	47361	REPAIR LIVER WOUND                      	     7.86	  $292.63	      ---	  $369.03	004	1	0	0.00	    $0.00	Y	
K	47361	REPAIR LIVER WOUND                      	    39.29	 $1462.77	      ---	 $1844.67	004	1	0	0.00	    $0.00	Y	
K	47362	REPAIR LIVER WOUND                      	    14.11	  $525.32	      ---	  $662.46	004	1	0	0.00	    $0.00	Y	
O	47362	REPAIR LIVER WOUND                      	     2.82	  $104.99	      ---	  $132.40	004	1	0	0.00	    $0.00	Y	
O	47370	LAPARO ABLATE LIVER TUMOR RF            	     4.26	  $158.60	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	47370	LAPARO ABLATE LIVER TUMOR RF            	    21.29	  $792.63	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	47371	LAPARO ABLATE LIVER CRYOSURG            	    20.06	  $746.83	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	47371	LAPARO ABLATE LIVER CRYOSURG            	     4.01	  $149.29	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	47379	UNLISTED LAPS PX LIVER                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	47379	UNLISTED LAPS PX LIVER                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	47380	OPEN ABLATE LIVER TUMOR RF              	    25.02	  $931.49	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	47380	OPEN ABLATE LIVER TUMOR RF              	     5.00	  $186.15	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	47381	OPEN ABLATE LIVER TUMOR CRYO            	     4.95	  $184.29	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	47381	OPEN ABLATE LIVER TUMOR CRYO            	    24.73	  $920.70	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	47382	PERCUT ABLATE LIVER RF                  	    14.88	  $553.98	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	47382	PERCUT ABLATE LIVER RF                  	     2.98	  $110.95	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	47383	PERQ ABLTJ LVR CRYOABLATION             	    11.20	  $416.98	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	47399	UNLISTED PROCEDURE LIVER                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	47399	UNLISTED PROCEDURE LIVER                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	47400	INCISION OF LIVER DUCT                  	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	47400	INCISION OF LIVER DUCT                  	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
K	47420	INCISION OF BILE DUCT                   	    19.25	  $716.68	      ---	  $903.79	004	1	0	0.00	    $0.00	Y	
O	47420	INCISION OF BILE DUCT                   	     3.85	  $143.34	      ---	  $180.76	004	1	0	0.00	    $0.00	Y	
O	47425	INCISION OF BILE DUCT                   	     4.30	  $160.09	      ---	  $201.89	004	1	0	0.00	    $0.00	Y	
K	47425	INCISION OF BILE DUCT                   	    21.52	  $801.19	      ---	 $1010.36	004	1	0	0.00	    $0.00	Y	
K	47460	INCISE BILE DUCT SPHINCTER              	    20.14	  $749.81	      ---	  $945.57	004	1	0	0.00	    $0.00	Y	
O	47460	INCISE BILE DUCT SPHINCTER              	     4.03	  $150.04	      ---	  $189.21	004	1	0	0.00	    $0.00	Y	
O	47480	INCISION OF GALLBLADDER                 	     2.68	   $99.78	      ---	  $125.83	004	1	0	0.00	    $0.00	Y	
K	47480	INCISION OF GALLBLADDER                 	    13.38	  $498.14	      ---	  $628.19	004	1	0	0.00	    $0.00	Y	
K	47490	INCISION OF GALLBLADDER                 	    11.69	  $435.22	      ---	  $548.85	004	1	0	0.00	    $0.00	Y	
O	47490	INCISION OF GALLBLADDER                 	     2.34	   $87.12	      ---	  $109.86	004	1	0	0.00	    $0.00	Y	
K	47531	INJECTION FOR CHOLANGIOGRAM             	     9.16	  $341.03	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	47532	INJECTION FOR CHOLANGIOGRAM             	    20.12	  $749.07	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	47533	PLMT BILIARY DRAINAGE CATH              	    32.92	 $1225.61	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	47534	PLMT BILIARY DRAINAGE CATH              	    40.50	 $1507.82	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	47535	CONVERSION EXT BIL DRG CATH             	    27.25	 $1014.52	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	47536	EXCHANGE BILIARY DRG CATH               	    20.20	  $752.05	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	47537	REMOVAL BILIARY DRG CATH                	     9.11	  $339.17	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	47538	PERQ PLMT BILE DUCT STENT               	   112.53	 $4189.49	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	47539	PERQ PLMT BILE DUCT STENT               	   122.77	 $4570.73	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	47540	PERQ PLMT BILE DUCT STENT               	   127.49	 $4746.45	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	47541	PLMT ACCESS BIL TREE SM BWL             	    29.05	 $1081.53	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	47542	DILATE BILIARY DUCT/AMPULLA             	    12.61	  $469.47	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	47543	ENDOLUMINAL BX BILIARY TREE             	    32.87	 $1223.75	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	47544	REMOVAL DUCT GLBLDR CALCULI             	    20.00	  $744.60	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	47550	BILE DUCT ENDOSCOPY ADD-ON              	     2.97	  $110.57	      ---	  $139.44	004	1	0	0.00	    $0.00	Y	
K	47552	BILIARY ENDO PERQ DX W/SPECI            	     4.46	  $166.05	      ---	  $209.40	004	1	0	0.00	    $0.00	Y	
K	47553	BILIARY ENDOSCOPY THRU SKIN             	     6.50	  $242.00	      ---	  $305.18	004	1	0	0.00	    $0.00	Y	
K	47554	BILIARY ENDOSCOPY THRU SKIN             	     8.15	  $303.42	      ---	  $382.64	004	1	0	0.00	    $0.00	Y	
K	47555	BILIARY ENDOSCOPY THRU SKIN             	     6.20	  $230.83	      ---	  $291.09	004	1	0	0.00	    $0.00	Y	
K	47556	BILIARY ENDOSCOPY THRU SKIN             	     9.24	  $344.01	      ---	  $433.82	004	1	0	0.00	    $0.00	Y	
K	47562	LAPAROSCOPIC CHOLECYSTECTOMY            	    12.52	  $466.12	      ---	  $587.81	004	1	0	0.00	    $0.00	Y	
O	47562	LAPAROSCOPIC CHOLECYSTECTOMY            	     2.50	   $93.08	      ---	  $117.38	004	1	0	0.00	    $0.00	Y	
O	47563	LAPARO CHOLECYSTECTOMY/GRAPH            	     2.88	  $107.22	      ---	  $135.22	004	1	0	0.00	    $0.00	Y	
K	47563	LAPARO CHOLECYSTECTOMY/GRAPH            	    14.41	  $536.48	      ---	  $676.55	004	1	0	0.00	    $0.00	Y	
K	47564	LAPARO CHOLECYSTECTOMY/EXPLR            	    17.66	  $657.48	      ---	  $829.14	004	1	0	0.00	    $0.00	Y	
O	47564	LAPARO CHOLECYSTECTOMY/EXPLR            	     3.53	  $131.42	      ---	  $165.73	004	1	0	0.00	    $0.00	Y	
O	47570	LAPARO CHOLECYSTOENTEROSTOMY            	     2.82	  $104.99	      ---	  $132.40	004	1	0	0.00	    $0.00	Y	
K	47570	LAPARO CHOLECYSTOENTEROSTOMY            	    14.10	  $524.94	      ---	  $662.00	004	1	0	0.00	    $0.00	Y	
K	47579	UNLISTED LAPS PX BILIARY TRC            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	47579	UNLISTED LAPS PX BILIARY TRC            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	47600	CHOLECYSTECTOMY                         	     3.10	  $115.41	      ---	  $145.55	004	1	0	0.00	    $0.00	Y	
K	47600	CHOLECYSTECTOMY                         	    15.49	  $576.69	      ---	  $727.26	004	1	0	0.00	    $0.00	Y	
K	47605	CHOLECYSTECTOMY W/CHOLANG               	    16.60	  $618.02	      ---	  $779.37	004	1	0	0.00	    $0.00	Y	
O	47605	CHOLECYSTECTOMY W/CHOLANG               	     3.32	  $123.60	      ---	  $155.87	004	1	0	0.00	    $0.00	Y	
O	47610	REMOVAL OF GALLBLADDER                  	     3.85	  $143.34	      ---	  $180.76	004	1	0	0.00	    $0.00	Y	
K	47610	REMOVAL OF GALLBLADDER                  	    19.25	  $716.68	      ---	  $903.79	004	1	0	0.00	    $0.00	Y	
K	47612	REMOVAL OF GALLBLADDER                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	47612	REMOVAL OF GALLBLADDER                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	47620	REMOVAL OF GALLBLADDER                  	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	47620	REMOVAL OF GALLBLADDER                  	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
K	47700	EXPLORATION OF BILE DUCTS               	    16.42	  $611.32	      ---	  $770.92	004	1	0	0.00	    $0.00	Y	
O	47700	EXPLORATION OF BILE DUCTS               	     3.28	  $122.11	      ---	  $154.00	004	1	0	0.00	    $0.00	Y	
O	47701	BILE DUCT REVISION                      	     7.23	  $269.17	      ---	  $339.45	004	1	0	0.00	    $0.00	Y	
K	47701	BILE DUCT REVISION                      	    36.15	 $1345.86	      ---	 $1697.24	004	1	0	0.00	    $0.00	Y	
K	47711	EXCISION OF BILE DUCT TUMOR             	    25.79	  $960.16	      ---	 $1210.84	004	1	0	0.00	    $0.00	Y	
O	47711	EXCISION OF BILE DUCT TUMOR             	     5.16	  $192.11	      ---	  $242.26	004	1	0	0.00	    $0.00	Y	
O	47712	EXCISION OF BILE DUCT TUMOR             	     6.52	  $242.74	      ---	  $306.11	004	1	0	0.00	    $0.00	Y	
K	47712	EXCISION OF BILE DUCT TUMOR             	    32.60	 $1213.70	      ---	 $1530.57	004	1	0	0.00	    $0.00	Y	
K	47715	EXCISION OF BILE DUCT CYST              	    21.78	  $810.87	      ---	 $1022.57	004	1	0	0.00	    $0.00	Y	
O	47715	EXCISION OF BILE DUCT CYST              	     4.36	  $162.32	      ---	  $204.70	004	1	0	0.00	    $0.00	Y	
O	47720	FUSE GALLBLADDER & BOWEL                	     3.28	  $122.11	      ---	  $154.00	004	1	0	0.00	    $0.00	Y	
K	47720	FUSE GALLBLADDER & BOWEL                	    16.42	  $611.32	      ---	  $770.92	004	1	0	0.00	    $0.00	Y	
K	47721	FUSE UPPER GI STRUCTURES                	    20.73	  $771.78	      ---	  $973.27	004	1	0	0.00	    $0.00	Y	
O	47721	FUSE UPPER GI STRUCTURES                	     4.19	  $155.99	      ---	  $196.72	004	1	0	0.00	    $0.00	Y	
O	47740	FUSE GALLBLADDER & BOWEL                	     3.62	  $134.77	      ---	  $169.96	004	1	0	0.00	    $0.00	Y	
K	47740	FUSE GALLBLADDER & BOWEL                	    18.12	  $674.61	      ---	  $850.73	004	1	0	0.00	    $0.00	Y	
K	47741	FUSE GALLBLADDER & BOWEL                	    25.35	  $943.78	      ---	 $1190.18	004	1	0	0.00	    $0.00	Y	
O	47741	FUSE GALLBLADDER & BOWEL                	     5.07	  $188.76	      ---	  $238.04	004	1	0	0.00	    $0.00	Y	
O	47760	FUSE BILE DUCTS AND BOWEL               	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	47760	FUSE BILE DUCTS AND BOWEL               	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
K	47765	FUSE LIVER DUCTS & BOWEL                	    31.15	 $1159.71	      ---	 $1462.49	004	1	0	0.00	    $0.00	Y	
O	47765	FUSE LIVER DUCTS & BOWEL                	     6.23	  $231.94	      ---	  $292.50	004	1	0	0.00	    $0.00	Y	
O	47780	FUSE BILE DUCTS AND BOWEL               	     4.98	  $185.41	      ---	  $233.81	004	1	0	0.00	    $0.00	Y	
K	47780	FUSE BILE DUCTS AND BOWEL               	    24.92	  $927.77	      ---	 $1169.99	004	1	0	0.00	    $0.00	Y	
K	47785	FUSE BILE DUCTS AND BOWEL               	    34.25	 $1275.13	      ---	 $1608.04	004	1	0	0.00	    $0.00	Y	
O	47785	FUSE BILE DUCTS AND BOWEL               	     6.85	  $255.03	      ---	  $321.61	004	1	0	0.00	    $0.00	Y	
O	47800	RECONSTRUCTION OF BILE DUCTS            	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	47800	RECONSTRUCTION OF BILE DUCTS            	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
K	47801	PLACEMENT BILE DUCT SUPPORT             	    18.15	  $675.72	      ---	  $852.14	004	1	0	0.00	    $0.00	Y	
O	47801	PLACEMENT BILE DUCT SUPPORT             	     3.63	  $135.14	      ---	  $170.43	004	1	0	0.00	    $0.00	Y	
O	47900	SUTURE BILE DUCT INJURY                 	     4.74	  $176.47	      ---	  $222.54	004	1	0	0.00	    $0.00	Y	
K	47900	SUTURE BILE DUCT INJURY                 	    23.69	  $881.98	      ---	 $1112.25	004	1	0	0.00	    $0.00	Y	
K	47999	UNLISTED PX BILIARY TRACT               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	47999	UNLISTED PX BILIARY TRACT               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	48000	DRAINAGE OF ABDOMEN                     	     2.94	  $109.46	      ---	  $138.03	004	1	0	0.00	    $0.00	Y	
K	48000	DRAINAGE OF ABDOMEN                     	    14.72	  $548.03	      ---	  $691.10	004	1	0	0.00	    $0.00	Y	
K	48001	PLACEMENT OF DRAIN PANCREAS             	    20.89	  $777.73	      ---	  $980.79	004	1	0	0.00	    $0.00	Y	
O	48001	PLACEMENT OF DRAIN PANCREAS             	     4.18	  $155.62	      ---	  $196.25	004	1	0	0.00	    $0.00	Y	
O	48020	REMOVAL OF PANCREATIC STONE             	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
K	48020	REMOVAL OF PANCREATIC STONE             	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
K	48100	BIOPSY OF PANCREAS OPEN                 	    15.48	  $576.32	      ---	  $726.79	004	1	0	0.00	    $0.00	Y	
O	48100	BIOPSY OF PANCREAS OPEN                 	     3.10	  $115.41	      ---	  $145.55	004	1	0	0.00	    $0.00	Y	
K	48102	NEEDLE BIOPSY PANCREAS                  	    10.17	  $378.63	      ---	  $477.48	004	1	0	0.00	    $0.00	Y	
K	48105	RESECT/DEBRIDE PANCREAS                 	    59.81	 $2226.73	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	48105	RESECT/DEBRIDE PANCREAS                 	    11.96	  $445.27	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	48120	REMOVAL OF PANCREAS LESION              	     3.78	  $140.73	      ---	  $177.47	004	1	0	0.00	    $0.00	Y	
K	48120	REMOVAL OF PANCREAS LESION              	    18.89	  $703.27	      ---	  $886.89	004	1	0	0.00	    $0.00	Y	
K	48140	PARTIAL REMOVAL OF PANCREAS             	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
O	48140	PARTIAL REMOVAL OF PANCREAS             	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
O	48145	PARTIAL REMOVAL OF PANCREAS             	     4.98	  $185.41	      ---	  $233.81	004	1	0	0.00	    $0.00	Y	
K	48145	PARTIAL REMOVAL OF PANCREAS             	    24.92	  $927.77	      ---	 $1169.99	004	1	0	0.00	    $0.00	Y	
K	48146	PANCREATECTOMY                          	    32.15	 $1196.94	      ---	 $1509.44	004	1	0	0.00	    $0.00	Y	
O	48146	PANCREATECTOMY                          	     6.43	  $239.39	      ---	  $301.89	004	1	0	0.00	    $0.00	Y	
O	48148	REMOVAL OF PANCREATIC DUCT              	     4.56	  $169.77	      ---	  $214.09	004	1	0	0.00	    $0.00	Y	
K	48148	REMOVAL OF PANCREATIC DUCT              	    22.81	  $849.22	      ---	 $1070.93	004	1	0	0.00	    $0.00	Y	
K	48150	PARTIAL REMOVAL OF PANCREAS             	    38.51	 $1433.73	      ---	 $1808.04	004	1	0	0.00	    $0.00	Y	
O	48150	PARTIAL REMOVAL OF PANCREAS             	     7.70	  $286.67	      ---	  $361.52	004	1	0	0.00	    $0.00	Y	
O	48152	PANCREATECTOMY                          	     9.60	  $357.41	      ---	  $450.72	004	1	0	0.00	    $0.00	Y	
K	48152	PANCREATECTOMY                          	    48.01	 $1787.41	      ---	 $2254.07	004	1	0	0.00	    $0.00	Y	
K	48153	PANCREATECTOMY                          	    50.45	 $1878.25	      ---	 $2368.63	004	1	0	0.00	    $0.00	Y	
O	48153	PANCREATECTOMY                          	    10.09	  $375.65	      ---	  $473.73	004	1	0	0.00	    $0.00	Y	
O	48154	PANCREATECTOMY                          	     9.60	  $357.41	      ---	  $450.72	004	1	0	0.00	    $0.00	Y	
K	48154	PANCREATECTOMY                          	    48.01	 $1787.41	      ---	 $2254.07	004	1	0	0.00	    $0.00	Y	
K	48155	REMOVAL OF PANCREAS                     	    34.00	 $1265.82	      ---	 $1596.30	004	1	0	0.00	    $0.00	Y	
O	48155	REMOVAL OF PANCREAS                     	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
O	48160	PANCREAS REMOVAL/TRANSPLANT             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	48160	PANCREAS REMOVAL/TRANSPLANT             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	48400	INJECTION INTRAOP ADD-ON                	     2.32	   $86.37	      ---	  $108.92	004	1	0	0.00	    $0.00	Y	
K	48500	SURGERY OF PANCREATIC CYST              	    16.42	  $611.32	      ---	  $770.92	004	1	0	0.00	    $0.00	Y	
O	48500	SURGERY OF PANCREATIC CYST              	     3.28	  $122.11	      ---	  $154.00	004	1	0	0.00	    $0.00	Y	
O	48510	DRAIN PANCREATIC PSEUDOCYST             	     3.42	  $127.33	      ---	  $160.57	004	1	0	0.00	    $0.00	Y	
K	48510	DRAIN PANCREATIC PSEUDOCYST             	    17.08	  $635.89	      ---	  $801.91	004	1	0	0.00	    $0.00	Y	
K	48520	FUSE PANCREAS CYST AND BOWEL            	    18.45	  $686.89	      ---	  $866.23	004	1	0	0.00	    $0.00	Y	
O	48520	FUSE PANCREAS CYST AND BOWEL            	     3.69	  $137.38	      ---	  $173.25	004	1	0	0.00	    $0.00	Y	
O	48540	FUSE PANCREAS CYST AND BOWEL            	     4.30	  $160.09	      ---	  $201.89	004	1	0	0.00	    $0.00	Y	
K	48540	FUSE PANCREAS CYST AND BOWEL            	    21.52	  $801.19	      ---	 $1010.36	004	1	0	0.00	    $0.00	Y	
K	48545	PANCREATORRHAPHY                        	    19.70	  $733.43	      ---	  $924.92	004	1	0	0.00	    $0.00	Y	
O	48545	PANCREATORRHAPHY                        	     3.94	  $146.69	      ---	  $184.98	004	1	0	0.00	    $0.00	Y	
O	48547	DUODENAL EXCLUSION                      	     5.70	  $212.21	      ---	  $267.62	004	1	0	0.00	    $0.00	Y	
K	48547	DUODENAL EXCLUSION                      	    28.47	 $1059.94	      ---	 $1336.67	004	1	0	0.00	    $0.00	Y	
K	48548	FUSE PANCREAS AND BOWEL                 	    34.93	 $1300.44	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	48548	FUSE PANCREAS AND BOWEL                 	     6.99	  $260.24	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	48554	TRANSPL ALLOGRAFT PANCREAS              	     7.20	  $268.06	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	48554	TRANSPL ALLOGRAFT PANCREAS              	    40.01	 $1489.57	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	48556	REMOVAL ALLOGRAFT PANCREAS              	    14.02	  $521.96	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	48556	REMOVAL ALLOGRAFT PANCREAS              	     2.84	  $105.73	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	48999	UNLISTED PROCEDURE PANCREAS             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	48999	UNLISTED PROCEDURE PANCREAS             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	49000	EXPLORATION OF ABDOMEN                  	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	49000	EXPLORATION OF ABDOMEN                  	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	49010	EXPLORATION BEHIND ABDOMEN              	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	49010	EXPLORATION BEHIND ABDOMEN              	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	49013	PRPERTL PEL PACK HEMRRG TRMA            	    10.10	  $376.02	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	49013	PRPERTL PEL PACK HEMRRG TRMA            	     2.02	   $75.20	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	49014	REEXPLORATION PELVIC WOUND              	     1.67	   $62.17	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49014	REEXPLORATION PELVIC WOUND              	     8.37	  $311.62	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49020	DRAINAGE ABDOM ABSCESS OPEN             	    12.46	  $463.89	      ---	  $585.00	004	1	0	0.00	    $0.00	Y	
O	49020	DRAINAGE ABDOM ABSCESS OPEN             	     2.49	   $92.70	      ---	  $116.91	004	1	0	0.00	    $0.00	Y	
O	49040	DRAIN OPEN ABDOM ABSCESS                	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	49040	DRAIN OPEN ABDOM ABSCESS                	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	49060	DRAIN OPEN RETROPERI ABSCESS            	    12.46	  $463.89	      ---	  $585.00	004	1	0	0.00	    $0.00	Y	
O	49060	DRAIN OPEN RETROPERI ABSCESS            	     2.49	   $92.70	      ---	  $116.91	004	1	0	0.00	    $0.00	Y	
O	49062	DRAIN TO PERITONEAL CAVITY              	     3.13	  $116.53	      ---	  $146.95	004	1	0	0.00	    $0.00	Y	
K	49062	DRAIN TO PERITONEAL CAVITY              	    15.62	  $581.53	      ---	  $733.36	004	1	0	0.00	    $0.00	Y	
K	49082	ABD PARACENTESIS                        	     1.57	   $58.45	      ---	   $73.71	004	1	0	0.00	    $0.00	Y	
X	49082	ABD PARACENTESIS                        	   199.17	  $199.17	      ---	       --	009	1	0	0.00	    $0.00	Y	
X	49083	ABD PARACENTESIS W/IMAGING              	   276.89	  $276.89	      ---	       --	009	1	0	0.00	    $0.00	Y	
K	49083	ABD PARACENTESIS W/IMAGING              	     2.41	   $89.72	      ---	  $113.15	004	1	0	0.00	    $0.00	Y	
K	49084	PERITONEAL LAVAGE                       	     2.19	   $81.53	      ---	  $102.82	004	1	0	0.00	    $0.00	Y	
K	49180	BIOPSY ABDOMINAL MASS                   	     6.71	  $249.81	      ---	  $315.03	004	1	0	0.00	    $0.00	Y	
K	49185	SCLEROTX FLUID COLLECTION               	    24.73	  $920.70	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49186	OPN EXC/DSTR NTRA-ABD 5 CM/<            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	49186	OPN EXC/DSTR NTRA-ABD 5 CM/<            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	49187	OPN EXC/DSTR NTRA-ABD 5.1-10            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49187	OPN EXC/DSTR NTRA-ABD 5.1-10            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49188	OPN EXC/DST NTRA-ABD 10.1-20            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	49188	OPN EXC/DST NTRA-ABD 10.1-20            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	49189	OPN EXC/DST NTRA-ABD 20.1-30            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49189	OPN EXC/DST NTRA-ABD 20.1-30            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49190	OPN EXC/DSTR NTRA-ABD >30 CM            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	49190	OPN EXC/DSTR NTRA-ABD >30 CM            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	49215	EXCISE SACRAL SPINE TUMOR               	     3.18	  $118.39	      ---	  $149.30	004	1	0	0.00	    $0.00	Y	
K	49215	EXCISE SACRAL SPINE TUMOR               	    15.89	  $591.58	      ---	  $746.04	004	1	0	0.00	    $0.00	Y	
K	49255	REMOVAL OF OMENTUM                      	    12.57	  $467.98	      ---	  $590.16	004	1	0	0.00	    $0.00	Y	
O	49255	REMOVAL OF OMENTUM                      	     2.49	   $92.70	      ---	  $116.91	004	1	0	0.00	    $0.00	Y	
O	49320	DIAG LAPARO SEPARATE PROC               	     1.26	   $46.91	      ---	   $59.16	004	1	0	0.00	    $0.00	Y	
K	49320	DIAG LAPARO SEPARATE PROC               	     6.29	  $234.18	      ---	  $295.32	004	1	0	0.00	    $0.00	Y	
K	49321	LAPAROSCOPY BIOPSY                      	     6.70	  $249.44	      ---	  $314.57	004	1	0	0.00	    $0.00	Y	
O	49321	LAPAROSCOPY BIOPSY                      	     1.34	   $49.89	      ---	   $62.91	004	1	0	0.00	    $0.00	Y	
O	49322	LAPAROSCOPY ASPIRATION                  	     1.39	   $51.75	      ---	   $65.26	004	1	0	0.00	    $0.00	Y	
K	49322	LAPAROSCOPY ASPIRATION                  	     6.97	  $259.49	      ---	  $327.24	004	1	0	0.00	    $0.00	Y	
K	49323	LAPARO DRAIN LYMPHOCELE                 	    11.51	  $428.52	      ---	  $540.39	004	1	0	0.00	    $0.00	Y	
O	49323	LAPARO DRAIN LYMPHOCELE                 	     2.30	   $85.63	      ---	  $107.99	004	1	0	0.00	    $0.00	Y	
K	49324	LAP INSERT TUNNEL IP CATH               	     8.37	  $311.62	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49325	LAP REVISION PERM IP CATH               	     9.00	  $335.07	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49326	LAP W/OMENTOPEXY ADD-ON                 	     4.09	  $152.27	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49327	LAP INS DEVICE FOR RT                   	     2.90	  $107.97	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	49327	LAP INS DEVICE FOR RT                   	     0.58	   $21.59	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	49329	UNLSTD LAPS PX ABD PERTM&OMN            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	49329	UNLSTD LAPS PX ABD PERTM&OMN            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	49400	AIR INJECTION INTO ABDOMEN              	     1.13	   $42.07	      ---	   $53.05	004	1	1	0.00	    $0.00	Y	
K	49402	REMOVE FOREIGN BODY ADBOMEN             	    18.05	  $672.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	49402	REMOVE FOREIGN BODY ADBOMEN             	     3.61	  $134.40	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49405	IMAGE CATH FLUID COLXN VISC             	     4.94	  $183.92	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49406	IMAGE CATH FLUID PERI/RETRO             	     4.95	  $184.29	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49407	IMAGE CATH FLUID TRNS/VGNL              	    15.98	  $594.94	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49411	INS MARK ABD/PEL FOR RT PERQ            	    12.17	  $453.09	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49412	INS DEVICE FOR RT GUIDE OPEN            	     1.81	   $67.39	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	49412	INS DEVICE FOR RT GUIDE OPEN            	     0.36	   $13.40	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49418	INSERT TUN IP CATH PERC                 	     5.24	  $195.09	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49419	INSERT TUN IP CATH W/PORT               	     5.70	  $212.21	      ---	  $267.62	004	1	0	0.00	    $0.00	Y	
K	49421	INS TUN IP CATH FOR DIAL OPN            	     7.03	  $261.73	      ---	  $330.06	004	1	0	0.00	    $0.00	Y	
K	49422	REMOVE TUNNELED IP CATH                 	     8.45	  $314.59	      ---	  $396.73	004	1	0	0.00	    $0.00	Y	
O	49422	REMOVE TUNNELED IP CATH                 	     1.69	   $62.92	      ---	   $79.35	004	1	0	0.00	    $0.00	Y	
K	49423	EXCHANGE DRAINAGE CATHETER              	     1.84	   $68.50	      ---	   $86.39	004	1	0	0.00	    $0.00	Y	
K	49424	ASSESS CYST CONTRAST INJECT             	     0.96	   $35.74	      ---	   $45.07	004	1	0	0.00	    $0.00	Y	
K	49425	INSERT ABDOMEN-VENOUS DRAIN             	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
O	49425	INSERT ABDOMEN-VENOUS DRAIN             	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
O	49426	REVISE ABDOMEN-VENOUS SHUNT             	     2.73	  $101.64	      ---	  $128.17	004	1	0	0.00	    $0.00	Y	
K	49426	REVISE ABDOMEN-VENOUS SHUNT             	    13.67	  $508.93	      ---	  $641.81	004	1	0	0.00	    $0.00	Y	
K	49427	INJECTION ABDOMINAL SHUNT               	     1.10	   $40.95	      ---	   $51.65	004	1	0	0.00	    $0.00	Y	
K	49428	LIGATION OF SHUNT                       	     2.87	  $106.85	      ---	  $134.75	004	1	0	0.00	    $0.00	Y	
O	49428	LIGATION OF SHUNT                       	     0.58	   $21.59	      ---	   $27.23	004	1	0	0.00	    $0.00	Y	
O	49429	REMOVAL OF SHUNT                        	     1.83	   $68.13	      ---	   $85.92	004	1	0	0.00	    $0.00	Y	
K	49429	REMOVAL OF SHUNT                        	     9.19	  $342.14	      ---	  $431.47	004	1	0	0.00	    $0.00	Y	
K	49435	INSERT SUBQ EXTEN TO IP CATH            	     2.63	   $97.91	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	49435	INSERT SUBQ EXTEN TO IP CATH            	     0.53	   $19.73	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	49436	EMBEDDED IP CATH EXIT-SITE              	     0.79	   $29.41	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49436	EMBEDDED IP CATH EXIT-SITE              	     3.97	  $147.80	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49440	PLACE GASTROSTOMY TUBE PERC             	    24.73	  $920.70	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49441	PLACE DUOD/JEJ TUBE PERC                	    29.38	 $1093.82	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49442	PLACE CECOSTOMY TUBE PERC               	    23.94	  $891.29	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49446	CHANGE G-TUBE TO G-J PERC               	    24.51	  $912.51	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49450	REPLACE G/C TUBE PERC                   	    17.20	  $640.36	      ---	       --	004	0	0	0.00	    $0.00	Y	
X	49450	REPLACE G/C TUBE PERC                   	   640.36	  $640.36	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	49451	REPLACE DUOD/JEJ TUBE PERC              	    18.21	  $677.96	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49452	REPLACE G-J TUBE PERC                   	    22.24	  $828.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49460	FIX G/COLON TUBE W/DEVICE               	    18.26	  $679.82	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49465	FLUORO EXAM OF G/COLON TUBE             	     3.79	  $141.10	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49491	RPR HERN PREEMIE REDUC                  	    14.52	  $540.58	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	49491	RPR HERN PREEMIE REDUC                  	     2.90	  $107.97	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	49492	RPR ING HERN PREMIE BLOCKED             	     3.55	  $132.17	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49492	RPR ING HERN PREMIE BLOCKED             	    17.77	  $661.58	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49495	RPR ING HERNIA BABY REDUC               	     8.58	  $319.43	      ---	  $402.83	004	1	0	0.00	    $0.00	Y	
O	49495	RPR ING HERNIA BABY REDUC               	     1.72	   $64.04	      ---	   $80.75	004	1	0	0.00	    $0.00	Y	
O	49496	RPR ING HERNIA BABY BLOCKED             	     2.38	   $88.61	      ---	  $111.74	004	1	0	0.00	    $0.00	Y	
K	49496	RPR ING HERNIA BABY BLOCKED             	    11.88	  $442.29	      ---	  $557.77	004	1	0	0.00	    $0.00	Y	
K	49500	RPR ING HERNIA INIT REDUCE              	     7.00	  $260.61	      ---	  $328.65	004	1	0	0.00	    $0.00	Y	
O	49500	RPR ING HERNIA INIT REDUCE              	     1.40	   $52.12	      ---	   $65.73	004	1	0	0.00	    $0.00	Y	
O	49501	RPR ING HERNIA INIT BLOCKED             	     2.05	   $76.32	      ---	   $96.25	004	1	0	0.00	    $0.00	Y	
K	49501	RPR ING HERNIA INIT BLOCKED             	    10.23	  $380.86	      ---	  $480.30	004	1	0	0.00	    $0.00	Y	
K	49505	PRP I/HERN INIT REDUC >5 YR             	     9.24	  $344.01	      ---	  $433.82	004	1	0	0.00	    $0.00	Y	
O	49505	PRP I/HERN INIT REDUC >5 YR             	     1.85	   $68.88	      ---	   $86.86	004	1	0	0.00	    $0.00	Y	
O	49507	PRP I/HERN INIT BLOCK >5 YR             	     2.23	   $83.02	      ---	  $104.70	004	1	0	0.00	    $0.00	Y	
K	49507	PRP I/HERN INIT BLOCK >5 YR             	    11.14	  $414.74	      ---	  $523.02	004	1	0	0.00	    $0.00	Y	
K	49520	REREPAIR ING HERNIA REDUCE              	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	49520	REREPAIR ING HERNIA REDUCE              	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	49521	REREPAIR ING HERNIA BLOCKED             	     2.54	   $94.56	      ---	  $119.25	004	1	0	0.00	    $0.00	Y	
K	49521	REREPAIR ING HERNIA BLOCKED             	    12.70	  $472.82	      ---	  $596.27	004	1	0	0.00	    $0.00	Y	
K	49525	REPAIR ING HERNIA SLIDING               	    10.34	  $384.96	      ---	  $485.46	004	1	0	0.00	    $0.00	Y	
O	49525	REPAIR ING HERNIA SLIDING               	     2.07	   $77.07	      ---	   $97.19	004	1	0	0.00	    $0.00	Y	
O	49540	REPAIR LUMBAR HERNIA                    	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	49540	REPAIR LUMBAR HERNIA                    	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	49550	RPR REM HERNIA INIT REDUCE              	    10.08	  $375.28	      ---	  $473.26	004	1	0	0.00	    $0.00	Y	
O	49550	RPR REM HERNIA INIT REDUCE              	     2.02	   $75.20	      ---	   $94.84	004	1	0	0.00	    $0.00	Y	
O	49553	RPR FEM HERNIA INIT BLOCKED             	     2.13	   $79.30	      ---	  $100.00	004	1	0	0.00	    $0.00	Y	
K	49553	RPR FEM HERNIA INIT BLOCKED             	    10.66	  $396.87	      ---	  $500.49	004	1	0	0.00	    $0.00	Y	
K	49555	REREPAIR FEM HERNIA REDUCE              	    10.91	  $406.18	      ---	  $512.22	004	1	0	0.00	    $0.00	Y	
O	49555	REREPAIR FEM HERNIA REDUCE              	     2.18	   $81.16	      ---	  $102.35	004	1	0	0.00	    $0.00	Y	
O	49557	REREPAIR FEM HERNIA BLOCKED             	     2.55	   $94.94	      ---	  $119.72	004	1	0	0.00	    $0.00	Y	
K	49557	REREPAIR FEM HERNIA BLOCKED             	    12.75	  $474.68	      ---	  $598.61	004	1	0	0.00	    $0.00	Y	
K	49591	RPR AA HRN 1ST < 3 CM RDC               	     7.46	  $277.74	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	49591	RPR AA HRN 1ST < 3 CM RDC               	     1.49	   $55.47	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	49592	RPR AA HRN 1ST < 3 NCR/STRN             	     2.06	   $76.69	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49592	RPR AA HRN 1ST < 3 NCR/STRN             	    10.34	  $384.96	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49593	RPR AA HRN 1ST 3-10 RDC                 	    12.45	  $463.51	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	49593	RPR AA HRN 1ST 3-10 RDC                 	     2.49	   $92.70	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	49594	RPR AA HRN 1ST 3-10 NCR/STRN            	     3.23	  $120.25	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49594	RPR AA HRN 1ST 3-10 NCR/STRN            	    16.18	  $602.38	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49595	RPR AA HRN 1ST > 10 RDC                 	    16.73	  $622.86	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	49595	RPR AA HRN 1ST > 10 RDC                 	     3.34	  $124.35	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	49596	RPR AA HRN 1ST > 10 NCR/STRN            	     4.44	  $165.30	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49596	RPR AA HRN 1ST > 10 NCR/STRN            	    22.20	  $826.51	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49600	REPAIR UMBILICAL LESION                 	    10.76	  $400.59	      ---	  $505.18	004	1	0	0.00	    $0.00	Y	
O	49600	REPAIR UMBILICAL LESION                 	     2.15	   $80.04	      ---	  $100.94	004	1	0	0.00	    $0.00	Y	
O	49605	REPAIR UMBILICAL LESION                 	     3.41	  $126.95	      ---	  $160.10	004	1	0	0.00	    $0.00	Y	
K	49605	REPAIR UMBILICAL LESION                 	    17.05	  $634.77	      ---	  $800.50	004	1	0	0.00	    $0.00	Y	
K	49606	REPAIR UMBILICAL LESION                 	    24.22	  $901.71	      ---	 $1137.13	004	1	0	0.00	    $0.00	Y	
O	49606	REPAIR UMBILICAL LESION                 	     4.84	  $180.19	      ---	  $227.24	004	1	0	0.00	    $0.00	Y	
O	49610	REPAIR UMBILICAL LESION                 	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	49610	REPAIR UMBILICAL LESION                 	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	49611	REPAIR UMBILICAL LESION                 	    13.07	  $486.60	      ---	  $613.64	004	1	0	0.00	    $0.00	Y	
O	49611	REPAIR UMBILICAL LESION                 	     2.61	   $97.17	      ---	  $122.54	004	1	0	0.00	    $0.00	Y	
O	49613	RPR AA HRN RCR < 3 RDC                  	     1.84	   $68.50	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49613	RPR AA HRN RCR < 3 RDC                  	     9.20	  $342.52	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49614	RPR AA HRN RCR < 3 NCR/STRN             	    12.42	  $462.40	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	49614	RPR AA HRN RCR < 3 NCR/STRN             	     2.48	   $92.33	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	49615	RPR AA HRN RCR 3-10 RDC                 	     2.78	  $103.50	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49615	RPR AA HRN RCR 3-10 RDC                 	    13.90	  $517.50	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49616	RPR AA HRN RCR 3-10 NCR/STRN            	    18.62	  $693.22	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	49616	RPR AA HRN RCR 3-10 NCR/STRN            	     3.72	  $138.50	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	49617	RPR AA HRN RCR > 10 RDC                 	     3.84	  $142.96	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49617	RPR AA HRN RCR > 10 RDC                 	    19.23	  $715.93	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49618	RPR AA HRN RCR > 10 NCR/STRN            	    26.88	 $1000.74	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	49618	RPR AA HRN RCR > 10 NCR/STRN            	     5.37	  $199.93	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	49621	RPR PARASTOMAL HERNIA RDC               	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49621	RPR PARASTOMAL HERNIA RDC               	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49622	RPR PARASTOMAL HRNA NCR/STRN            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	49622	RPR PARASTOMAL HRNA NCR/STRN            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	49623	RMVL NINFCT MESH HERNIA RPR             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49623	RMVL NINFCT MESH HERNIA RPR             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49650	LAP ING HERNIA REPAIR INIT              	     7.11	  $264.71	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	49650	LAP ING HERNIA REPAIR INIT              	     1.42	   $52.87	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	49651	LAP ING HERNIA REPAIR RECUR             	     1.73	   $64.41	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49651	LAP ING HERNIA REPAIR RECUR             	     8.67	  $322.78	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	49659	UNLSTD LAPS PX HRNAP HRNRPHY            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	49659	UNLSTD LAPS PX HRNAP HRNRPHY            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	49900	REPAIR OF ABDOMINAL WALL                	     1.80	   $67.01	      ---	   $84.51	004	1	0	0.00	    $0.00	Y	
K	49900	REPAIR OF ABDOMINAL WALL                	     8.99	  $334.70	      ---	  $422.08	004	1	0	0.00	    $0.00	Y	
K	49904	OMENTAL FLAP EXTRA-ABDOM                	    17.32	  $644.82	      ---	  $813.17	004	1	0	0.00	    $0.00	Y	
O	49904	OMENTAL FLAP EXTRA-ABDOM                	     3.46	  $128.82	      ---	  $162.45	004	1	0	0.00	    $0.00	Y	
O	49905	OMENTAL FLAP INTRA-ABDOM                	     1.69	   $62.92	      ---	   $79.35	004	1	0	0.00	    $0.00	Y	
K	49905	OMENTAL FLAP INTRA-ABDOM                	     8.47	  $315.34	      ---	  $397.67	004	1	0	0.00	    $0.00	Y	
K	49906	FREE OMENTAL FLAP MICROVASC             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	49906	FREE OMENTAL FLAP MICROVASC             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	49999	UNLISTED PX ABD PERTM&OMN               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	49999	UNLISTED PX ABD PERTM&OMN               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	50010	RENAL EXPLORATION                       	    16.60	  $618.02	      ---	  $779.37	004	1	0	0.00	    $0.00	Y	
O	50010	RENAL EXPLORATION                       	     3.30	  $122.86	      ---	  $154.94	004	1	0	0.00	    $0.00	Y	
O	50020	DRG PERIRNL/RENAL ABSC OPEN             	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
K	50020	DRG PERIRNL/RENAL ABSC OPEN             	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
K	50040	NFROS NFROT W/DRG                       	    21.50	  $800.45	      ---	 $1009.43	004	1	0	0.00	    $0.00	Y	
O	50040	NFROS NFROT W/DRG                       	     4.30	  $160.09	      ---	  $201.89	004	1	0	0.00	    $0.00	Y	
O	50045	NEPHROTOMY W/EXPLORATION                	     4.05	  $150.78	      ---	  $190.15	004	1	0	0.00	    $0.00	Y	
K	50045	NEPHROTOMY W/EXPLORATION                	    20.27	  $754.65	      ---	  $951.68	004	1	0	0.00	    $0.00	Y	
K	50060	NL REMOVAL CALCULUS                     	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
O	50060	NL REMOVAL CALCULUS                     	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
O	50065	NL SEC SURG OPERJ CALCULUS              	     5.27	  $196.20	      ---	  $247.43	004	1	0	0.00	    $0.00	Y	
K	50065	NL SEC SURG OPERJ CALCULUS              	    26.36	  $981.38	      ---	 $1237.60	004	1	0	0.00	    $0.00	Y	
K	50070	NL COMP CGEN KDN ABNORMALITY            	    25.97	  $966.86	      ---	 $1219.29	004	1	0	0.00	    $0.00	Y	
O	50070	NL COMP CGEN KDN ABNORMALITY            	     5.19	  $193.22	      ---	  $243.67	004	1	0	0.00	    $0.00	Y	
O	50075	NL RMVL LG STAGHORN CALCULUS            	     5.89	  $219.28	      ---	  $276.54	004	1	0	0.00	    $0.00	Y	
K	50075	NL RMVL LG STAGHORN CALCULUS            	    29.45	 $1096.42	      ---	 $1382.68	004	1	0	0.00	    $0.00	Y	
K	50080	PERQ NL/PL LITHOTRP SMPL<2CM            	    15.18	  $565.15	      ---	  $712.70	004	1	0	0.00	    $0.00	Y	
O	50080	PERQ NL/PL LITHOTRP SMPL<2CM            	     3.04	  $113.18	      ---	  $142.73	004	1	0	0.00	    $0.00	Y	
O	50081	PERQ NL/PL LITHOTRP CPLX>2CM            	     3.40	  $126.58	      ---	  $159.63	004	1	0	0.00	    $0.00	Y	
K	50081	PERQ NL/PL LITHOTRP CPLX>2CM            	    16.99	  $632.54	      ---	  $797.68	004	1	0	0.00	    $0.00	Y	
K	50100	TRNSXJ/REPOS ABRRNT RNL VSLS            	    19.25	  $716.68	      ---	  $903.79	004	1	0	0.00	    $0.00	Y	
O	50100	TRNSXJ/REPOS ABRRNT RNL VSLS            	     3.85	  $143.34	      ---	  $180.76	004	1	0	0.00	    $0.00	Y	
O	50120	PYELOTOMY W/EXPLORATION                 	     4.14	  $154.13	      ---	  $194.37	004	1	0	0.00	    $0.00	Y	
K	50120	PYELOTOMY W/EXPLORATION                 	    20.72	  $771.41	      ---	  $972.80	004	1	0	0.00	    $0.00	Y	
K	50125	PYELOTOMY W/DRG PYELOSTOMY              	    21.70	  $807.89	      ---	 $1018.82	004	1	0	0.00	    $0.00	Y	
O	50125	PYELOTOMY W/DRG PYELOSTOMY              	     4.34	  $161.58	      ---	  $203.76	004	1	0	0.00	    $0.00	Y	
O	50130	PYELOTOMY W/REMOVAL CALCULUS            	     4.47	  $166.42	      ---	  $209.87	004	1	0	0.00	    $0.00	Y	
K	50130	PYELOTOMY W/REMOVAL CALCULUS            	    22.35	  $832.09	      ---	 $1049.33	004	1	0	0.00	    $0.00	Y	
K	50200	RENAL BIOPSY PERQ                       	     1.90	   $70.74	      ---	   $89.21	004	1	0	0.00	    $0.00	Y	
K	50205	RENAL BX SURG EXPOSURE KDN              	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	50205	RENAL BX SURG EXPOSURE KDN              	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
O	50220	REMOVE KIDNEY OPEN                      	     4.49	  $167.16	      ---	  $210.81	004	1	0	0.00	    $0.00	Y	
K	50220	REMOVE KIDNEY OPEN                      	    22.43	  $835.07	      ---	 $1053.09	004	1	0	0.00	    $0.00	Y	
K	50225	REMOVAL KIDNEY OPEN COMPLEX             	    25.89	  $963.88	      ---	 $1215.54	004	1	0	0.00	    $0.00	Y	
O	50225	REMOVAL KIDNEY OPEN COMPLEX             	     5.18	  $192.85	      ---	  $243.20	004	1	0	0.00	    $0.00	Y	
O	50230	REMOVAL KIDNEY OPEN RADICAL             	     5.58	  $207.74	      ---	  $261.98	004	1	0	0.00	    $0.00	Y	
K	50230	REMOVAL KIDNEY OPEN RADICAL             	    27.90	 $1038.72	      ---	 $1309.91	004	1	0	0.00	    $0.00	Y	
K	50234	REMOVAL OF KIDNEY & URETER              	    27.18	 $1011.91	      ---	 $1276.10	004	1	0	0.00	    $0.00	Y	
O	50234	REMOVAL OF KIDNEY & URETER              	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
O	50236	REMOVAL OF KIDNEY & URETER              	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
K	50236	REMOVAL OF KIDNEY & URETER              	    27.18	 $1011.91	      ---	 $1276.10	004	1	0	0.00	    $0.00	Y	
K	50240	NEPHRECTOMY PARTIAL                     	    27.18	 $1011.91	      ---	 $1276.10	004	1	0	0.00	    $0.00	Y	
O	50240	NEPHRECTOMY PARTIAL                     	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
O	50250	OPN ABLTJ 1/> RNL MAS CRYSRG            	     5.00	  $186.15	      ---	  $234.75	004	1	0	0.00	    $0.00	Y	
K	50250	OPN ABLTJ 1/> RNL MAS CRYSRG            	    25.01	  $931.12	      ---	 $1174.22	004	1	0	0.00	    $0.00	Y	
K	50280	EXC/UNROOFING CYST KIDNEY               	    20.39	  $759.12	      ---	  $957.31	004	1	0	0.00	    $0.00	Y	
O	50280	EXC/UNROOFING CYST KIDNEY               	     4.08	  $151.90	      ---	  $191.56	004	1	0	0.00	    $0.00	Y	
O	50290	EXCISION PERINEPHRIC CYST               	     3.91	  $145.57	      ---	  $183.57	004	1	0	0.00	    $0.00	Y	
K	50290	EXCISION PERINEPHRIC CYST               	    19.53	  $727.10	      ---	  $916.93	004	1	0	0.00	    $0.00	Y	
K	50320	REMOVE KIDNEY LIVING DONOR              	    27.18	 $1011.91	      ---	 $1276.10	004	1	0	0.00	    $0.00	Y	
O	50320	REMOVE KIDNEY LIVING DONOR              	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
O	50340	RECIPIENT NEPHRECTOMY                   	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
K	50340	RECIPIENT NEPHRECTOMY                   	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
K	50360	RNL ALTRNSPLJ W/O RCP NFRCT             	    33.98	 $1265.08	      ---	 $1595.36	004	1	0	0.00	    $0.00	Y	
O	50360	RNL ALTRNSPLJ W/O RCP NFRCT             	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
O	50365	RNL ALTRNSPLJ W/RCP NFRCT               	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
K	50365	RNL ALTRNSPLJ W/RCP NFRCT               	    50.00	 $1861.50	      ---	 $2347.50	004	1	0	0.00	    $0.00	Y	
K	50370	RMVL TRANSPLANTED RNL ALGRFT            	    15.63	  $581.90	      ---	  $733.83	004	1	0	0.00	    $0.00	Y	
O	50370	RMVL TRANSPLANTED RNL ALGRFT            	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
O	50380	RNL AUTOTRNSPLJ RIMPLTJ KDN             	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
K	50380	RNL AUTOTRNSPLJ RIMPLTJ KDN             	    30.00	 $1116.90	      ---	 $1408.50	004	1	0	0.00	    $0.00	Y	
K	50382	CHANGE URETER STENT PERCUT              	    36.61	 $1362.99	      ---	 $1718.84	004	1	0	0.00	    $0.00	Y	
K	50384	REMOVE URETER STENT PERCUT              	    35.39	 $1317.57	      ---	 $1661.56	004	1	0	0.00	    $0.00	Y	
K	50385	CHANGE STENT VIA TRANSURETH             	    29.55	 $1100.15	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	50386	REMOVE STENT VIA TRANSURETH             	    19.08	  $710.35	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	50387	CHANGE NEPHROURETERAL CATH              	    12.13	  $451.60	      ---	  $569.50	004	1	0	0.00	    $0.00	Y	
K	50389	REMOVE RENAL TUBE W/FLUORO              	    12.21	  $454.58	      ---	  $573.26	004	1	0	0.00	    $0.00	Y	
K	50390	DRAINAGE OF KIDNEY LESION               	     1.90	   $70.74	      ---	   $89.21	004	1	0	0.00	    $0.00	Y	
K	50391	INSTLL RX AGNT INTO RNAL TUB            	     3.20	  $119.14	      ---	  $150.24	004	1	0	0.00	    $0.00	Y	
K	50396	MEASURE KIDNEY PRESSURE                 	     1.23	   $45.79	      ---	   $57.75	004	1	1	0.00	    $0.00	Y	
K	50400	REVISION OF KIDNEY/URETER               	    24.92	  $927.77	      ---	 $1169.99	004	1	0	0.00	    $0.00	Y	
O	50400	REVISION OF KIDNEY/URETER               	     4.98	  $185.41	      ---	  $233.81	004	1	0	0.00	    $0.00	Y	
O	50405	REVISION OF KIDNEY/URETER               	     5.89	  $219.28	      ---	  $276.54	004	1	0	0.00	    $0.00	Y	
K	50405	REVISION OF KIDNEY/URETER               	    29.45	 $1096.42	      ---	 $1382.68	004	1	0	0.00	    $0.00	Y	
K	50430	NJX PX NFROSGRM &/URTRGRM               	    12.76	  $475.05	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	50431	NJX PX NFROSGRM &/URTRGRM               	     3.95	  $147.06	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	50432	PLMT NEPHROSTOMY CATHETER               	    20.78	  $773.64	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	50433	PLMT NEPHROURETERAL CATHETER            	    28.02	 $1043.18	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	50434	CONVERT NEPHROSTOMY CATHETER            	    22.19	  $826.13	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	50435	EXCHANGE NEPHROSTOMY CATH               	    11.67	  $434.47	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	50436	DILAT XST TRC NDURLGC PX                	     3.53	  $131.42	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	50437	DILAT XST TRC NEW ACCESS RCS            	     5.88	  $218.91	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	50500	REPAIR OF KIDNEY WOUND                  	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
O	50500	REPAIR OF KIDNEY WOUND                  	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
O	50520	CLOSE KIDNEY-SKIN FISTULA               	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	50520	CLOSE KIDNEY-SKIN FISTULA               	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
K	50525	CLOSE NEPHROVISCERAL FISTULA            	    27.18	 $1011.91	      ---	 $1276.10	004	1	0	0.00	    $0.00	Y	
O	50525	CLOSE NEPHROVISCERAL FISTULA            	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
O	50526	CLOSE NEPHROVISCERAL FISTULA            	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
K	50526	CLOSE NEPHROVISCERAL FISTULA            	    27.18	 $1011.91	      ---	 $1276.10	004	1	0	0.00	    $0.00	Y	
K	50540	REVISION OF HORSESHOE KIDNEY            	    28.00	 $1042.44	      ---	 $1314.60	004	1	0	0.00	    $0.00	Y	
O	50540	REVISION OF HORSESHOE KIDNEY            	     5.60	  $208.49	      ---	  $262.92	004	1	0	0.00	    $0.00	Y	
O	50541	LAPARO ABLATE RENAL CYST                	     3.12	  $116.16	      ---	  $146.48	004	1	0	0.00	    $0.00	Y	
K	50541	LAPARO ABLATE RENAL CYST                	    15.58	  $580.04	      ---	  $731.48	004	1	0	0.00	    $0.00	Y	
K	50542	LAPARO ABLATE RENAL MASS                	    16.96	  $631.42	      ---	  $796.27	004	1	0	0.00	    $0.00	Y	
O	50542	LAPARO ABLATE RENAL MASS                	     3.39	  $126.21	      ---	  $159.16	004	1	0	0.00	    $0.00	Y	
O	50543	LAPARO PARTIAL NEPHRECTOMY              	     3.44	  $128.07	      ---	  $161.51	004	1	0	0.00	    $0.00	Y	
K	50543	LAPARO PARTIAL NEPHRECTOMY              	    17.22	  $641.10	      ---	  $808.48	004	1	0	0.00	    $0.00	Y	
K	50544	LAPAROSCOPY PYELOPLASTY                 	    21.45	  $798.58	      ---	 $1007.08	004	1	0	0.00	    $0.00	Y	
O	50544	LAPAROSCOPY PYELOPLASTY                 	     4.29	  $159.72	      ---	  $201.42	004	1	0	0.00	    $0.00	Y	
O	50545	LAPARO RADICAL NEPHRECTOMY              	     6.06	  $225.61	      ---	  $284.52	004	1	0	0.00	    $0.00	Y	
K	50545	LAPARO RADICAL NEPHRECTOMY              	    30.30	 $1128.07	      ---	 $1422.59	004	1	0	0.00	    $0.00	Y	
K	50546	LAPAROSCOPIC NEPHRECTOMY                	    19.89	  $740.50	      ---	  $933.84	004	1	0	0.00	    $0.00	Y	
O	50546	LAPAROSCOPIC NEPHRECTOMY                	     3.98	  $148.18	      ---	  $186.86	004	1	0	0.00	    $0.00	Y	
O	50547	LAPARO REMOVAL DONOR KIDNEY             	     5.11	  $190.25	      ---	  $239.91	004	1	0	0.00	    $0.00	Y	
K	50547	LAPARO REMOVAL DONOR KIDNEY             	    25.56	  $951.60	      ---	 $1200.04	004	1	0	0.00	    $0.00	Y	
K	50548	LAPARO REMOVE W/URETER                  	    23.34	  $868.95	      ---	 $1095.81	004	1	0	0.00	    $0.00	Y	
O	50548	LAPARO REMOVE W/URETER                  	     4.67	  $173.86	      ---	  $219.26	004	1	0	0.00	    $0.00	Y	
O	50549	UNLISTED LAPS PX RENAL                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	50549	UNLISTED LAPS PX RENAL                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	50551	KIDNEY ENDOSCOPY                        	     4.68	  $174.24	      ---	  $219.73	004	1	1	0.00	    $0.00	Y	
K	50553	KIDNEY ENDOSCOPY                        	    10.63	  $395.75	      ---	  $499.08	004	1	1	0.00	    $0.00	Y	
K	50555	KIDNEY ENDOSCOPY & BIOPSY               	     9.03	  $336.19	      ---	  $423.96	004	1	1	0.00	    $0.00	Y	
K	50557	KIDNEY ENDOSCOPY & TREATMENT            	    11.74	  $437.08	      ---	  $551.19	004	1	1	0.00	    $0.00	Y	
K	50561	KIDNEY ENDOSCOPY & TREATMENT            	    11.34	  $422.19	      ---	  $532.41	004	1	1	0.00	    $0.00	Y	
K	50562	RENAL SCOPE W/TUMOR RESECT              	    11.02	  $410.27	      ---	  $517.39	004	1	1	0.00	    $0.00	Y	
K	50570	KIDNEY ENDOSCOPY                        	     5.89	  $219.28	      ---	  $276.54	004	1	0	0.00	    $0.00	Y	
K	50572	KIDNEY ENDOSCOPY                        	     6.33	  $235.67	      ---	  $297.19	004	1	0	0.00	    $0.00	Y	
K	50574	KIDNEY ENDOSCOPY & BIOPSY               	     6.78	  $252.42	      ---	  $318.32	004	1	0	0.00	    $0.00	Y	
K	50575	KIDNEY ENDOSCOPY                        	    16.06	  $597.91	      ---	  $754.02	004	1	0	0.00	    $0.00	Y	
K	50576	KIDNEY ENDOSCOPY & TREATMENT            	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
K	50580	KIDNEY ENDOSCOPY & TREATMENT            	     7.33	  $272.90	      ---	  $344.14	004	1	0	0.00	    $0.00	Y	
K	50590	FRAGMENTING OF KIDNEY STONE             	    18.00	  $670.14	      ---	  $845.10	004	1	0	0.00	    $0.00	Y	
K	50592	PERC RF ABLATE RENAL TUMOR              	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	50593	PERC CRYO ABLATE RENAL TUM              	   104.63	 $3895.37	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	50600	EXPLORATION OF URETER                   	    20.39	  $759.12	      ---	  $957.31	004	1	0	0.00	    $0.00	Y	
O	50600	EXPLORATION OF URETER                   	     4.08	  $151.90	      ---	  $191.56	004	1	0	0.00	    $0.00	Y	
O	50605	INSERT URETERAL SUPPORT                 	     4.10	  $152.64	      ---	  $192.50	004	1	0	0.00	    $0.00	Y	
K	50605	INSERT URETERAL SUPPORT                 	    20.52	  $763.96	      ---	  $963.41	004	1	0	0.00	    $0.00	Y	
K	50606	ENDOLUMINAL BX URTR RNL PLVS            	    12.91	  $480.64	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	50610	REMOVAL OF URETER STONE                 	    21.00	  $781.83	      ---	  $985.95	004	1	0	0.00	    $0.00	Y	
O	50610	REMOVAL OF URETER STONE                 	     4.20	  $156.37	      ---	  $197.19	004	1	0	0.00	    $0.00	Y	
O	50620	REMOVAL OF URETER STONE                 	     3.97	  $147.80	      ---	  $186.39	004	1	0	0.00	    $0.00	Y	
K	50620	REMOVAL OF URETER STONE                 	    19.83	  $738.27	      ---	  $931.02	004	1	0	0.00	    $0.00	Y	
K	50630	REMOVAL OF URETER STONE                 	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
O	50630	REMOVAL OF URETER STONE                 	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
O	50650	REMOVAL OF URETER                       	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	50650	REMOVAL OF URETER                       	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
K	50660	REMOVAL OF URETER                       	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
O	50660	REMOVAL OF URETER                       	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	50684	INJECTION FOR URETER X-RAY              	     6.78	  $252.42	      ---	  $318.32	004	1	0	0.00	    $0.00	Y	
K	50686	MEASURE URETER PRESSURE                 	     2.84	  $105.73	      ---	  $133.34	004	1	1	0.00	    $0.00	Y	
K	50688	CHANGE OF URETER TUBE/STENT             	     1.21	   $45.05	      ---	   $56.81	004	1	1	0.00	    $0.00	Y	
K	50690	INJECTION FOR URETER X-RAY              	     7.22	  $268.80	      ---	  $338.98	004	1	0	0.00	    $0.00	Y	
K	50693	PLMT URETERAL STENT PRQ                 	    26.16	  $973.94	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	50694	PLMT URETERAL STENT PRQ                 	    28.71	 $1068.87	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	50695	PLMT URETERAL STENT PRQ                 	    34.97	 $1301.93	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	50700	REVISION OF URETER                      	    20.31	  $756.14	      ---	  $953.55	004	1	0	0.00	    $0.00	Y	
O	50700	REVISION OF URETER                      	     4.06	  $151.15	      ---	  $190.62	004	1	0	0.00	    $0.00	Y	
K	50705	URETERAL EMBOLIZATION/OCCL              	    42.38	 $1577.81	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	50706	BALLOON DILATE URTRL STRIX              	    18.80	  $699.92	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	50715	RELEASE OF URETER                       	    18.12	  $674.61	      ---	  $850.73	004	1	0	0.00	    $0.00	Y	
O	50715	RELEASE OF URETER                       	     3.62	  $134.77	      ---	  $169.96	004	1	0	0.00	    $0.00	Y	
O	50722	RELEASE OF URETER                       	     3.62	  $134.77	      ---	  $169.96	004	1	0	0.00	    $0.00	Y	
K	50722	RELEASE OF URETER                       	    18.12	  $674.61	      ---	  $850.73	004	1	0	0.00	    $0.00	Y	
K	50725	RELEASE/REVISE URETER                   	    26.00	  $967.98	      ---	 $1220.70	004	1	0	0.00	    $0.00	Y	
O	50725	RELEASE/REVISE URETER                   	     5.20	  $193.60	      ---	  $244.14	004	1	0	0.00	    $0.00	Y	
O	50727	REVISE URETER                           	     2.00	   $74.46	      ---	   $93.90	004	1	0	0.00	    $0.00	Y	
K	50727	REVISE URETER                           	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
K	50728	REVISE URETER                           	    14.74	  $548.77	      ---	  $692.04	004	1	0	0.00	    $0.00	Y	
O	50728	REVISE URETER                           	     2.94	  $109.46	      ---	  $138.03	004	1	0	0.00	    $0.00	Y	
O	50740	FUSION OF URETER & KIDNEY               	     4.80	  $178.70	      ---	  $225.36	004	1	0	0.00	    $0.00	Y	
K	50740	FUSION OF URETER & KIDNEY               	    23.98	  $892.78	      ---	 $1125.86	004	1	0	0.00	    $0.00	Y	
K	50750	FUSION OF URETER & KIDNEY               	    24.92	  $927.77	      ---	 $1169.99	004	1	0	0.00	    $0.00	Y	
O	50750	FUSION OF URETER & KIDNEY               	     4.98	  $185.41	      ---	  $233.81	004	1	0	0.00	    $0.00	Y	
O	50760	URETEROURETEROSTOMY                     	     4.80	  $178.70	      ---	  $225.36	004	1	0	0.00	    $0.00	Y	
K	50760	URETEROURETEROSTOMY                     	    23.99	  $893.15	      ---	 $1126.33	004	1	0	0.00	    $0.00	Y	
K	50770	SPLICING OF URETERS                     	    25.12	  $935.22	      ---	 $1179.38	004	1	0	0.00	    $0.00	Y	
O	50770	SPLICING OF URETERS                     	     5.02	  $186.89	      ---	  $235.69	004	1	0	0.00	    $0.00	Y	
O	50780	REIMPLANT URETER IN BLADDER             	     4.77	  $177.59	      ---	  $223.95	004	1	0	0.00	    $0.00	Y	
K	50780	REIMPLANT URETER IN BLADDER             	    23.86	  $888.31	      ---	 $1120.23	004	1	0	0.00	    $0.00	Y	
K	50782	REIMPLANT URETER IN BLADDER             	    24.96	  $929.26	      ---	 $1171.87	004	1	0	0.00	    $0.00	Y	
O	50782	REIMPLANT URETER IN BLADDER             	     4.99	  $185.78	      ---	  $234.28	004	1	0	0.00	    $0.00	Y	
O	50783	REIMPLANT URETER IN BLADDER             	     5.13	  $190.99	      ---	  $240.85	004	1	0	0.00	    $0.00	Y	
K	50783	REIMPLANT URETER IN BLADDER             	    25.63	  $954.20	      ---	 $1203.33	004	1	0	0.00	    $0.00	Y	
K	50785	REIMPLANT URETER IN BLADDER             	    26.40	  $982.87	      ---	 $1239.48	004	1	0	0.00	    $0.00	Y	
O	50785	REIMPLANT URETER IN BLADDER             	     5.28	  $196.57	      ---	  $247.90	004	1	0	0.00	    $0.00	Y	
O	50800	IMPLANT URETER IN BOWEL                 	     4.40	  $163.81	      ---	  $206.58	004	1	0	0.00	    $0.00	Y	
K	50800	IMPLANT URETER IN BOWEL                 	    22.00	  $819.06	      ---	 $1032.90	004	1	0	0.00	    $0.00	Y	
K	50810	FUSION OF URETER & BOWEL                	    30.00	 $1116.90	      ---	 $1408.50	004	1	0	0.00	    $0.00	Y	
O	50810	FUSION OF URETER & BOWEL                	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
O	50815	URINE SHUNT TO INTESTINE                	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
K	50815	URINE SHUNT TO INTESTINE                	    30.00	 $1116.90	      ---	 $1408.50	004	1	0	0.00	    $0.00	Y	
K	50820	CONSTRUCT BOWEL BLADDER                 	    30.00	 $1116.90	      ---	 $1408.50	004	1	0	0.00	    $0.00	Y	
O	50820	CONSTRUCT BOWEL BLADDER                 	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
O	50825	CONSTRUCT BOWEL BLADDER                 	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
K	50825	CONSTRUCT BOWEL BLADDER                 	    33.98	 $1265.08	      ---	 $1595.36	004	1	0	0.00	    $0.00	Y	
K	50830	REVISE URINE FLOW                       	    34.75	 $1293.74	      ---	 $1631.51	004	1	0	0.00	    $0.00	Y	
O	50830	REVISE URINE FLOW                       	     6.95	  $258.75	      ---	  $326.30	004	1	0	0.00	    $0.00	Y	
O	50840	REPLACE URETER BY BOWEL                 	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
K	50840	REPLACE URETER BY BOWEL                 	    30.00	 $1116.90	      ---	 $1408.50	004	1	0	0.00	    $0.00	Y	
K	50845	APPENDICO-VESICOSTOMY                   	    22.90	  $852.57	      ---	 $1075.16	004	1	0	0.00	    $0.00	Y	
O	50845	APPENDICO-VESICOSTOMY                   	     4.58	  $170.51	      ---	  $215.03	004	1	0	0.00	    $0.00	Y	
O	50860	TRANSPLANT URETER TO SKIN               	     4.08	  $151.90	      ---	  $191.56	004	1	0	0.00	    $0.00	Y	
K	50860	TRANSPLANT URETER TO SKIN               	    20.39	  $759.12	      ---	  $957.31	004	1	0	0.00	    $0.00	Y	
K	50900	REPAIR OF URETER                        	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
O	50900	REPAIR OF URETER                        	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
O	50920	CLOSURE URETER/SKIN FISTULA             	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
K	50920	CLOSURE URETER/SKIN FISTULA             	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
K	50930	CLOSURE URETER/BOWEL FISTULA            	    24.11	  $897.62	      ---	 $1131.96	004	1	0	0.00	    $0.00	Y	
O	50930	CLOSURE URETER/BOWEL FISTULA            	     4.78	  $177.96	      ---	  $224.42	004	1	0	0.00	    $0.00	Y	
O	50940	RELEASE OF URETER                       	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
K	50940	RELEASE OF URETER                       	    20.12	  $749.07	      ---	  $944.63	004	1	0	0.00	    $0.00	Y	
K	50945	LAPAROSCOPY URETEROLITHOTOMY            	    16.47	  $613.18	      ---	  $773.27	004	1	0	0.00	    $0.00	Y	
O	50945	LAPAROSCOPY URETEROLITHOTOMY            	     3.29	  $122.49	      ---	  $154.47	004	1	0	0.00	    $0.00	Y	
O	50947	LAPARO NEW URETER/BLADDER               	     6.56	  $244.23	      ---	  $307.99	004	1	0	0.00	    $0.00	Y	
K	50947	LAPARO NEW URETER/BLADDER               	    32.79	 $1220.77	      ---	 $1539.49	004	1	0	0.00	    $0.00	Y	
K	50948	LAPARO NEW URETER/BLADDER               	    29.97	 $1115.78	      ---	 $1407.09	004	1	0	0.00	    $0.00	Y	
O	50948	LAPARO NEW URETER/BLADDER               	     5.99	  $223.01	      ---	  $281.23	004	1	0	0.00	    $0.00	Y	
O	50949	UNLISTED LAPS PX URETER                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	50949	UNLISTED LAPS PX URETER                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	50951	ENDOSCOPY OF URETER                     	     4.90	  $182.43	      ---	  $230.06	004	1	1	0.00	    $0.00	Y	
K	50953	ENDOSCOPY OF URETER                     	    10.83	  $403.20	      ---	  $508.47	004	1	1	0.00	    $0.00	Y	
K	50955	URETER ENDOSCOPY & BIOPSY               	     9.06	  $337.30	      ---	  $425.37	004	1	1	0.00	    $0.00	Y	
K	50957	URETER ENDOSCOPY & TREATMENT            	     9.11	  $339.17	      ---	  $427.71	004	1	1	0.00	    $0.00	Y	
K	50961	URETER ENDOSCOPY & TREATMENT            	    13.41	  $499.25	      ---	  $629.60	004	1	1	0.00	    $0.00	Y	
K	50970	URETER ENDOSCOPY                        	     4.43	  $164.93	      ---	  $207.99	004	1	0	0.00	    $0.00	Y	
K	50972	URETER ENDOSCOPY & CATHETER             	     4.25	  $158.23	      ---	  $199.54	004	1	0	0.00	    $0.00	Y	
K	50974	URETER ENDOSCOPY & BIOPSY               	     5.66	  $210.72	      ---	  $265.74	004	1	0	0.00	    $0.00	Y	
K	50976	URETER ENDOSCOPY & TREATMENT            	     5.60	  $208.49	      ---	  $262.92	004	1	0	0.00	    $0.00	Y	
K	50980	URETER ENDOSCOPY & TREATMENT            	     4.20	  $156.37	      ---	  $197.19	004	1	0	0.00	    $0.00	Y	
K	51020	CYSTOTOMY/CYSTOSTOMY W/FULG             	    14.50	  $539.84	      ---	  $680.78	004	1	0	0.00	    $0.00	Y	
O	51020	CYSTOTOMY/CYSTOSTOMY W/FULG             	     2.90	  $107.97	      ---	  $136.16	004	1	0	0.00	    $0.00	Y	
O	51040	INCISE & DRAIN BLADDER                  	     2.40	   $89.35	      ---	  $112.68	004	1	0	0.00	    $0.00	Y	
K	51040	INCISE & DRAIN BLADDER                  	    12.00	  $446.76	      ---	  $563.40	004	1	0	0.00	    $0.00	Y	
K	51045	INCISE BLADDER/DRAIN URETER             	    12.00	  $446.76	      ---	  $563.40	004	1	0	0.00	    $0.00	Y	
O	51045	INCISE BLADDER/DRAIN URETER             	     2.40	   $89.35	      ---	  $112.68	004	1	0	0.00	    $0.00	Y	
O	51050	REMOVAL OF BLADDER STONE                	     2.90	  $107.97	      ---	  $136.16	004	1	0	0.00	    $0.00	Y	
K	51050	REMOVAL OF BLADDER STONE                	    14.50	  $539.84	      ---	  $680.78	004	1	0	0.00	    $0.00	Y	
K	51060	REMOVAL OF URETER STONE                 	    18.00	  $670.14	      ---	  $845.10	004	1	0	0.00	    $0.00	Y	
O	51060	REMOVAL OF URETER STONE                 	     3.60	  $134.03	      ---	  $169.02	004	1	0	0.00	    $0.00	Y	
O	51065	REMOVE URETER CALCULUS                  	     2.90	  $107.97	      ---	  $136.16	004	1	0	0.00	    $0.00	Y	
K	51065	REMOVE URETER CALCULUS                  	    14.50	  $539.84	      ---	  $680.78	004	1	0	0.00	    $0.00	Y	
K	51080	DRAINAGE OF BLADDER ABSCESS             	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	51080	DRAINAGE OF BLADDER ABSCESS             	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
K	51100	DRAIN BLADDER BY NEEDLE                 	     1.40	   $52.12	      ---	   $65.73	004	1	0	0.00	    $0.00	Y	
K	51101	DRAIN BLADDER BY TROCAR/CATH            	     2.86	  $106.48	      ---	  $134.28	004	1	0	0.00	    $0.00	Y	
K	51102	DRAIN BL W/CATH INSERTION               	     7.40	  $275.50	      ---	  $347.43	004	1	0	0.00	    $0.00	Y	
K	51500	REMOVAL OF BLADDER CYST                 	    14.00	  $521.22	      ---	  $657.30	004	1	0	0.00	    $0.00	Y	
O	51500	REMOVAL OF BLADDER CYST                 	     2.80	  $104.24	      ---	  $131.46	004	1	0	0.00	    $0.00	Y	
O	51520	REMOVAL OF BLADDER LESION               	     3.20	  $119.14	      ---	  $150.24	004	1	0	0.00	    $0.00	Y	
K	51520	REMOVAL OF BLADDER LESION               	    16.00	  $595.68	      ---	  $751.20	004	1	0	0.00	    $0.00	Y	
K	51525	REMOVAL OF BLADDER LESION               	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
O	51525	REMOVAL OF BLADDER LESION               	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
O	51530	REMOVAL OF BLADDER LESION               	     3.37	  $125.47	      ---	  $158.22	004	1	0	0.00	    $0.00	Y	
K	51530	REMOVAL OF BLADDER LESION               	    16.84	  $626.95	      ---	  $790.64	004	1	0	0.00	    $0.00	Y	
K	51535	REPAIR OF URETER LESION                 	    17.19	  $639.98	      ---	  $807.07	004	1	0	0.00	    $0.00	Y	
O	51535	REPAIR OF URETER LESION                 	     3.44	  $128.07	      ---	  $161.51	004	1	0	0.00	    $0.00	Y	
O	51550	PARTIAL REMOVAL OF BLADDER              	     4.08	  $151.90	      ---	  $191.56	004	1	0	0.00	    $0.00	Y	
K	51550	PARTIAL REMOVAL OF BLADDER              	    20.39	  $759.12	      ---	  $957.31	004	1	0	0.00	    $0.00	Y	
K	51555	PARTIAL REMOVAL OF BLADDER              	    20.39	  $759.12	      ---	  $957.31	004	1	0	0.00	    $0.00	Y	
O	51555	PARTIAL REMOVAL OF BLADDER              	     4.08	  $151.90	      ---	  $191.56	004	1	0	0.00	    $0.00	Y	
O	51565	REVISE BLADDER & URETER(S)              	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
K	51565	REVISE BLADDER & URETER(S)              	    27.18	 $1011.91	      ---	 $1276.10	004	1	0	0.00	    $0.00	Y	
K	51570	REMOVAL OF BLADDER                      	    29.45	 $1096.42	      ---	 $1382.68	004	1	0	0.00	    $0.00	Y	
O	51570	REMOVAL OF BLADDER                      	     5.89	  $219.28	      ---	  $276.54	004	1	0	0.00	    $0.00	Y	
O	51575	REMOVAL OF BLADDER & NODES              	     7.70	  $286.67	      ---	  $361.52	004	1	0	0.00	    $0.00	Y	
K	51575	REMOVAL OF BLADDER & NODES              	    38.51	 $1433.73	      ---	 $1808.04	004	1	0	0.00	    $0.00	Y	
K	51580	REMOVE BLADDER/REVISE TRACT             	    38.51	 $1433.73	      ---	 $1808.04	004	1	0	0.00	    $0.00	Y	
O	51580	REMOVE BLADDER/REVISE TRACT             	     7.70	  $286.67	      ---	  $361.52	004	1	0	0.00	    $0.00	Y	
O	51585	REMOVAL OF BLADDER & NODES              	     8.87	  $330.23	      ---	  $416.45	004	1	0	0.00	    $0.00	Y	
K	51585	REMOVAL OF BLADDER & NODES              	    44.36	 $1651.52	      ---	 $2082.70	004	1	0	0.00	    $0.00	Y	
K	51590	REMOVE BLADDER/REVISE TRACT             	    44.00	 $1638.12	      ---	 $2065.80	004	1	0	0.00	    $0.00	Y	
O	51590	REMOVE BLADDER/REVISE TRACT             	     8.80	  $327.62	      ---	  $413.16	004	1	0	0.00	    $0.00	Y	
O	51595	REMOVE BLADDER/REVISE TRACT             	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
K	51595	REMOVE BLADDER/REVISE TRACT             	    50.00	 $1861.50	      ---	 $2347.50	004	1	0	0.00	    $0.00	Y	
K	51596	REMOVE BLADDER/CREATE POUCH             	    49.27	 $1834.32	      ---	 $2313.23	004	1	0	0.00	    $0.00	Y	
O	51596	REMOVE BLADDER/CREATE POUCH             	     9.85	  $366.72	      ---	  $462.46	004	1	0	0.00	    $0.00	Y	
O	51597	REMOVAL OF PELVIC STRUCTURES            	     8.78	  $326.88	      ---	  $412.22	004	1	0	0.00	    $0.00	Y	
K	51597	REMOVAL OF PELVIC STRUCTURES            	    43.88	 $1633.65	      ---	 $2060.17	004	1	0	0.00	    $0.00	Y	
K	51600	INJECTION FOR BLADDER X-RAY             	     6.90	  $256.89	      ---	  $323.96	004	1	1	0.00	    $0.00	Y	
K	51605	PREPARATION FOR BLADDER XRAY            	     7.03	  $261.73	      ---	  $330.06	004	1	0	0.00	    $0.00	Y	
K	51610	INJECTION FOR BLADDER X-RAY             	     7.39	  $275.13	      ---	  $346.96	004	1	1	0.00	    $0.00	Y	
K	51700	IRRIGATION OF BLADDER                   	     2.11	   $78.56	      ---	   $99.06	004	1	1	0.00	    $0.00	Y	
K	51701	INSERT BLADDER CATHETER                 	     2.95	  $109.83	      ---	  $138.50	004	1	1	0.00	    $0.00	Y	
K	51702	INSERT TEMP BLADDER CATH                	     2.67	   $99.40	      ---	  $125.36	004	1	1	0.00	    $0.00	Y	
X	51702	INSERT TEMP BLADDER CATH                	    99.46	   $99.46	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	51703	INSERT BLADDER CATH COMPLEX             	     2.90	  $107.97	      ---	  $136.16	004	1	1	0.00	    $0.00	Y	
K	51705	CHANGE OF BLADDER TUBE                  	     1.58	   $58.82	      ---	   $74.18	004	1	1	0.00	    $0.00	Y	
O	51705	CHANGE OF BLADDER TUBE                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	51710	CHANGE OF BLADDER TUBE                  	     2.82	  $104.99	      ---	  $132.40	004	1	0	0.00	    $0.00	Y	
K	51715	ENDOSCOPIC INJECTION/IMPLANT            	     4.39	  $163.44	      ---	  $206.11	004	1	0	0.00	    $0.00	Y	
K	51720	TREATMENT OF BLADDER LESION             	     2.68	   $99.78	      ---	       --	004	0	1	0.00	    $0.00	Y	
K	51725	SIMPLE CYSTOMETROGRAM                   	     1.14	   $42.44	      ---	   $53.52	004	1	0	0.43	    $0.00	Y	
K	51726	COMPLEX CYSTOMETROGRAM                  	     2.45	   $91.21	      ---	  $115.03	004	1	0	0.32	    $0.00	Y	
K	51727	CYSTOMETROGRAM W/UP                     	     7.04	  $262.10	      ---	       --	004	0	1	0.37	    $0.00	Y	
K	51728	CYSTOMETROGRAM W/VP                     	     7.04	  $262.10	      ---	       --	004	0	1	0.37	    $0.00	Y	
K	51729	CYSTOMETROGRAM W/VP&UP                  	     7.55	  $281.09	      ---	       --	004	0	1	0.41	    $0.00	Y	
K	51736	URINE FLOW MEASUREMENT                  	     0.79	   $29.41	      ---	   $37.09	004	1	0	0.62	    $0.00	Y	
K	51741	ELECTRO-UROFLOWMETRY FIRST              	     1.13	   $42.07	      ---	   $53.05	004	1	0	0.72	    $0.00	Y	
K	51784	ANAL/URINARY MUSCLE STUDY               	     1.95	   $72.60	      ---	   $91.55	004	1	0	0.44	    $0.00	Y	
K	51785	ANAL/URINARY MUSCLE STUDY               	     1.70	   $63.29	      ---	   $79.82	004	1	0	0.40	    $0.00	Y	
K	51792	URINARY REFLEX STUDY                    	     2.85	  $106.11	      ---	  $133.81	004	1	0	0.30	    $0.00	Y	
K	51797	INTRAABDOMINAL PRESSURE TEST            	     1.59	   $59.20	      ---	   $74.65	004	1	0	0.40	    $0.00	Y	
K	51798	US URINE CAPACITY MEASURE               	     1.59	   $59.20	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	51798	US URINE CAPACITY MEASURE               	     0.32	   $11.91	      ---	       --	004	0	0	0.00	    $0.00	Y	
X	51798	US URINE CAPACITY MEASURE               	    59.20	   $59.20	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	51800	REVISION OF BLADDER/URETHRA             	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	51800	REVISION OF BLADDER/URETHRA             	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
K	51820	REVISION OF URINARY TRACT               	    30.00	 $1116.90	      ---	 $1408.50	004	1	0	0.00	    $0.00	Y	
O	51820	REVISION OF URINARY TRACT               	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
O	51840	ATTACH BLADDER/URETHRA                  	     2.92	  $108.71	      ---	  $137.09	004	1	0	0.00	    $0.00	Y	
K	51840	ATTACH BLADDER/URETHRA                  	    14.59	  $543.19	      ---	  $685.00	004	1	0	0.00	    $0.00	Y	
K	51841	ATTACH BLADDER/URETHRA                  	    16.42	  $611.32	      ---	  $770.92	004	1	0	0.00	    $0.00	Y	
O	51841	ATTACH BLADDER/URETHRA                  	     3.28	  $122.11	      ---	  $154.00	004	1	0	0.00	    $0.00	Y	
O	51845	REPAIR BLADDER NECK                     	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	51845	REPAIR BLADDER NECK                     	    13.36	  $497.39	      ---	  $627.25	004	1	0	0.00	    $0.00	Y	
K	51860	REPAIR OF BLADDER WOUND                 	    16.42	  $611.32	      ---	  $770.92	004	1	0	0.00	    $0.00	Y	
O	51860	REPAIR OF BLADDER WOUND                 	     3.28	  $122.11	      ---	  $154.00	004	1	0	0.00	    $0.00	Y	
O	51865	REPAIR OF BLADDER WOUND                 	     4.01	  $149.29	      ---	  $188.27	004	1	0	0.00	    $0.00	Y	
K	51865	REPAIR OF BLADDER WOUND                 	    20.18	  $751.30	      ---	  $947.45	004	1	0	0.00	    $0.00	Y	
K	51880	REPAIR OF BLADDER OPENING               	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	51880	REPAIR OF BLADDER OPENING               	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
O	51900	REPAIR BLADDER/VAGINA LESION            	     4.40	  $163.81	      ---	  $206.58	004	1	0	0.00	    $0.00	Y	
K	51900	REPAIR BLADDER/VAGINA LESION            	    22.00	  $819.06	      ---	 $1032.90	004	1	0	0.00	    $0.00	Y	
K	51920	CLOSE BLADDER-UTERUS FISTULA            	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
O	51920	CLOSE BLADDER-UTERUS FISTULA            	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
O	51925	HYSTERECTOMY/BLADDER REPAIR             	     4.22	  $157.11	      ---	  $198.13	004	1	0	0.00	    $0.00	Y	
K	51925	HYSTERECTOMY/BLADDER REPAIR             	    21.09	  $785.18	      ---	  $990.18	004	1	0	0.00	    $0.00	Y	
K	51940	CORRECTION OF BLADDER DEFECT            	    34.91	 $1299.70	      ---	 $1639.02	004	1	0	0.00	    $0.00	Y	
O	51940	CORRECTION OF BLADDER DEFECT            	     6.98	  $259.87	      ---	  $327.71	004	1	0	0.00	    $0.00	Y	
O	51960	REVISION OF BLADDER & BOWEL             	     6.05	  $225.24	      ---	  $284.05	004	1	0	0.00	    $0.00	Y	
K	51960	REVISION OF BLADDER & BOWEL             	    30.24	 $1125.84	      ---	 $1419.77	004	1	0	0.00	    $0.00	Y	
K	51980	CONSTRUCT BLADDER OPENING               	    18.00	  $670.14	      ---	  $845.10	004	1	0	0.00	    $0.00	Y	
O	51980	CONSTRUCT BLADDER OPENING               	     3.60	  $134.03	      ---	  $169.02	004	1	0	0.00	    $0.00	Y	
O	51990	LAPARO URETHRAL SUSPENSION              	     2.56	   $95.31	      ---	  $120.19	004	1	0	0.00	    $0.00	Y	
K	51990	LAPARO URETHRAL SUSPENSION              	    12.80	  $476.54	      ---	  $600.96	004	1	0	0.00	    $0.00	Y	
K	51992	LAPARO SLING OPERATION                  	    13.93	  $518.61	      ---	  $654.01	004	1	0	0.00	    $0.00	Y	
O	51992	LAPARO SLING OPERATION                  	     2.79	  $103.87	      ---	  $130.99	004	1	0	0.00	    $0.00	Y	
O	51999	UNLISTED LAPS PX BLADDER                	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	51999	UNLISTED LAPS PX BLADDER                	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	52000	CYSTOURETHROSCOPY                       	     2.33	   $86.75	      ---	  $109.39	004	1	1	0.00	    $0.00	Y	
K	52001	CYSTO W/IRRG&EVAC MLT CLOTS             	     2.97	  $110.57	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	52005	CYSTO W/URTRL CATHJ                     	     4.08	  $151.90	      ---	  $191.56	004	1	1	0.00	    $0.00	Y	
K	52007	CYSTO URTRL CATHJ BRUSH BX              	    13.28	  $494.41	      ---	  $623.50	004	1	0	0.00	    $0.00	Y	
K	52010	CYSTOSCOPY & DUCT CATHETER              	     4.08	  $151.90	      ---	  $191.56	004	1	1	0.00	    $0.00	Y	
K	52204	CYSTOSCOPY W/BIOPSY(S)                  	     3.67	  $136.63	      ---	       --	004	0	1	0.00	    $0.00	Y	
K	52214	CYSTOSCOPY AND TREATMENT                	     4.46	  $166.05	      ---	  $209.40	004	1	1	0.00	    $0.00	Y	
K	52224	CYSTOSCOPY AND TREATMENT                	     4.13	  $153.76	      ---	  $193.90	004	1	1	0.00	    $0.00	Y	
K	52234	CYSTOSCOPY AND TREATMENT                	     6.80	  $253.16	      ---	  $319.26	004	1	1	0.00	    $0.00	Y	
O	52234	CYSTOSCOPY AND TREATMENT                	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
O	52235	CYSTOSCOPY AND TREATMENT                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	52235	CYSTOSCOPY AND TREATMENT                	    12.00	  $446.76	      ---	  $563.40	004	1	0	0.00	    $0.00	Y	
K	52240	CYSTOSCOPY AND TREATMENT                	    18.00	  $670.14	      ---	  $845.10	004	1	0	0.00	    $0.00	Y	
O	52240	CYSTOSCOPY AND TREATMENT                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	52250	CYSTOSCOPY AND RADIOTRACER              	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
K	52260	CYSTOSCOPY AND TREATMENT                	     3.40	  $126.58	      ---	  $159.63	004	1	0	0.00	    $0.00	Y	
K	52265	CYSTOSCOPY AND TREATMENT                	     2.95	  $109.83	      ---	  $138.50	004	1	1	0.00	    $0.00	Y	
K	52270	CYSTOSCOPY & REVISE URETHRA             	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	52275	CYSTOSCOPY & REVISE URETHRA             	     5.32	  $198.06	      ---	  $249.77	004	1	0	0.00	    $0.00	Y	
K	52276	CYSTOSCOPY AND TREATMENT                	    10.24	  $381.24	      ---	  $480.77	004	1	0	0.00	    $0.00	Y	
K	52277	CYSTOSCOPY AND TREATMENT                	     6.57	  $244.60	      ---	  $308.46	004	1	0	0.00	    $0.00	Y	
K	52281	CYSTOSCOPY AND TREATMENT                	     3.40	  $126.58	      ---	  $159.63	004	1	1	0.00	    $0.00	Y	
K	52282	CYSTOSCOPY IMPLANT STENT                	     8.83	  $328.74	      ---	  $414.57	004	1	0	0.00	    $0.00	Y	
K	52283	CYSTOSCOPY AND TREATMENT                	     4.59	  $170.89	      ---	  $215.50	004	1	1	0.00	    $0.00	Y	
K	52284	CYSTO RX BALO CATH URTL STRX            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	52285	CYSTOSCOPY AND TREATMENT                	     4.63	  $172.37	      ---	  $217.38	004	1	0	0.00	    $0.00	Y	
K	52287	CYSTOSCOPY CHEMODENERVATION             	     3.69	  $137.38	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	52290	CYSTOSCOPY AND TREATMENT                	     4.53	  $168.65	      ---	  $212.68	004	1	1	0.00	    $0.00	Y	
K	52300	CYSTOSCOPY AND TREATMENT                	     6.11	  $227.48	      ---	  $286.86	004	1	0	0.00	    $0.00	Y	
K	52301	CYSTOSCOPY AND TREATMENT                	     6.30	  $234.55	      ---	  $295.79	004	1	0	0.00	    $0.00	Y	
O	52301	CYSTOSCOPY AND TREATMENT                	     1.26	   $46.91	      ---	   $59.16	004	1	0	0.00	    $0.00	Y	
K	52305	CYSTOSCOPY AND TREATMENT                	     6.10	  $227.10	      ---	  $286.40	004	1	0	0.00	    $0.00	Y	
K	52310	CYSTOSCOPY AND TREATMENT                	     7.92	  $294.86	      ---	  $371.84	004	1	1	0.00	    $0.00	Y	
K	52315	CYSTOSCOPY AND TREATMENT                	   367.37	  $367.37	      ---	       --	042	0	0	0.00	    $0.00	Y	
K	52317	REMOVE BLADDER STONE                    	    13.87	  $516.38	      ---	  $651.20	004	1	0	0.00	    $0.00	Y	
K	52318	REMOVE BLADDER STONE                    	    14.00	  $521.22	      ---	  $657.30	004	1	0	0.00	    $0.00	Y	
K	52320	CYSTOSCOPY AND TREATMENT                	     7.00	  $260.61	      ---	  $328.65	004	1	0	0.00	    $0.00	Y	
K	52325	CYSTOSCOPY STONE REMOVAL                	    14.00	  $521.22	      ---	  $657.30	004	1	0	0.00	    $0.00	Y	
K	52327	CYSTOSCOPY INJECT MATERIAL              	     5.93	  $220.77	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	52330	CYSTOSCOPY AND TREATMENT                	    11.27	  $419.58	      ---	  $529.13	004	1	0	0.00	    $0.00	Y	
K	52332	CYSTOSCOPY AND TREATMENT                	    14.79	  $550.63	      ---	  $694.39	004	1	0	0.00	    $0.00	Y	
K	52334	CREATE PASSAGE TO KIDNEY                	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	52341	CYSTO W/URETER STRICTURE TX             	     7.55	  $281.09	      ---	  $354.47	004	1	0	0.00	    $0.00	Y	
K	52342	CYSTO W/UP STRICTURE TX                 	     8.17	  $304.17	      ---	  $383.58	004	1	0	0.00	    $0.00	Y	
K	52343	CYSTO W/RENAL STRICTURE TX              	     9.05	  $336.93	      ---	  $424.90	004	1	0	0.00	    $0.00	Y	
K	52344	CYSTO/URETERO STRICTURE TX              	     9.67	  $360.01	      ---	  $454.01	004	1	0	0.00	    $0.00	Y	
K	52345	CYSTO/URETERO W/UP STRICTURE            	    10.31	  $383.84	      ---	  $484.05	004	1	0	0.00	    $0.00	Y	
K	52346	CYSTOURETERO W/RENAL STRICT             	    11.60	  $431.87	      ---	  $544.62	004	1	0	0.00	    $0.00	Y	
K	52351	CYSTOURETERO & OR PYELOSCOPE            	     7.00	  $260.61	      ---	  $328.65	004	1	0	0.00	    $0.00	Y	
K	52352	CYSTOURETERO W/STONE REMOVE             	     8.23	  $306.40	      ---	  $386.40	004	1	0	0.00	    $0.00	Y	
K	52353	CYSTOURETERO W/LITHOTRIPSY              	     9.52	  $354.43	      ---	  $446.96	004	1	0	0.00	    $0.00	Y	
K	52354	CYSTOURETERO W/BIOPSY                   	     8.78	  $326.88	      ---	  $412.22	004	1	0	0.00	    $0.00	Y	
K	52355	CYSTOURETERO W/EXCISE TUMOR             	    10.56	  $393.15	      ---	  $495.79	004	1	0	0.00	    $0.00	Y	
K	52356	CYSTO/URETERO W/LITHOTRIPSY             	     9.51	  $354.06	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	52400	CYSTOURETERO W/CONGEN REPR              	    13.54	  $504.09	      ---	  $635.70	004	1	0	0.00	    $0.00	Y	
O	52400	CYSTOURETERO W/CONGEN REPR              	     2.71	  $100.89	      ---	  $127.23	004	1	0	0.00	    $0.00	Y	
K	52402	CYSTOURETHRO CUT EJACUL DUCT            	     4.69	  $174.61	      ---	  $220.20	004	1	0	0.00	    $0.00	Y	
K	52441	CYSTOURETHRO W/IMPLANT                  	    30.54	 $1137.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	52442	CYSTOURETHRO W/ADDL IMPLANT             	    23.62	  $879.37	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	52450	INCISION OF PROSTATE                    	     8.89	  $330.97	      ---	  $417.39	004	1	0	0.00	    $0.00	Y	
O	52450	INCISION OF PROSTATE                    	     1.78	   $66.27	      ---	   $83.57	004	1	0	0.00	    $0.00	Y	
O	52500	REVISION OF BLADDER NECK                	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	52500	REVISION OF BLADDER NECK                	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	52601	PROSTATECTOMY (TURP)                    	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
O	52601	PROSTATECTOMY (TURP)                    	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	52630	REMOVE PROSTATE REGROWTH                	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	52630	REMOVE PROSTATE REGROWTH                	    20.00	  $744.60	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	52640	RELIEVE BLADDER CONTRACTURE             	    10.17	  $378.63	      ---	  $477.48	004	1	0	0.00	    $0.00	Y	
O	52640	RELIEVE BLADDER CONTRACTURE             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	52647	LASER SURGERY OF PROSTATE               	     2.66	   $99.03	      ---	  $124.89	004	1	0	0.00	    $0.00	Y	
K	52647	LASER SURGERY OF PROSTATE               	    13.29	  $494.79	      ---	  $623.97	004	1	0	0.00	    $0.00	Y	
K	52648	LASER SURGERY OF PROSTATE               	    15.71	  $584.88	      ---	  $737.58	004	1	0	0.00	    $0.00	Y	
O	52648	LASER SURGERY OF PROSTATE               	     3.14	  $116.90	      ---	  $147.42	004	1	0	0.00	    $0.00	Y	
O	52649	PROSTATE LASER ENUCLEATION              	     4.29	  $159.72	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	52649	PROSTATE LASER ENUCLEATION              	    21.45	  $798.58	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	52700	DRAINAGE OF PROSTATE ABSCESS            	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
K	53000	INCISION OF URETHRA                     	     4.15	  $154.50	      ---	  $194.84	004	1	0	0.00	    $0.00	Y	
K	53010	INCISION OF URETHRA                     	     6.32	  $235.29	      ---	  $296.72	004	1	0	0.00	    $0.00	Y	
K	53020	INCISION OF URETHRA                     	     2.67	   $99.40	      ---	  $125.36	004	1	1	0.00	    $0.00	Y	
K	53025	INCISION OF URETHRA                     	     2.52	   $93.82	      ---	  $118.31	004	1	1	0.00	    $0.00	Y	
K	53040	DRAINAGE OF URETHRA ABSCESS             	     7.27	  $270.66	      ---	  $341.33	004	1	0	0.00	    $0.00	Y	
K	53060	DRAINAGE OF URETHRA ABSCESS             	     3.98	  $148.18	      ---	  $186.86	004	1	1	0.00	    $0.00	Y	
K	53080	DRAINAGE OF URINARY LEAKAGE             	     6.78	  $252.42	      ---	  $318.32	004	1	0	0.00	    $0.00	Y	
K	53085	DRAINAGE OF URINARY LEAKAGE             	    19.10	  $711.09	      ---	  $896.75	004	1	0	0.00	    $0.00	Y	
O	53085	DRAINAGE OF URINARY LEAKAGE             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	53200	BIOPSY OF URETHRA                       	     3.56	  $132.54	      ---	  $167.14	004	1	1	0.00	    $0.00	Y	
K	53210	REMOVAL OF URETHRA                      	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
O	53210	REMOVAL OF URETHRA                      	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
O	53215	REMOVAL OF URETHRA                      	     4.08	  $151.90	      ---	  $191.56	004	1	0	0.00	    $0.00	Y	
K	53215	REMOVAL OF URETHRA                      	    20.39	  $759.12	      ---	  $957.31	004	1	0	0.00	    $0.00	Y	
K	53220	TREATMENT OF URETHRA LESION             	     8.78	  $326.88	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	53220	TREATMENT OF URETHRA LESION             	     1.76	   $65.52	      ---	   $82.63	004	1	0	0.00	    $0.00	Y	
O	53230	REMOVAL OF URETHRA LESION               	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	53230	REMOVAL OF URETHRA LESION               	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	53235	REMOVAL OF URETHRA LESION               	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	53235	REMOVAL OF URETHRA LESION               	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	53240	SURGERY FOR URETHRA POUCH               	     5.16	  $192.11	      ---	  $242.26	004	1	0	0.00	    $0.00	Y	
K	53250	REMOVAL OF URETHRA GLAND                	    11.80	  $439.31	      ---	  $554.01	004	1	0	0.00	    $0.00	Y	
O	53250	REMOVAL OF URETHRA GLAND                	     2.40	   $89.35	      ---	  $112.68	004	1	0	0.00	    $0.00	Y	
K	53260	TREATMENT OF URETHRA LESION             	     3.94	  $146.69	      ---	  $184.98	004	1	1	0.00	    $0.00	Y	
K	53265	TREATMENT OF URETHRA LESION             	     4.19	  $155.99	      ---	  $196.72	004	1	1	0.00	    $0.00	Y	
K	53270	REMOVAL OF URETHRA GLAND                	     4.02	  $149.66	      ---	  $188.74	004	1	1	0.00	    $0.00	Y	
K	53275	REPAIR OF URETHRA DEFECT                	     3.48	  $129.56	      ---	  $163.39	004	1	0	0.00	    $0.00	Y	
K	53400	REVISE URETHRA STAGE 1                  	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	53400	REVISE URETHRA STAGE 1                  	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	53405	REVISE URETHRA STAGE 2                  	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
K	53405	REVISE URETHRA STAGE 2                  	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
K	53410	RECONSTRUCTION OF URETHRA               	    18.12	  $674.61	      ---	  $850.73	004	1	0	0.00	    $0.00	Y	
O	53410	RECONSTRUCTION OF URETHRA               	     3.62	  $134.77	      ---	  $169.96	004	1	0	0.00	    $0.00	Y	
O	53415	RECONSTRUCTION OF URETHRA               	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	53415	RECONSTRUCTION OF URETHRA               	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
K	53420	RECONSTRUCT URETHRA STAGE 1             	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
O	53420	RECONSTRUCT URETHRA STAGE 1             	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
O	53425	RECONSTRUCT URETHRA STAGE 2             	     4.22	  $157.11	      ---	  $198.13	004	1	0	0.00	    $0.00	Y	
K	53425	RECONSTRUCT URETHRA STAGE 2             	    21.11	  $785.93	      ---	  $991.11	004	1	0	0.00	    $0.00	Y	
K	53430	RECONSTRUCTION OF URETHRA               	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
O	53430	RECONSTRUCTION OF URETHRA               	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
O	53431	RECONSTRUCT URETHRA/BLADDER             	     4.74	  $176.47	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	53431	RECONSTRUCT URETHRA/BLADDER             	    23.72	  $883.10	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	53440	MALE SLING PROCEDURE                    	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
O	53440	MALE SLING PROCEDURE                    	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
O	53442	REMOVE/REVISE MALE SLING                	     2.48	   $92.33	      ---	  $116.44	004	1	0	0.00	    $0.00	Y	
K	53442	REMOVE/REVISE MALE SLING                	    12.41	  $462.02	      ---	  $582.65	004	1	0	0.00	    $0.00	Y	
K	53444	INSERT TANDEM CUFF                      	    17.09	  $636.26	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	53444	INSERT TANDEM CUFF                      	     3.42	  $127.33	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	53445	INSERT URO/VES NCK SPHINCTER            	     3.41	  $126.95	      ---	  $160.10	004	1	0	0.00	    $0.00	Y	
K	53445	INSERT URO/VES NCK SPHINCTER            	    17.03	  $634.03	      ---	  $799.56	004	1	0	0.00	    $0.00	Y	
K	53446	REMOVE URO SPHINCTER                    	    15.99	  $595.31	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	53446	REMOVE URO SPHINCTER                    	     3.20	  $119.14	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	53447	REMOVE/REPLACE UR SPHINCTER             	     3.18	  $118.39	      ---	  $149.30	004	1	0	0.00	    $0.00	Y	
K	53447	REMOVE/REPLACE UR SPHINCTER             	    15.88	  $591.21	      ---	  $745.57	004	1	0	0.00	    $0.00	Y	
K	53448	REMOV/REPLC UR SPHINCTR COMP            	    28.58	 $1064.03	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	53448	REMOV/REPLC UR SPHINCTR COMP            	     5.72	  $212.96	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	53449	REPAIR URO SPHINCTER                    	     2.87	  $106.85	      ---	  $134.75	004	1	0	0.00	    $0.00	Y	
K	53449	REPAIR URO SPHINCTER                    	    14.34	  $533.88	      ---	  $673.26	004	1	0	0.00	    $0.00	Y	
K	53450	REVISION OF URETHRA                     	     4.89	  $182.05	      ---	  $229.59	004	1	0	0.00	    $0.00	Y	
O	53450	REVISION OF URETHRA                     	     0.98	   $36.49	      ---	   $46.01	004	1	0	0.00	    $0.00	Y	
O	53451	TPRNL BALO CNTNC DEV BI                 	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	53451	TPRNL BALO CNTNC DEV BI                 	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	53452	TPRNL BALO CNTNC DEV UNI                	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	53452	TPRNL BALO CNTNC DEV UNI                	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	53453	TPRNL BALO CNTNC DEV RMVL EA            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	53453	TPRNL BALO CNTNC DEV RMVL EA            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	53454	TPRNL BALO CNTNC DEV ADJMT              	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	53460	REVISION OF URETHRA                     	     5.51	  $205.14	      ---	  $258.69	004	1	0	0.00	    $0.00	Y	
K	53500	URETHRLYS TRANSVAG W/ SCOPE             	    10.34	  $384.96	      ---	  $485.46	004	1	0	0.00	    $0.00	Y	
O	53500	URETHRLYS TRANSVAG W/ SCOPE             	     2.07	   $77.07	      ---	   $97.19	004	1	0	0.00	    $0.00	Y	
K	53502	REPAIR OF URETHRA INJURY                	    11.13	  $414.37	      ---	  $522.55	004	1	0	0.00	    $0.00	Y	
K	53505	REPAIR OF URETHRA INJURY                	    10.87	  $404.69	      ---	  $510.35	004	1	0	0.00	    $0.00	Y	
O	53505	REPAIR OF URETHRA INJURY                	     2.15	   $80.04	      ---	  $100.94	004	1	0	0.00	    $0.00	Y	
O	53510	REPAIR OF URETHRA INJURY                	     2.87	  $106.85	      ---	  $134.75	004	1	0	0.00	    $0.00	Y	
K	53510	REPAIR OF URETHRA INJURY                	    14.16	  $527.18	      ---	  $664.81	004	1	0	0.00	    $0.00	Y	
K	53515	REPAIR OF URETHRA INJURY                	    19.10	  $711.09	      ---	  $896.75	004	1	0	0.00	    $0.00	Y	
O	53515	REPAIR OF URETHRA INJURY                	     3.80	  $141.47	      ---	  $178.41	004	1	0	0.00	    $0.00	Y	
O	53520	REPAIR OF URETHRA DEFECT                	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
K	53520	REPAIR OF URETHRA DEFECT                	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
K	53600	DILATE URETHRA STRICTURE                	     2.34	   $87.12	      ---	  $109.86	004	1	1	0.00	    $0.00	Y	
K	53601	DILATE URETHRA STRICTURE                	     2.21	   $82.28	      ---	  $103.76	004	1	1	0.00	    $0.00	Y	
K	53605	DILATE URETHRA STRICTURE                	     0.79	   $29.41	      ---	   $37.09	004	1	0	0.00	    $0.00	Y	
K	53620	DILATE URETHRA STRICTURE                	     3.41	  $126.95	      ---	  $160.10	004	1	1	0.00	    $0.00	Y	
K	53621	DILATE URETHRA STRICTURE                	     3.28	  $122.11	      ---	  $154.00	004	1	1	0.00	    $0.00	Y	
K	53660	DILATION OF URETHRA                     	     2.01	   $74.83	      ---	   $94.37	004	1	1	0.00	    $0.00	Y	
K	53661	DILATION OF URETHRA                     	     2.04	   $75.95	      ---	   $95.78	004	1	1	0.00	    $0.00	Y	
K	53665	DILATION OF URETHRA                     	     0.47	   $17.50	      ---	   $22.07	004	1	0	0.00	    $0.00	Y	
K	53850	PROSTATIC MICROWAVE THERMOTX            	    50.60	 $1883.84	      ---	 $2375.67	004	1	0	0.00	    $0.00	Y	
K	53852	PROSTATIC RF THERMOTX                   	    46.46	 $1729.71	      ---	 $2181.30	004	1	1	0.00	    $0.00	Y	
K	53854	TRURL DSTRJ PRST8 TISS RF WV            	    45.58	 $1696.94	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	53855	INSERT PROST URETHRAL STENT             	    16.17	  $602.01	      ---	  $759.18	004	1	0	0.00	    $0.00	Y	
K	53860	TRANSURETHRAL RF TREATMENT              	     5.22	  $194.34	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	53899	UNLISTED PX URINARY SYSTEM              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	53899	UNLISTED PX URINARY SYSTEM              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	54000	SLITTING OF PREPUCE                     	     3.16	  $117.65	      ---	  $148.36	004	1	1	0.00	    $0.00	Y	
K	54001	SLITTING OF PREPUCE                     	     3.64	  $135.52	      ---	  $170.90	004	1	1	0.00	    $0.00	Y	
K	54015	DRAIN PENIS LESION                      	     5.92	  $220.40	      ---	  $277.94	004	1	0	0.00	    $0.00	Y	
K	54050	DESTRUCTION PENIS LESION(S)             	     1.63	   $60.68	      ---	   $76.53	004	1	1	0.00	    $0.00	Y	
X	54050	DESTRUCTION PENIS LESION(S)             	   133.47	  $133.47	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	54055	DESTRUCTION PENIS LESION(S)             	     3.41	  $126.95	      ---	  $160.10	004	1	1	0.00	    $0.00	Y	
K	54056	CRYOSURGERY PENIS LESION(S)             	     1.87	   $69.62	      ---	   $87.80	004	1	0	0.00	    $0.00	Y	
X	54056	CRYOSURGERY PENIS LESION(S)             	   133.60	  $133.60	      ---	       --	009	1	0	0.00	    $0.00	Y	
K	54057	LASER SURG PENIS LESION(S)              	     1.77	   $65.90	      ---	   $83.10	004	1	0	0.00	    $0.00	Y	
K	54060	EXCISION OF PENIS LESION(S)             	     3.24	  $120.63	      ---	  $152.12	004	1	1	0.00	    $0.00	Y	
K	54065	DESTRUCTION PENIS LESION(S)             	   183.69	  $183.69	      ---	       --	042	0	0	0.00	    $0.00	Y	
K	54100	BIOPSY OF PENIS                         	     2.49	   $92.70	      ---	  $116.91	004	1	1	0.00	    $0.00	Y	
K	54105	BIOPSY OF PENIS                         	     4.36	  $162.32	      ---	  $204.70	004	1	0	0.00	    $0.00	Y	
K	54110	TREATMENT OF PENIS LESION               	     8.83	  $328.74	      ---	  $414.57	004	1	0	0.00	    $0.00	Y	
O	54110	TREATMENT OF PENIS LESION               	     1.77	   $65.90	      ---	   $83.10	004	1	0	0.00	    $0.00	Y	
O	54111	TREAT PENIS LESION GRAFT                	     3.62	  $134.77	      ---	  $169.96	004	1	0	0.00	    $0.00	Y	
K	54111	TREAT PENIS LESION GRAFT                	    18.12	  $674.61	      ---	  $850.73	004	1	0	0.00	    $0.00	Y	
K	54112	TREAT PENIS LESION GRAFT                	    22.03	  $820.18	      ---	 $1034.31	004	1	0	0.00	    $0.00	Y	
O	54112	TREAT PENIS LESION GRAFT                	     4.41	  $164.18	      ---	  $207.05	004	1	0	0.00	    $0.00	Y	
O	54115	TREATMENT OF PENIS LESION               	     1.52	   $56.59	      ---	   $71.36	004	1	0	0.00	    $0.00	Y	
K	54115	TREATMENT OF PENIS LESION               	     7.59	  $282.58	      ---	  $356.35	004	1	0	0.00	    $0.00	Y	
K	54120	PARTIAL REMOVAL OF PENIS                	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	54120	PARTIAL REMOVAL OF PENIS                	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	54125	REMOVAL OF PENIS                        	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
K	54125	REMOVAL OF PENIS                        	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
K	54130	REMOVE PENIS & NODES                    	    26.95	 $1003.35	      ---	 $1265.30	004	1	0	0.00	    $0.00	Y	
O	54130	REMOVE PENIS & NODES                    	     5.39	  $200.67	      ---	  $253.06	004	1	0	0.00	    $0.00	Y	
O	54135	REMOVE PENIS & NODES                    	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
K	54135	REMOVE PENIS & NODES                    	    33.98	 $1265.08	      ---	 $1595.36	004	1	0	0.00	    $0.00	Y	
K	54161	CIRCUM 28 DAYS OR OLDER                 	     3.40	  $126.58	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	54162	LYSIS PENIL CIRCUMIC LESION             	     5.06	  $188.38	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	54163	REPAIR OF CIRCUMCISION                  	     4.74	  $176.47	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	54164	FRENULOTOMY OF PENIS                    	     4.17	  $155.25	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	54200	INJECTION PX PEYRONIE DS                	     1.56	   $58.08	      ---	   $73.24	004	1	1	0.00	    $0.00	Y	
K	54205	NJX PX PEYRONIE DS EXPS PLAQ            	     8.83	  $328.74	      ---	  $414.57	004	1	0	0.00	    $0.00	Y	
O	54205	NJX PX PEYRONIE DS EXPS PLAQ            	     1.77	   $65.90	      ---	   $83.10	004	1	0	0.00	    $0.00	Y	
K	54220	IRRG CRPRA CAVRNOSA PRIAPISM            	     3.63	  $135.14	      ---	  $170.43	004	1	0	0.00	    $0.00	Y	
K	54230	NJX CORPORA CAVERNOSOGRAPY              	     1.65	   $61.43	      ---	   $77.47	004	1	0	0.00	    $0.00	Y	
K	54240	PENILE PLETHYSMOGRAPHY                  	     2.12	   $78.93	      ---	   $99.53	004	1	0	0.75	    $0.00	Y	
K	54250	NCTRNL PEN TMSCN&/RGDITY TST            	     2.67	   $99.40	      ---	  $125.36	004	1	0	0.90	    $0.00	Y	
K	54300	REVISION OF PENIS                       	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	54300	REVISION OF PENIS                       	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
O	54304	REVISION OF PENIS                       	     3.00	  $111.69	      ---	  $140.85	004	1	0	0.00	    $0.00	Y	
K	54304	REVISION OF PENIS                       	    15.01	  $558.82	      ---	  $704.72	004	1	0	0.00	    $0.00	Y	
K	54308	RECONSTRUCTION OF URETHRA               	    17.68	  $658.23	      ---	  $830.08	004	1	0	0.00	    $0.00	Y	
O	54308	RECONSTRUCTION OF URETHRA               	     3.54	  $131.79	      ---	  $166.20	004	1	0	0.00	    $0.00	Y	
O	54312	RECONSTRUCTION OF URETHRA               	     3.96	  $147.43	      ---	  $185.92	004	1	0	0.00	    $0.00	Y	
K	54312	RECONSTRUCTION OF URETHRA               	    19.82	  $737.90	      ---	  $930.55	004	1	0	0.00	    $0.00	Y	
K	54316	RECONSTRUCTION OF URETHRA               	    20.39	  $759.12	      ---	  $957.31	004	1	0	0.00	    $0.00	Y	
O	54316	RECONSTRUCTION OF URETHRA               	     4.08	  $151.90	      ---	  $191.56	004	1	0	0.00	    $0.00	Y	
O	54318	RECONSTRUCTION OF URETHRA               	     2.94	  $109.46	      ---	  $138.03	004	1	0	0.00	    $0.00	Y	
K	54318	RECONSTRUCTION OF URETHRA               	    14.72	  $548.03	      ---	  $691.10	004	1	0	0.00	    $0.00	Y	
K	54322	RECONSTRUCTION OF URETHRA               	    18.12	  $674.61	      ---	  $850.73	004	1	0	0.00	    $0.00	Y	
O	54322	RECONSTRUCTION OF URETHRA               	     3.62	  $134.77	      ---	  $169.96	004	1	0	0.00	    $0.00	Y	
O	54324	RECONSTRUCTION OF URETHRA               	     3.62	  $134.77	      ---	  $169.96	004	1	0	0.00	    $0.00	Y	
K	54324	RECONSTRUCTION OF URETHRA               	    18.12	  $674.61	      ---	  $850.73	004	1	0	0.00	    $0.00	Y	
K	54326	RECONSTRUCTION OF URETHRA               	    18.12	  $674.61	      ---	  $850.73	004	1	0	0.00	    $0.00	Y	
O	54326	RECONSTRUCTION OF URETHRA               	     3.62	  $134.77	      ---	  $169.96	004	1	0	0.00	    $0.00	Y	
O	54328	REVISE PENIS/URETHRA                    	     4.08	  $151.90	      ---	  $191.56	004	1	0	0.00	    $0.00	Y	
K	54328	REVISE PENIS/URETHRA                    	    20.39	  $759.12	      ---	  $957.31	004	1	0	0.00	    $0.00	Y	
K	54332	REVISE PENIS/URETHRA                    	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
O	54332	REVISE PENIS/URETHRA                    	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
O	54336	REVISE PENIS/URETHRA                    	     4.98	  $185.41	      ---	  $233.81	004	1	0	0.00	    $0.00	Y	
K	54336	REVISE PENIS/URETHRA                    	    24.92	  $927.77	      ---	 $1169.99	004	1	0	0.00	    $0.00	Y	
K	54340	RPR HYPSPAD COMP SIMPLE                 	     7.65	  $284.81	      ---	  $359.17	004	1	0	0.00	    $0.00	Y	
K	54344	RRP HYPSPAD COMP MOBLJ&URTP             	    12.03	  $447.88	      ---	  $564.81	004	1	0	0.00	    $0.00	Y	
O	54344	RRP HYPSPAD COMP MOBLJ&URTP             	     2.41	   $89.72	      ---	  $113.15	004	1	0	0.00	    $0.00	Y	
O	54348	RPR HYPSPAD COMP DSJ & URTP             	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
K	54348	RPR HYPSPAD COMP DSJ & URTP             	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
K	54352	REVJ PRIOR HYPSPAD REPAIR               	    24.92	  $927.77	      ---	 $1169.99	004	1	0	0.00	    $0.00	Y	
O	54352	REVJ PRIOR HYPSPAD REPAIR               	     4.98	  $185.41	      ---	  $233.81	004	1	0	0.00	    $0.00	Y	
O	54360	PENIS PLASTIC SURGERY                   	     2.86	  $106.48	      ---	  $134.28	004	1	0	0.00	    $0.00	Y	
K	54360	PENIS PLASTIC SURGERY                   	    14.30	  $532.39	      ---	  $671.39	004	1	0	0.00	    $0.00	Y	
K	54380	REPAIR PENIS                            	    15.06	  $560.68	      ---	  $707.07	004	1	0	0.00	    $0.00	Y	
O	54380	REPAIR PENIS                            	     3.06	  $113.92	      ---	  $143.67	004	1	0	0.00	    $0.00	Y	
O	54385	REPAIR PENIS                            	     4.62	  $172.00	      ---	  $216.91	004	1	0	0.00	    $0.00	Y	
K	54385	REPAIR PENIS                            	    23.11	  $860.39	      ---	 $1085.01	004	1	0	0.00	    $0.00	Y	
K	54390	REPAIR PENIS AND BLADDER                	    30.55	 $1137.38	      ---	 $1434.32	004	1	0	0.00	    $0.00	Y	
O	54390	REPAIR PENIS AND BLADDER                	     6.11	  $227.48	      ---	  $286.86	004	1	0	0.00	    $0.00	Y	
O	54400	INSERT SEMI-RIGID PROSTHESIS            	     2.80	  $104.24	      ---	  $131.46	004	1	0	0.00	    $0.00	Y	
K	54400	INSERT SEMI-RIGID PROSTHESIS            	    14.00	  $521.22	      ---	  $657.30	004	1	0	0.00	    $0.00	Y	
K	54401	INSERT SELF-CONTD PROSTHESIS            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	N	
O	54401	INSERT SELF-CONTD PROSTHESIS            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	N	
O	54405	INSERT MULTI-COMP PENIS PROS            	     0.00	    $0.00	      ---	       --	008	1	0	0.00	    $0.00	N	
K	54405	INSERT MULTI-COMP PENIS PROS            	     0.00	    $0.00	      ---	       --	008	1	0	0.00	    $0.00	N	
K	54406	REMOVE MUTI-COMP PENIS PROS             	    15.55	  $578.93	      ---	  $730.07	004	1	0	0.00	    $0.00	Y	
O	54406	REMOVE MUTI-COMP PENIS PROS             	     3.11	  $115.79	      ---	  $146.01	004	1	0	0.00	    $0.00	Y	
O	54408	REPAIR MULTI-COMP PENIS PROS            	     3.28	  $122.11	      ---	  $154.00	004	1	0	0.00	    $0.00	Y	
K	54408	REPAIR MULTI-COMP PENIS PROS            	    16.40	  $610.57	      ---	  $769.98	004	1	0	0.00	    $0.00	Y	
K	54410	REMOVE/REPLACE PENIS PROSTH             	    19.39	  $721.89	      ---	  $910.36	004	1	0	0.00	    $0.00	Y	
O	54410	REMOVE/REPLACE PENIS PROSTH             	     3.88	  $144.45	      ---	  $182.17	004	1	0	0.00	    $0.00	Y	
O	54411	REMOV/REPLC PENIS PROS COMP             	     4.24	  $157.86	      ---	  $199.07	004	1	0	0.00	    $0.00	Y	
K	54411	REMOV/REPLC PENIS PROS COMP             	    21.20	  $789.28	      ---	  $995.34	004	1	0	0.00	    $0.00	Y	
K	54415	REMOVE SELF-CONTD PENIS PROS            	    11.61	  $432.24	      ---	  $545.09	004	1	0	0.00	    $0.00	Y	
O	54415	REMOVE SELF-CONTD PENIS PROS            	     2.32	   $86.37	      ---	  $108.92	004	1	0	0.00	    $0.00	Y	
O	54416	REMV/REPL PENIS CONTAIN PROS            	     3.03	  $112.81	      ---	  $142.26	004	1	0	0.00	    $0.00	Y	
K	54416	REMV/REPL PENIS CONTAIN PROS            	    15.14	  $563.66	      ---	  $710.82	004	1	0	0.00	    $0.00	Y	
K	54417	REMV/REPLC PENIS PROS COMPL             	    18.64	  $693.97	      ---	  $875.15	004	1	0	0.00	    $0.00	Y	
O	54417	REMV/REPLC PENIS PROS COMPL             	     3.73	  $138.87	      ---	  $175.12	004	1	0	0.00	    $0.00	Y	
O	54420	REVISION OF PENIS                       	     2.61	   $97.17	      ---	  $122.54	004	1	0	0.00	    $0.00	Y	
K	54420	REVISION OF PENIS                       	    13.14	  $489.20	      ---	  $616.92	004	1	0	0.00	    $0.00	Y	
K	54430	REVISION OF PENIS                       	    13.14	  $489.20	      ---	  $616.92	004	1	0	0.00	    $0.00	Y	
O	54430	REVISION OF PENIS                       	     2.61	   $97.17	      ---	  $122.54	004	1	0	0.00	    $0.00	Y	
O	54435	REVISION OF PENIS                       	     2.32	   $86.37	      ---	  $108.92	004	1	0	0.00	    $0.00	Y	
K	54435	REVISION OF PENIS                       	    11.60	  $431.87	      ---	  $544.62	004	1	0	0.00	    $0.00	Y	
K	54437	REPAIR CORPOREAL TEAR                   	    15.91	  $592.33	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	54437	REPAIR CORPOREAL TEAR                   	     3.18	  $118.39	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	54440	REPAIR OF PENIS                         	     0.99	   $36.86	      ---	   $46.48	004	1	0	0.00	    $0.00	Y	
K	54440	REPAIR OF PENIS                         	     4.93	  $183.54	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	54500	BIOPSY OF TESTIS                        	     3.19	  $118.76	      ---	  $149.77	004	1	1	0.00	    $0.00	Y	
K	54505	BIOPSY OF TESTIS                        	     3.40	  $126.58	      ---	  $159.63	004	1	0	0.00	    $0.00	Y	
K	54512	EXCISE LESION TESTIS                    	    12.13	  $451.60	      ---	  $569.50	004	1	0	0.00	    $0.00	Y	
K	54520	REMOVAL OF TESTIS                       	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
O	54520	REMOVAL OF TESTIS                       	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
O	54522	ORCHIECTOMY PARTIAL                     	     2.76	  $102.75	      ---	  $129.58	004	1	0	0.00	    $0.00	Y	
K	54522	ORCHIECTOMY PARTIAL                     	    13.81	  $514.15	      ---	  $648.38	004	1	0	0.00	    $0.00	Y	
K	54530	REMOVAL OF TESTIS                       	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	54530	REMOVAL OF TESTIS                       	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
O	54535	EXTENSIVE TESTIS SURGERY                	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	54535	EXTENSIVE TESTIS SURGERY                	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	54550	EXPLORATION FOR TESTIS                  	     8.83	  $328.74	      ---	  $414.57	004	1	0	0.00	    $0.00	Y	
O	54550	EXPLORATION FOR TESTIS                  	     1.77	   $65.90	      ---	   $83.10	004	1	0	0.00	    $0.00	Y	
O	54560	EXPLORATION FOR TESTIS                  	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	54560	EXPLORATION FOR TESTIS                  	    13.36	  $497.39	      ---	  $627.25	004	1	0	0.00	    $0.00	Y	
K	54600	REDUCE TESTIS TORSION                   	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	54600	REDUCE TESTIS TORSION                   	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
O	54620	SUSPENSION OF TESTIS                    	     0.91	   $33.88	      ---	   $42.72	004	1	0	0.00	    $0.00	Y	
K	54620	SUSPENSION OF TESTIS                    	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	54640	ORCHIOPEXY INGUN/SCROT APPR             	    12.00	  $446.76	      ---	  $563.40	004	1	0	0.00	    $0.00	Y	
O	54640	ORCHIOPEXY INGUN/SCROT APPR             	     2.40	   $89.35	      ---	  $112.68	004	1	0	0.00	    $0.00	Y	
O	54650	ORCHIOPEXY (FOWLER-STEPHENS)            	     2.80	  $104.24	      ---	  $131.46	004	1	0	0.00	    $0.00	Y	
K	54650	ORCHIOPEXY (FOWLER-STEPHENS)            	    13.99	  $520.85	      ---	  $656.83	004	1	0	0.00	    $0.00	Y	
K	54670	REPAIR TESTIS INJURY                    	     8.80	  $327.62	      ---	  $413.16	004	1	0	0.00	    $0.00	Y	
O	54670	REPAIR TESTIS INJURY                    	     1.76	   $65.52	      ---	   $82.63	004	1	0	0.00	    $0.00	Y	
O	54680	RELOCATION OF TESTIS(ES)                	     2.15	   $80.04	      ---	  $100.94	004	1	0	0.00	    $0.00	Y	
K	54680	RELOCATION OF TESTIS(ES)                	    10.87	  $404.69	      ---	  $510.35	004	1	0	0.00	    $0.00	Y	
K	54690	LAPAROSCOPY ORCHIECTOMY                 	    12.94	  $481.76	      ---	  $607.53	004	1	0	0.00	    $0.00	Y	
O	54690	LAPAROSCOPY ORCHIECTOMY                 	     2.59	   $96.43	      ---	  $121.60	004	1	0	0.00	    $0.00	Y	
K	54692	LAPAROSCOPY ORCHIOPEXY                  	    12.77	  $475.43	      ---	  $599.55	004	1	0	0.00	    $0.00	Y	
K	54699	UNLISTED LAPS PX TESTIS                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	54699	UNLISTED LAPS PX TESTIS                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	54700	DRAINAGE OF SCROTUM                     	     5.33	  $198.44	      ---	  $250.24	004	1	0	0.00	    $0.00	Y	
K	54800	BIOPSY OF EPIDIDYMIS                    	     3.68	  $137.01	      ---	  $172.78	004	1	1	0.00	    $0.00	Y	
K	54830	REMOVE EPIDIDYMIS LESION                	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
O	54830	REMOVE EPIDIDYMIS LESION                	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
O	54840	REMOVE EPIDIDYMIS LESION                	     1.60	   $59.57	      ---	   $75.12	004	1	0	0.00	    $0.00	Y	
K	54840	REMOVE EPIDIDYMIS LESION                	     8.00	  $297.84	      ---	  $375.60	004	1	0	0.00	    $0.00	Y	
K	54860	REMOVAL OF EPIDIDYMIS                   	     8.84	  $329.11	      ---	  $415.04	004	1	0	0.00	    $0.00	Y	
O	54860	REMOVAL OF EPIDIDYMIS                   	     1.77	   $65.90	      ---	   $83.10	004	1	0	0.00	    $0.00	Y	
O	54861	REMOVAL OF EPIDIDYMIS                   	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	54861	REMOVAL OF EPIDIDYMIS                   	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	54865	EXPLORE EPIDIDYMIS                      	     9.11	  $339.17	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	54865	EXPLORE EPIDIDYMIS                      	     1.82	   $67.76	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	55000	DRAINAGE OF HYDROCELE                   	     1.50	   $55.85	      ---	   $70.43	004	1	1	0.00	    $0.00	Y	
K	55040	REMOVAL OF HYDROCELE                    	     8.00	  $297.84	      ---	  $375.60	004	1	0	0.00	    $0.00	Y	
O	55040	REMOVAL OF HYDROCELE                    	     1.60	   $59.57	      ---	   $75.12	004	1	0	0.00	    $0.00	Y	
O	55041	REMOVAL OF HYDROCELES                   	     2.40	   $89.35	      ---	  $112.68	004	1	0	0.00	    $0.00	Y	
K	55041	REMOVAL OF HYDROCELES                   	    12.00	  $446.76	      ---	  $563.40	004	1	0	0.00	    $0.00	Y	
K	55060	REPAIR OF HYDROCELE                     	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
O	55060	REPAIR OF HYDROCELE                     	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
K	55100	DRAINAGE OF SCROTUM ABSCESS             	     5.24	  $195.09	      ---	  $246.02	004	1	1	0.00	    $0.00	Y	
K	55110	EXPLORE SCROTUM                         	     7.85	  $292.26	      ---	  $368.56	004	1	0	0.00	    $0.00	Y	
O	55110	EXPLORE SCROTUM                         	     1.57	   $58.45	      ---	   $73.71	004	1	0	0.00	    $0.00	Y	
O	55120	REMOVAL OF SCROTUM LESION               	     1.51	   $56.22	      ---	   $70.89	004	1	0	0.00	    $0.00	Y	
K	55120	REMOVAL OF SCROTUM LESION               	     7.57	  $281.83	      ---	  $355.41	004	1	0	0.00	    $0.00	Y	
K	55150	REMOVAL OF SCROTUM                      	     8.22	  $306.03	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	55150	REMOVAL OF SCROTUM                      	     1.64	   $61.06	      ---	   $77.00	004	1	0	0.00	    $0.00	Y	
O	55175	REVISION OF SCROTUM                     	     1.40	   $52.12	      ---	   $65.73	004	1	0	0.00	    $0.00	Y	
K	55175	REVISION OF SCROTUM                     	     7.00	  $260.61	      ---	  $328.65	004	1	0	0.00	    $0.00	Y	
K	55180	REVISION OF SCROTUM                     	    14.43	  $537.23	      ---	  $677.49	004	1	0	0.00	    $0.00	Y	
O	55180	REVISION OF SCROTUM                     	     2.89	  $107.59	      ---	  $135.69	004	1	0	0.00	    $0.00	Y	
K	55200	INCISION OF SPERM DUCT                  	     4.08	  $151.90	      ---	  $191.56	004	1	0	0.00	    $0.00	Y	
K	55250	REMOVAL OF SPERM DUCT(S)                	     7.00	  $260.61	      ---	  $328.65	004	1	1	0.00	    $0.00	Y	
K	55300	PREPARE SPERM DUCT X-RAY                	     4.08	  $151.90	      ---	  $191.56	004	1	0	0.00	    $0.00	Y	
K	55500	REMOVAL OF HYDROCELE                    	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
O	55500	REMOVAL OF HYDROCELE                    	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
O	55520	REMOVAL OF SPERM CORD LESION            	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
K	55520	REMOVAL OF SPERM CORD LESION            	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
K	55530	REVISE SPERMATIC CORD VEINS             	     8.00	  $297.84	      ---	  $375.60	004	1	0	0.00	    $0.00	Y	
O	55530	REVISE SPERMATIC CORD VEINS             	     1.60	   $59.57	      ---	   $75.12	004	1	0	0.00	    $0.00	Y	
O	55535	REVISE SPERMATIC CORD VEINS             	     1.90	   $70.74	      ---	   $89.21	004	1	0	0.00	    $0.00	Y	
K	55535	REVISE SPERMATIC CORD VEINS             	     9.50	  $353.69	      ---	  $446.03	004	1	0	0.00	    $0.00	Y	
K	55540	REVISE HERNIA & SPERM VEINS             	    10.49	  $390.54	      ---	  $492.51	004	1	0	0.00	    $0.00	Y	
O	55540	REVISE HERNIA & SPERM VEINS             	     2.10	   $78.18	      ---	   $98.60	004	1	0	0.00	    $0.00	Y	
O	55550	LAPARO LIGATE SPERMATIC VEIN            	     1.34	   $49.89	      ---	   $62.91	004	1	0	0.00	    $0.00	Y	
K	55550	LAPARO LIGATE SPERMATIC VEIN            	     6.72	  $250.19	      ---	  $315.50	004	1	0	0.00	    $0.00	Y	
K	55559	UNLSTD LAPS PX SPRMATIC CORD            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	55559	UNLSTD LAPS PX SPRMATIC CORD            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	55600	VESICULOTOMY                            	     1.77	   $65.90	      ---	   $83.10	004	1	0	0.00	    $0.00	Y	
K	55600	VESICULOTOMY                            	     8.83	  $328.74	      ---	  $414.57	004	1	0	0.00	    $0.00	Y	
K	55605	VESICULOTOMY COMPLICATED                	    13.30	  $495.16	      ---	  $624.44	004	1	0	0.00	    $0.00	Y	
O	55605	VESICULOTOMY COMPLICATED                	     2.70	  $100.52	      ---	  $126.77	004	1	0	0.00	    $0.00	Y	
O	55650	REMOVE SPERM DUCT POUCH                 	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
K	55650	REMOVE SPERM DUCT POUCH                 	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
K	55680	REMOVE SPERM POUCH LESION               	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
O	55680	REMOVE SPERM POUCH LESION               	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
K	55700	BIOPSY OF PROSTATE                      	     2.35	   $87.49	      ---	  $110.33	004	1	0	0.00	    $0.00	Y	
K	55705	BIOPSY OF PROSTATE                      	     8.00	  $297.84	      ---	  $375.60	004	1	0	0.00	    $0.00	Y	
O	55705	BIOPSY OF PROSTATE                      	     1.60	   $59.57	      ---	   $75.12	004	1	0	0.00	    $0.00	Y	
K	55706	PROSTATE SATURATION SAMPLING            	     7.99	  $297.47	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	55720	DRAINAGE OF PROSTATE ABSCESS            	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	55720	DRAINAGE OF PROSTATE ABSCESS            	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
O	55725	DRAINAGE OF PROSTATE ABSCESS            	     2.80	  $104.24	      ---	  $131.46	004	1	0	0.00	    $0.00	Y	
K	55725	DRAINAGE OF PROSTATE ABSCESS            	    14.00	  $521.22	      ---	  $657.30	004	1	0	0.00	    $0.00	Y	
K	55801	REMOVAL OF PROSTATE                     	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
O	55801	REMOVAL OF PROSTATE                     	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
O	55810	EXTENSIVE PROSTATE SURGERY              	     5.72	  $212.96	      ---	  $268.55	004	1	0	0.00	    $0.00	Y	
K	55810	EXTENSIVE PROSTATE SURGERY              	    28.62	 $1065.52	      ---	 $1343.71	004	1	0	0.00	    $0.00	Y	
K	55812	EXTENSIVE PROSTATE SURGERY              	    35.11	 $1307.15	      ---	 $1648.41	004	1	0	0.00	    $0.00	Y	
O	55812	EXTENSIVE PROSTATE SURGERY              	     7.02	  $261.35	      ---	  $329.59	004	1	0	0.00	    $0.00	Y	
O	55815	EXTENSIVE PROSTATE SURGERY              	     8.00	  $297.84	      ---	  $375.60	004	1	0	0.00	    $0.00	Y	
K	55815	EXTENSIVE PROSTATE SURGERY              	    40.00	 $1489.20	      ---	 $1878.00	004	1	0	0.00	    $0.00	Y	
K	55821	REMOVAL OF PROSTATE                     	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
O	55821	REMOVAL OF PROSTATE                     	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
O	55831	REMOVAL OF PROSTATE                     	     4.08	  $151.90	      ---	  $191.56	004	1	0	0.00	    $0.00	Y	
K	55831	REMOVAL OF PROSTATE                     	    20.42	  $760.24	      ---	  $958.72	004	1	0	0.00	    $0.00	Y	
K	55840	EXTENSIVE PROSTATE SURGERY              	    29.45	 $1096.42	      ---	 $1382.68	004	1	0	0.00	    $0.00	Y	
O	55840	EXTENSIVE PROSTATE SURGERY              	     5.89	  $219.28	      ---	  $276.54	004	1	0	0.00	    $0.00	Y	
O	55842	EXTENSIVE PROSTATE SURGERY              	     6.12	  $227.85	      ---	  $287.33	004	1	0	0.00	    $0.00	Y	
K	55842	EXTENSIVE PROSTATE SURGERY              	    30.58	 $1138.49	      ---	 $1435.73	004	1	0	0.00	    $0.00	Y	
K	55845	EXTENSIVE PROSTATE SURGERY              	    36.12	 $1344.75	      ---	 $1695.83	004	1	0	0.00	    $0.00	Y	
O	55845	EXTENSIVE PROSTATE SURGERY              	     7.18	  $267.31	      ---	  $337.10	004	1	0	0.00	    $0.00	Y	
O	55860	SURGICAL EXPOSURE PROSTATE              	     2.61	   $97.17	      ---	  $122.54	004	1	0	0.00	    $0.00	Y	
K	55860	SURGICAL EXPOSURE PROSTATE              	    13.03	  $485.11	      ---	  $611.76	004	1	0	0.00	    $0.00	Y	
K	55862	EXTENSIVE PROSTATE SURGERY              	    14.72	  $548.03	      ---	  $691.10	004	1	0	0.00	    $0.00	Y	
O	55862	EXTENSIVE PROSTATE SURGERY              	     2.94	  $109.46	      ---	  $138.03	004	1	0	0.00	    $0.00	Y	
O	55865	EXTENSIVE PROSTATE SURGERY              	     5.21	  $193.97	      ---	  $244.61	004	1	0	0.00	    $0.00	Y	
K	55865	EXTENSIVE PROSTATE SURGERY              	    26.05	  $969.84	      ---	 $1223.05	004	1	0	0.00	    $0.00	Y	
K	55866	LAPS SURG PRST8ECT RPBIC RAD            	    25.60	  $953.09	      ---	 $1201.92	004	1	0	0.00	    $0.00	Y	
O	55866	LAPS SURG PRST8ECT RPBIC RAD            	     5.12	  $190.62	      ---	  $240.38	004	1	0	0.00	    $0.00	Y	
O	55867	LAPS SURG PRST8ECT SMPL STOT            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	55867	LAPS SURG PRST8ECT SMPL STOT            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	55874	TPRNL PLMT BIODEGRDABL MATRL            	    93.49	 $3480.63	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	55875	TRANSPERI NEEDLE PLACE PROS             	    19.29	  $718.17	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	55875	TRANSPERI NEEDLE PLACE PROS             	     3.86	  $143.71	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	55876	PLACE RT DEVICE/MARKER PROS             	     3.55	  $132.17	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	55880	ABLTJ MAL PRST8 TISS HIFU               	    22.50	  $837.68	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	55899	UNLISTED PX MALE GENITAL SYS            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	55899	UNLISTED PX MALE GENITAL SYS            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	55920	PLACE NEEDLES PELVIC FOR RT             	     1.85	   $68.88	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	55920	PLACE NEEDLES PELVIC FOR RT             	     9.24	  $344.01	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	56405	I & D OF VULVA/PERINEUM                 	     1.79	   $90.70	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	56405	I & D OF VULVA/PERINEUM                 	   136.42	  $136.42	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	56420	DRAINAGE OF GLAND ABSCESS               	   173.94	  $173.94	      ---	       --	009	0	1	0.00	    $0.00	Y	
K	56420	DRAINAGE OF GLAND ABSCESS               	     1.24	   $62.83	      ---	       --	016	0	1	0.00	    $0.00	Y	
K	56440	MRSPLZATN BRTHLNS GLND CST              	     4.00	  $202.68	      ---	       --	016	0	1	0.00	    $0.00	Y	
X	56440	MRSPLZATN BRTHLNS GLND CST              	   202.68	  $202.68	      ---	       --	009	0	1	0.00	    $0.00	Y	
X	56441	LYSIS OF LABIAL ADHESIONS               	   169.00	  $169.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	56441	LYSIS OF LABIAL ADHESIONS               	     1.49	   $75.50	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	56442	HYMENOTOMY                              	     1.72	   $87.15	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	56442	HYMENOTOMY                              	    87.11	   $87.11	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	56501	DESTROY VULVA LESIONS SIM               	   180.42	  $180.42	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	56501	DESTROY VULVA LESIONS SIM               	     1.58	   $80.06	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	56515	DESTROY VULVA LESION/S COMPL            	     2.42	  $122.62	      ---	       --	016	0	1	0.00	    $0.00	Y	
X	56515	DESTROY VULVA LESION/S COMPL            	   255.40	  $255.40	      ---	       --	009	0	1	0.00	    $0.00	Y	
O	56515	DESTROY VULVA LESION/S COMPL            	     0.48	   $24.32	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	56605	BIOPSY OF VULVA/PERINEUM                	    88.54	   $88.54	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	56605	BIOPSY OF VULVA/PERINEUM                	     1.16	   $58.78	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	56606	BIOPSY OF VULVA/PERINEUM                	     0.69	   $34.96	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	56606	BIOPSY OF VULVA/PERINEUM                	    34.96	   $34.96	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	56620	VULVECTOMY SIMPLE PARTIAL               	   608.04	  $608.04	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	56620	VULVECTOMY SIMPLE PARTIAL               	     2.40	  $121.61	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	56620	VULVECTOMY SIMPLE PARTIAL               	    12.00	  $608.04	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	56625	VULVECTOMY SIMPLE COMPLETE              	    15.00	  $760.05	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	56625	VULVECTOMY SIMPLE COMPLETE              	     3.00	  $152.01	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	56625	VULVECTOMY SIMPLE COMPLETE              	   760.05	  $760.05	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	56630	VULVECTOMY RADICAL PARTIAL              	  1013.40	 $1013.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	56630	VULVECTOMY RADICAL PARTIAL              	     4.00	  $202.68	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	56630	VULVECTOMY RADICAL PARTIAL              	    20.00	 $1013.40	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	56631	VLVCTMY RAD PRTL UNI LYMPHAD            	    29.19	 $1479.06	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	56631	VLVCTMY RAD PRTL UNI LYMPHAD            	     5.84	  $295.91	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	56631	VLVCTMY RAD PRTL UNI LYMPHAD            	  1479.06	 $1479.06	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	56632	VLVCTMY RAD PRTL BI LYMPHAD             	  1447.14	 $1447.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	56632	VLVCTMY RAD PRTL BI LYMPHAD             	     5.71	  $289.33	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	56632	VLVCTMY RAD PRTL BI LYMPHAD             	    28.56	 $1447.14	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	56633	VULVECTOMY RADICAL COMPLETE             	    23.03	 $1166.93	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	56633	VULVECTOMY RADICAL COMPLETE             	     4.61	  $233.59	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	56633	VULVECTOMY RADICAL COMPLETE             	  1166.93	 $1166.93	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	56634	VLVCTMY RAD COMP UNI LYMPHAD            	  1525.67	 $1525.67	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	56634	VLVCTMY RAD COMP UNI LYMPHAD            	     6.02	  $305.03	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	56634	VLVCTMY RAD COMP UNI LYMPHAD            	    30.11	 $1525.67	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	56637	VLVCTMY RAD COMP BI LYMPHAD             	    30.70	 $1555.57	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	56637	VLVCTMY RAD COMP BI LYMPHAD             	     6.14	  $311.11	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	56640	VLVCTMY RAD COMP W/LYMPHADEC            	     5.20	  $263.48	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	56640	VLVCTMY RAD COMP W/LYMPHADEC            	    26.00	 $1317.42	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	56700	PRTL HYMNCTMY/REVJ HYMNL RNG            	     2.72	  $137.82	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	56700	PRTL HYMNCTMY/REVJ HYMNL RNG            	   184.42	  $184.42	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	56740	EXC BARTHOLINS GLAND/CYST               	   282.75	  $282.75	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	56740	EXC BARTHOLINS GLAND/CYST               	     4.80	  $243.22	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	56800	PLASTIC REPAIR INTROITUS                	     4.80	  $243.22	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	56800	PLASTIC REPAIR INTROITUS                	   243.22	  $243.22	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	56800	PLASTIC REPAIR INTROITUS                	     0.96	   $48.64	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	56805	CLITOROPLASTY INTERSEX STATE            	     3.49	  $176.84	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	56805	CLITOROPLASTY INTERSEX STATE            	  1036.96	 $1036.96	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	56805	CLITOROPLASTY INTERSEX STATE            	    17.46	  $884.70	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	56810	PERINEOPLASTY RPR PER NONOB             	     4.90	  $248.28	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	56810	PERINEOPLASTY RPR PER NONOB             	   248.28	  $248.28	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	56810	PERINEOPLASTY RPR PER NONOB             	     0.98	   $49.66	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	56820	COLPOSCOPY VULVA                        	   125.61	  $125.61	      ---	       --	009	0	1	0.00	    $0.00	Y	
K	56820	COLPOSCOPY VULVA                        	     2.48	  $125.66	      ---	       --	016	0	1	0.00	    $0.00	Y	
K	56821	COLPOSCOPY VULVA W/BIOPSY               	     3.21	  $162.65	      ---	       --	016	0	1	0.00	    $0.00	Y	
X	56821	COLPOSCOPY VULVA W/BIOPSY               	   162.50	  $162.50	      ---	       --	009	0	1	0.00	    $0.00	Y	
X	57000	COLPOTOMY W/EXPLORATION                 	   202.68	  $202.68	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	57000	COLPOTOMY W/EXPLORATION                 	     0.80	   $40.54	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57000	COLPOTOMY W/EXPLORATION                 	     4.00	  $202.68	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57010	COLPOTOMY DRG PEL ABSCESS               	     4.53	  $229.54	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	57010	COLPOTOMY DRG PEL ABSCESS               	     0.91	   $46.11	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	57010	COLPOTOMY DRG PEL ABSCESS               	   412.68	  $412.68	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	57020	COLPOCENTESIS SEP PX                    	   115.29	  $115.29	      ---	       --	009	0	1	0.00	    $0.00	Y	
K	57020	COLPOCENTESIS SEP PX                    	     1.01	   $51.18	      ---	       --	016	0	1	0.00	    $0.00	Y	
K	57061	DESTRUCTION VAG LESIONS SMPL            	     1.16	   $58.78	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	57061	DESTRUCTION VAG LESIONS SMPL            	   156.71	  $156.71	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	57065	DESTRUCTION VAG LESION XTNSV            	   228.04	  $228.04	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	57065	DESTRUCTION VAG LESION XTNSV            	     1.84	   $93.23	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57100	BIOPSY VAGINAL MUCOSA SIMPLE            	     0.81	   $41.04	      ---	       --	016	0	1	0.00	    $0.00	Y	
X	57100	BIOPSY VAGINAL MUCOSA SIMPLE            	    94.62	   $94.62	      ---	       --	009	0	1	0.00	    $0.00	Y	
X	57105	BIOPSY VAGINAL MUCOSA XTNSV             	   163.85	  $163.85	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	57105	BIOPSY VAGINAL MUCOSA XTNSV             	     0.39	   $19.76	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57105	BIOPSY VAGINAL MUCOSA XTNSV             	     1.93	   $97.79	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57106	VAGNC PRTL RMVL VAG WALL                	     5.83	  $295.41	      ---	       --	016	1	0	0.00	    $0.00	Y	
O	57106	VAGNC PRTL RMVL VAG WALL                	     1.17	   $59.28	      ---	       --	016	1	0	0.00	    $0.00	Y	
X	57106	VAGNC PRTL RMVL VAG WALL                	   485.69	  $485.69	      ---	       --	009	1	0	0.00	    $0.00	Y	
X	57107	VAGNC COMPL RMVL PARAVAG TIS            	  1294.23	 $1294.23	      ---	       --	009	1	0	0.00	    $0.00	Y	
O	57107	VAGNC COMPL RMVL PARAVAG TIS            	     4.03	  $204.20	      ---	       --	016	1	0	0.00	    $0.00	Y	
K	57107	VAGNC COMPL RMVL PARAVAG TIS            	    20.16	 $1021.51	      ---	       --	016	1	0	0.00	    $0.00	Y	
K	57109	VAGNC BI TOTAL PEL LYMPHADEC            	    24.68	 $1250.54	      ---	       --	016	1	0	0.00	    $0.00	Y	
O	57109	VAGNC BI TOTAL PEL LYMPHADEC            	     4.93	  $249.80	      ---	       --	016	1	0	0.00	    $0.00	Y	
X	57109	VAGNC BI TOTAL PEL LYMPHADEC            	  1536.00	 $1536.00	      ---	       --	009	1	0	0.00	    $0.00	Y	
X	57110	VAGNC COMPL RMVL VAG WALL               	   804.28	  $804.28	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	57110	VAGNC COMPL RMVL VAG WALL               	     2.80	  $141.88	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57110	VAGNC COMPL RMVL VAG WALL               	    14.00	  $709.38	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57111	VAGNC COMPL RMVL PARAVAG TIS            	    24.73	 $1253.07	      ---	       --	016	1	0	0.00	    $0.00	Y	
O	57111	VAGNC COMPL RMVL PARAVAG TIS            	     4.94	  $250.31	      ---	       --	016	1	0	0.00	    $0.00	Y	
X	57111	VAGNC COMPL RMVL PARAVAG TIS            	  1536.00	 $1536.00	      ---	       --	009	1	0	0.00	    $0.00	Y	
X	57120	COLPOCLEISIS LE FORT TYPE               	   608.04	  $608.04	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	57120	COLPOCLEISIS LE FORT TYPE               	     2.40	  $121.61	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57120	COLPOCLEISIS LE FORT TYPE               	    12.00	  $608.04	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57130	EXCISION VAGINAL SEPTUM                 	     3.20	  $162.14	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	57130	EXCISION VAGINAL SEPTUM                 	     0.64	   $32.43	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	57130	EXCISION VAGINAL SEPTUM                 	   213.65	  $213.65	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	57135	EXCISION VAGINAL CYST/TUMOR             	   228.79	  $228.79	      ---	       --	009	0	1	0.00	    $0.00	Y	
O	57135	EXCISION VAGINAL CYST/TUMOR             	     0.54	   $27.36	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57135	EXCISION VAGINAL CYST/TUMOR             	     2.72	  $137.82	      ---	       --	016	0	1	0.00	    $0.00	Y	
K	57150	TREAT VAGINA INFECTION                  	     0.50	   $25.34	      ---	       --	016	0	1	0.00	    $0.00	Y	
X	57150	TREAT VAGINA INFECTION                  	    53.94	   $53.94	      ---	       --	009	0	1	0.00	    $0.00	Y	
X	57155	INSERT UTERI TANDEM/OVOIDS              	   364.39	  $364.39	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	57155	INSERT UTERI TANDEM/OVOIDS              	     6.35	  $321.75	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57156	INS VAG BRACHYTX DEVICE                 	     2.33	  $118.06	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	57156	INS VAG BRACHYTX DEVICE                 	   211.59	  $211.59	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	57160	INSERT PESSARY/OTHER DEVICE             	    68.06	   $68.06	      ---	       --	009	0	1	0.00	    $0.00	Y	
K	57160	INSERT PESSARY/OTHER DEVICE             	     0.74	   $37.50	      ---	       --	016	0	1	0.00	    $0.00	Y	
K	57170	FITTING OF DIAPHRAGM/CAP                	     0.75	   $38.00	      ---	       --	016	0	1	0.00	    $0.00	Y	
K	57180	TREAT VAGINAL BLEEDING                  	     1.27	   $64.35	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	57180	TREAT VAGINAL BLEEDING                  	   186.58	  $186.58	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	57200	REPAIR OF VAGINA                        	   301.02	  $301.02	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	57200	REPAIR OF VAGINA                        	     0.72	   $36.48	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57200	REPAIR OF VAGINA                        	     3.63	  $183.93	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57210	REPAIR VAGINA/PERINEUM                  	   147.28	  $147.28	      ---	       --	042	0	0	0.00	    $0.00	Y	
O	57210	REPAIR VAGINA/PERINEUM                  	     0.00	    $0.00	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	57210	REPAIR VAGINA/PERINEUM                  	   355.17	  $355.17	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	57220	REVISION OF URETHRA                     	   354.69	  $354.69	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	57220	REVISION OF URETHRA                     	     1.40	   $70.94	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57220	REVISION OF URETHRA                     	     7.00	  $354.69	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57230	REPAIR OF URETHRAL LESION               	     7.00	  $354.69	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	57230	REPAIR OF URETHRAL LESION               	     1.40	   $70.94	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	57230	REPAIR OF URETHRAL LESION               	   378.17	  $378.17	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	57240	ANTERIOR COLPORRHAPHY                   	   548.84	  $548.84	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	57240	ANTERIOR COLPORRHAPHY                   	     1.70	   $86.14	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57240	ANTERIOR COLPORRHAPHY                   	     8.50	  $430.70	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57250	REPAIR RECTUM & VAGINA                  	     7.00	  $354.69	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	57250	REPAIR RECTUM & VAGINA                  	     1.40	   $70.94	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	57250	REPAIR RECTUM & VAGINA                  	   550.83	  $550.83	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	57260	CMBN ANT PST COLPRHY                    	   693.60	  $693.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	57260	CMBN ANT PST COLPRHY                    	     2.40	  $121.61	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57260	CMBN ANT PST COLPRHY                    	    12.00	  $608.04	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57265	CMBN AP COLPRHY W/NTRCL RPR             	    14.00	  $709.38	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	57265	CMBN AP COLPRHY W/NTRCL RPR             	     2.80	  $141.88	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	57265	CMBN AP COLPRHY W/NTRCL RPR             	   774.96	  $774.96	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	57267	INSERT MESH/PELVIC FLR ADDON            	   218.67	  $218.67	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	57267	INSERT MESH/PELVIC FLR ADDON            	     0.67	   $33.95	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57267	INSERT MESH/PELVIC FLR ADDON            	     3.33	  $168.73	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57268	REPAIR OF BOWEL BULGE                   	     9.00	  $456.03	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	57268	REPAIR OF BOWEL BULGE                   	     1.80	   $91.21	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	57268	REPAIR OF BOWEL BULGE                   	   457.07	  $457.07	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	57270	REPAIR OF BOWEL POUCH                   	   725.48	  $725.48	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	57270	REPAIR OF BOWEL POUCH                   	     2.80	  $141.88	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57270	REPAIR OF BOWEL POUCH                   	    14.00	  $709.38	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57280	SUSPENSION OF VAGINA                    	    14.13	  $715.97	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	57280	SUSPENSION OF VAGINA                    	     2.82	  $142.89	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	57280	SUSPENSION OF VAGINA                    	   857.91	  $857.91	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	57282	COLPOPEXY EXTRAPERITONEAL               	   619.57	  $619.57	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	57282	COLPOPEXY EXTRAPERITONEAL               	     1.38	   $69.92	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57282	COLPOPEXY EXTRAPERITONEAL               	     6.91	  $350.13	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57283	COLPOPEXY INTRAPERITONEAL               	     7.19	  $364.32	      ---	       --	016	1	0	0.00	    $0.00	Y	
O	57283	COLPOPEXY INTRAPERITONEAL               	     1.44	   $72.96	      ---	       --	016	1	0	0.00	    $0.00	Y	
X	57283	COLPOPEXY INTRAPERITONEAL               	   623.94	  $623.94	      ---	       --	009	1	0	0.00	    $0.00	Y	
X	57284	REPAIR PARAVAG DEFECT OPEN              	   813.25	  $813.25	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	57284	REPAIR PARAVAG DEFECT OPEN              	     3.21	  $162.65	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57284	REPAIR PARAVAG DEFECT OPEN              	    16.05	  $813.25	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57285	REPAIR PARAVAG DEFECT VAG               	     9.85	  $499.10	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	57285	REPAIR PARAVAG DEFECT VAG               	     1.97	   $99.82	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	57285	REPAIR PARAVAG DEFECT VAG               	   618.47	  $618.47	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	57287	REVISE/REMOVE SLING REPAIR              	   668.84	  $668.84	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	57287	REVISE/REMOVE SLING REPAIR              	     2.36	  $119.58	      ---	       --	016	1	0	0.00	    $0.00	Y	
K	57287	REVISE/REMOVE SLING REPAIR              	    11.78	  $596.89	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57288	REPAIR BLADDER DEFECT                   	    15.30	  $775.25	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	57288	REPAIR BLADDER DEFECT                   	     3.10	  $157.08	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	57288	REPAIR BLADDER DEFECT                   	   775.25	  $775.25	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	57289	REPAIR BLADDER & VAGINA                 	     2.40	  $121.61	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57289	REPAIR BLADDER & VAGINA                 	    11.80	  $597.91	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57291	CONSTRUCTION OF VAGINA                  	     7.46	  $378.00	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	57291	CONSTRUCTION OF VAGINA                  	     1.49	   $75.50	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	57291	CONSTRUCTION OF VAGINA                  	   493.24	  $493.24	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	57292	CONSTRUCT VAGINA WITH GRAFT             	   737.83	  $737.83	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	57292	CONSTRUCT VAGINA WITH GRAFT             	     2.53	  $128.20	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57292	CONSTRUCT VAGINA WITH GRAFT             	    12.63	  $639.96	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57295	REVISE VAG GRAFT VIA VAGINA             	     7.70	  $390.16	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	57295	REVISE VAG GRAFT VIA VAGINA             	     1.54	   $78.03	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	57295	REVISE VAG GRAFT VIA VAGINA             	   451.20	  $451.20	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	57296	REVISE VAG GRAFT OPEN ABD               	   851.36	  $851.36	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	57296	REVISE VAG GRAFT OPEN ABD               	     3.12	  $158.09	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57296	REVISE VAG GRAFT OPEN ABD               	    15.61	  $790.96	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57300	REPAIR RECTUM-VAGINA FISTULA            	    14.50	  $734.72	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	57300	REPAIR RECTUM-VAGINA FISTULA            	     2.90	  $146.94	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	57300	REPAIR RECTUM-VAGINA FISTULA            	   734.72	  $734.72	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	57305	REPAIR RECTUM-VAGINA FISTULA            	   912.06	  $912.06	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	57305	REPAIR RECTUM-VAGINA FISTULA            	     3.60	  $182.41	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57305	REPAIR RECTUM-VAGINA FISTULA            	    18.00	  $912.06	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57307	FISTULA REPAIR & COLOSTOMY              	    20.00	 $1013.40	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	57307	FISTULA REPAIR & COLOSTOMY              	     4.00	  $202.68	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	57307	FISTULA REPAIR & COLOSTOMY              	  1013.40	 $1013.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	57308	FISTULA REPAIR TRANSPERINE              	   644.52	  $644.52	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	57308	FISTULA REPAIR TRANSPERINE              	     2.54	  $128.70	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57308	FISTULA REPAIR TRANSPERINE              	    12.72	  $644.52	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57310	REPAIR URETHROVAGINAL LESION            	    14.50	  $734.72	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	57310	REPAIR URETHROVAGINAL LESION            	     2.90	  $146.94	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	57311	REPAIR URETHROVAGINAL LESION            	     1.70	   $86.14	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57311	REPAIR URETHROVAGINAL LESION            	     8.52	  $431.71	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57320	REPAIR BLADDER-VAGINA LESION            	    14.50	  $734.72	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	57320	REPAIR BLADDER-VAGINA LESION            	     2.90	  $146.94	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	57320	REPAIR BLADDER-VAGINA LESION            	   734.72	  $734.72	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	57330	REPAIR BLADDER-VAGINA LESION            	   682.33	  $682.33	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	57330	REPAIR BLADDER-VAGINA LESION            	     2.56	  $129.72	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57330	REPAIR BLADDER-VAGINA LESION            	    12.79	  $648.07	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57335	REPAIR VAGINA                           	    17.52	  $887.74	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	57335	REPAIR VAGINA                           	     3.50	  $177.35	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	57335	REPAIR VAGINA                           	  1047.62	 $1047.62	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	57400	DILATION OF VAGINA                      	   114.11	  $114.11	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	57400	DILATION OF VAGINA                      	     1.19	   $60.30	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57410	PELVIC EXAMINATION                      	     1.48	   $74.99	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	57410	PELVIC EXAMINATION                      	    93.45	   $93.45	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	57415	REMOVE VAGINAL FOREIGN BODY             	   158.69	  $158.69	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	57415	REMOVE VAGINAL FOREIGN BODY             	     1.86	   $94.25	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57420	EXAM OF VAGINA W/SCOPE                  	     2.69	  $136.30	      ---	       --	016	0	1	0.00	    $0.00	Y	
X	57420	EXAM OF VAGINA W/SCOPE                  	   136.26	  $136.26	      ---	       --	009	0	1	0.00	    $0.00	Y	
X	57421	EXAM/BIOPSY OF VAG W/SCOPE              	   161.73	  $161.73	      ---	       --	009	0	1	0.00	    $0.00	Y	
K	57421	EXAM/BIOPSY OF VAG W/SCOPE              	     2.69	  $136.30	      ---	       --	016	0	1	0.00	    $0.00	Y	
K	57423	REPAIR PARAVAG DEFECT LAP               	    13.58	  $688.10	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	57423	REPAIR PARAVAG DEFECT LAP               	   824.73	  $824.73	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	57423	REPAIR PARAVAG DEFECT LAP               	     2.72	  $137.82	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	57425	LAPAROSCOPY SURG COLPOPEXY              	     2.02	  $102.35	      ---	       --	016	1	0	0.00	    $0.00	Y	
X	57425	LAPAROSCOPY SURG COLPOPEXY              	   863.04	  $863.04	      ---	       --	009	1	0	0.00	    $0.00	Y	
K	57425	LAPAROSCOPY SURG COLPOPEXY              	    10.08	  $510.75	      ---	       --	016	1	0	0.00	    $0.00	Y	
K	57426	REVISE PROSTH VAG GRAFT LAP             	    14.09	  $713.94	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	57426	REVISE PROSTH VAG GRAFT LAP             	   778.57	  $778.57	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	57426	REVISE PROSTH VAG GRAFT LAP             	     2.82	  $142.89	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	57452	EXAM OF CERVIX W/SCOPE                  	   115.93	  $115.93	      ---	       --	009	0	1	0.00	    $0.00	Y	
K	57452	EXAM OF CERVIX W/SCOPE                  	     1.02	   $51.68	      ---	       --	016	0	1	0.00	    $0.00	Y	
K	57454	BX/CURETT OF CERVIX W/SCOPE             	     1.70	   $86.14	      ---	       --	016	0	1	0.00	    $0.00	Y	
X	57454	BX/CURETT OF CERVIX W/SCOPE             	   153.04	  $153.04	      ---	       --	009	0	1	0.00	    $0.00	Y	
X	57455	BIOPSY OF CERVIX W/SCOPE                	   147.15	  $147.15	      ---	       --	009	0	1	0.00	    $0.00	Y	
K	57455	BIOPSY OF CERVIX W/SCOPE                	     1.57	   $79.55	      ---	       --	016	0	1	0.00	    $0.00	Y	
K	57456	ENDOCERV CURETTAGE W/SCOPE              	     1.48	   $74.99	      ---	       --	016	0	1	0.00	    $0.00	Y	
X	57456	ENDOCERV CURETTAGE W/SCOPE              	   138.90	  $138.90	      ---	       --	009	0	1	0.00	    $0.00	Y	
X	57460	BX OF CERVIX W/SCOPE LEEP               	   292.89	  $292.89	      ---	       --	009	0	1	0.00	    $0.00	Y	
K	57460	BX OF CERVIX W/SCOPE LEEP               	     3.69	  $186.97	      ---	       --	016	0	1	0.00	    $0.00	Y	
K	57461	CONZ OF CERVIX W/SCOPE LEEP             	     5.57	  $282.23	      ---	       --	016	0	1	0.00	    $0.00	Y	
X	57461	CONZ OF CERVIX W/SCOPE LEEP             	   325.25	  $325.25	      ---	       --	009	0	1	0.00	    $0.00	Y	
X	57465	CAM CERVIX UTERI DRG COLP               	    49.32	   $49.32	      ---	       --	009	0	1	0.00	    $0.00	Y	
K	57465	CAM CERVIX UTERI DRG COLP               	     0.97	   $49.15	      ---	       --	016	0	1	0.00	    $0.00	Y	
K	57500	BIOPSY OF CERVIX                        	     0.80	   $40.54	      ---	       --	016	0	1	0.00	    $0.00	Y	
X	57500	BIOPSY OF CERVIX                        	   143.89	  $143.89	      ---	       --	009	0	1	0.00	    $0.00	Y	
X	57505	ENDOCERVICAL CURETTAGE                  	   145.19	  $145.19	      ---	       --	009	0	1	0.00	    $0.00	Y	
K	57505	ENDOCERVICAL CURETTAGE                  	     1.00	   $50.67	      ---	       --	016	0	1	0.00	    $0.00	Y	
K	57510	CAUTERIZATION OF CERVIX                 	     1.67	   $84.62	      ---	       --	016	0	1	0.00	    $0.00	Y	
X	57510	CAUTERIZATION OF CERVIX                 	   153.85	  $153.85	      ---	       --	009	0	1	0.00	    $0.00	Y	
X	57511	CRYOCAUTERY OF CERVIX                   	   184.97	  $184.97	      ---	       --	009	0	1	0.00	    $0.00	Y	
K	57511	CRYOCAUTERY OF CERVIX                   	     1.42	   $71.95	      ---	       --	016	0	1	0.00	    $0.00	Y	
K	57513	LASER SURGERY OF CERVIX                 	     4.34	  $219.91	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	57513	LASER SURGERY OF CERVIX                 	   219.91	  $219.91	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	57520	CONIZATION OF CERVIX                    	   324.05	  $324.05	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	57520	CONIZATION OF CERVIX                    	     5.09	  $257.91	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57522	CONIZATION OF CERVIX                    	     4.43	  $224.47	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	57522	CONIZATION OF CERVIX                    	   277.68	  $277.68	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	57530	REMOVAL OF CERVIX                       	   338.58	  $338.58	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	57530	REMOVAL OF CERVIX                       	     1.04	   $52.70	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57530	REMOVAL OF CERVIX                       	     5.20	  $263.48	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57531	REMOVAL OF CERVIX RADICAL               	    29.94	 $1517.06	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	57531	REMOVAL OF CERVIX RADICAL               	     5.99	  $303.51	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	57531	REMOVAL OF CERVIX RADICAL               	  1573.52	 $1573.52	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	57540	REMOVAL OF RESIDUAL CERVIX              	   705.81	  $705.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	57540	REMOVAL OF RESIDUAL CERVIX              	     2.40	  $121.61	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57540	REMOVAL OF RESIDUAL CERVIX              	    12.00	  $608.04	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57545	REMOVE CERVIX/REPAIR PELVIS             	    13.16	  $666.82	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	57545	REMOVE CERVIX/REPAIR PELVIS             	     2.63	  $133.26	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	57545	REMOVE CERVIX/REPAIR PELVIS             	   742.65	  $742.65	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	57550	REMOVAL OF RESIDUAL CERVIX              	   608.04	  $608.04	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	57550	REMOVAL OF RESIDUAL CERVIX              	     2.40	  $121.61	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57550	REMOVAL OF RESIDUAL CERVIX              	    12.00	  $608.04	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57555	REMOVE CERVIX/REPAIR VAGINA             	    14.50	  $734.72	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	57555	REMOVE CERVIX/REPAIR VAGINA             	     2.90	  $146.94	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	57555	REMOVE CERVIX/REPAIR VAGINA             	   734.72	  $734.72	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	57556	REMOVE CERVIX REPAIR BOWEL              	   734.72	  $734.72	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	57556	REMOVE CERVIX REPAIR BOWEL              	     2.90	  $146.94	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57556	REMOVE CERVIX REPAIR BOWEL              	    14.50	  $734.72	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57558	D&C OF CERVICAL STUMP                   	     4.00	  $202.68	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	57558	D&C OF CERVICAL STUMP                   	   202.68	  $202.68	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	57700	REVISION OF CERVIX                      	   326.74	  $326.74	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	57700	REVISION OF CERVIX                      	     1.20	   $60.80	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57700	REVISION OF CERVIX                      	     6.00	  $304.02	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	57720	REVISION OF CERVIX                      	     6.00	  $304.02	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	57720	REVISION OF CERVIX                      	     1.20	   $60.80	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	57720	REVISION OF CERVIX                      	   304.02	  $304.02	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	57800	DILATION OF CERVICAL CANAL              	    71.76	   $71.76	      ---	       --	009	0	1	0.00	    $0.00	Y	
K	57800	DILATION OF CERVICAL CANAL              	     0.68	   $34.46	      ---	       --	016	0	1	0.00	    $0.00	Y	
K	58100	BIOPSY OF UTERUS LINING                 	     0.81	   $41.04	      ---	       --	016	0	1	0.00	    $0.00	Y	
X	58100	BIOPSY OF UTERUS LINING                 	    93.00	   $93.00	      ---	       --	009	0	1	0.00	    $0.00	Y	
X	58110	BX DONE W/COLPOSCOPY ADD-ON             	    44.57	   $44.57	      ---	       --	009	1	1	0.00	    $0.00	Y	
O	58110	BX DONE W/COLPOSCOPY ADD-ON             	     0.17	    $8.61	      ---	       --	016	1	1	0.00	    $0.00	Y	
K	58110	BX DONE W/COLPOSCOPY ADD-ON             	     0.85	   $43.07	      ---	       --	016	1	1	0.00	    $0.00	Y	
K	58120	DILATION AND CURETTAGE                  	     4.40	  $222.95	      ---	       --	016	0	1	0.00	    $0.00	Y	
X	58120	DILATION AND CURETTAGE                  	   272.38	  $272.38	      ---	       --	009	0	1	0.00	    $0.00	Y	
X	58140	MYOMECTOMY ABDOM METHOD                 	   829.48	  $829.48	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	58140	MYOMECTOMY ABDOM METHOD                 	     2.80	  $141.88	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58140	MYOMECTOMY ABDOM METHOD                 	    14.00	  $709.38	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58145	MYOMECTOMY VAG METHOD                   	     7.36	  $372.93	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	58145	MYOMECTOMY VAG METHOD                   	     1.47	   $74.48	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58145	MYOMECTOMY VAG METHOD                   	   509.19	  $509.19	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	58146	MYOMECTOMY ABDOM COMPLEX                	  1023.47	 $1023.47	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	58146	MYOMECTOMY ABDOM COMPLEX                	     2.38	  $120.59	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58146	MYOMECTOMY ABDOM COMPLEX                	    11.92	  $603.99	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58150	TOTAL HYSTERECTOMY                      	    16.00	  $810.72	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	58150	TOTAL HYSTERECTOMY                      	     3.20	  $162.14	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58150	TOTAL HYSTERECTOMY                      	   899.16	  $899.16	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	58152	TOTAL HYSTERECTOMY                      	  1096.00	 $1096.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	58152	TOTAL HYSTERECTOMY                      	     3.80	  $192.55	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58152	TOTAL HYSTERECTOMY                      	    19.10	  $967.80	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58180	PARTIAL HYSTERECTOMY                    	    16.00	  $810.72	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	58180	PARTIAL HYSTERECTOMY                    	     3.20	  $162.14	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58180	PARTIAL HYSTERECTOMY                    	   849.86	  $849.86	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	58200	EXTENSIVE HYSTERECTOMY                  	  1190.55	 $1190.55	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	58200	EXTENSIVE HYSTERECTOMY                  	     4.09	  $207.24	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58200	EXTENSIVE HYSTERECTOMY                  	    20.47	 $1037.21	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58210	EXTENSIVE HYSTERECTOMY                  	    30.00	 $1520.10	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	58210	EXTENSIVE HYSTERECTOMY                  	     6.00	  $304.02	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58210	EXTENSIVE HYSTERECTOMY                  	  1611.86	 $1611.86	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	58240	REMOVAL OF PELVIS CONTENTS              	  2595.46	 $2595.46	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	58240	REMOVAL OF PELVIS CONTENTS              	     7.19	  $364.32	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58240	REMOVAL OF PELVIS CONTENTS              	    35.97	 $1822.60	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58260	VAGINAL HYSTERECTOMY                    	    16.00	  $810.72	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	58260	VAGINAL HYSTERECTOMY                    	     3.20	  $162.14	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58260	VAGINAL HYSTERECTOMY                    	   810.72	  $810.72	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	58262	VAG HYST INCLUDING T/O                  	   824.23	  $824.23	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	58262	VAG HYST INCLUDING T/O                  	     3.19	  $161.64	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58262	VAG HYST INCLUDING T/O                  	    15.94	  $807.68	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58263	VAG HYST W/T/O & VAG REPAIR             	    17.02	  $862.40	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	58263	VAG HYST W/T/O & VAG REPAIR             	     3.40	  $172.28	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58263	VAG HYST W/T/O & VAG REPAIR             	   883.23	  $883.23	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	58267	VAG HYST W/URINARY REPAIR               	  1053.94	 $1053.94	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	58267	VAG HYST W/URINARY REPAIR               	     4.20	  $212.81	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58267	VAG HYST W/URINARY REPAIR               	    20.80	 $1053.94	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58270	VAG HYST W/ENTEROCELE REPAIR            	    17.40	  $881.66	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	58270	VAG HYST W/ENTEROCELE REPAIR            	     3.50	  $177.35	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58270	VAG HYST W/ENTEROCELE REPAIR            	   881.66	  $881.66	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	58275	HYSTERECTOMY/REVISE VAGINA              	   912.06	  $912.06	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	58275	HYSTERECTOMY/REVISE VAGINA              	     3.60	  $182.41	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58275	HYSTERECTOMY/REVISE VAGINA              	    18.00	  $912.06	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58280	HYSTERECTOMY/REVISE VAGINA              	    18.00	  $912.06	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	58280	HYSTERECTOMY/REVISE VAGINA              	     3.60	  $182.41	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58280	HYSTERECTOMY/REVISE VAGINA              	   941.60	  $941.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	58285	EXTENSIVE HYSTERECTOMY                  	  1262.15	 $1262.15	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	58285	EXTENSIVE HYSTERECTOMY                  	     4.80	  $243.22	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58285	EXTENSIVE HYSTERECTOMY                  	    24.00	 $1216.08	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58290	VAG HYST COMPLEX                        	    11.81	  $598.41	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	58290	VAG HYST COMPLEX                        	     2.36	  $119.58	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58290	VAG HYST COMPLEX                        	  1020.22	 $1020.22	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	58291	VAG HYST INCL T/O COMPLEX               	  1101.64	 $1101.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	58291	VAG HYST INCL T/O COMPLEX               	     2.59	  $131.24	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58291	VAG HYST INCL T/O COMPLEX               	    12.96	  $656.68	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58292	VAG HYST T/O & REPAIR COMPL             	    13.78	  $698.23	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	58292	VAG HYST T/O & REPAIR COMPL             	     2.76	  $139.85	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58292	VAG HYST T/O & REPAIR COMPL             	  1160.46	 $1160.46	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	58294	VAG HYST W/ENTEROCELE COMPL             	  1078.42	 $1078.42	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	58294	VAG HYST W/ENTEROCELE COMPL             	     2.53	  $128.20	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58294	VAG HYST W/ENTEROCELE COMPL             	    12.63	  $639.96	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58300	INSERT INTRAUTERINE DEVICE              	     3.32	  $168.22	      ---	       --	016	0	1	0.00	    $0.00	Y	
K	58301	REMOVE INTRAUTERINE DEVICE              	     0.96	   $48.64	      ---	       --	016	0	1	0.00	    $0.00	Y	
K	58340	CATHETER FOR HYSTEROGRAPHY              	     3.66	  $185.45	      ---	       --	016	0	1	0.00	    $0.00	Y	
K	58346	INSERT HEYMAN UTERI CAPSULE             	     6.77	  $343.04	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58346	INSERT HEYMAN UTERI CAPSULE             	   453.19	  $453.19	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	58350	REOPEN FALLOPIAN TUBE                   	   144.92	  $144.92	      ---	       --	009	0	1	0.00	    $0.00	Y	
K	58350	REOPEN FALLOPIAN TUBE                   	     1.13	   $57.26	      ---	       --	016	0	1	0.00	    $0.00	Y	
K	58353	ENDOMETR ABLATE THERMAL                 	    21.07	 $1067.62	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58353	ENDOMETR ABLATE THERMAL                 	  1067.62	 $1067.62	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	58356	ENDOMETRIAL CRYOABLATION                	  2334.87	 $2334.87	      ---	       --	009	1	1	0.00	    $0.00	Y	
O	58356	ENDOMETRIAL CRYOABLATION                	     9.22	  $467.18	      ---	       --	016	1	1	0.00	    $0.00	Y	
K	58356	ENDOMETRIAL CRYOABLATION                	    46.08	 $2334.87	      ---	       --	016	1	1	0.00	    $0.00	Y	
K	58520	REPAIR OF RUPTURED UTERUS               	    12.00	  $608.04	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	58520	REPAIR OF RUPTURED UTERUS               	     2.40	  $121.61	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58520	REPAIR OF RUPTURED UTERUS               	   712.74	  $712.74	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	58541	LSH UTERUS 250 G OR LESS                	   710.90	  $710.90	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	58541	LSH UTERUS 250 G OR LESS                	     2.81	  $142.38	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58541	LSH UTERUS 250 G OR LESS                	    14.03	  $710.90	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58542	LSH W/T/O UT 250 G OR LESS              	    13.79	  $698.74	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	58542	LSH W/T/O UT 250 G OR LESS              	     3.75	  $190.01	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58542	LSH W/T/O UT 250 G OR LESS              	   739.45	  $739.45	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	58543	LSH UTERUS ABOVE 250 G                  	   800.08	  $800.08	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	58543	LSH UTERUS ABOVE 250 G                  	     3.16	  $160.12	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58543	LSH UTERUS ABOVE 250 G                  	    15.79	  $800.08	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58544	LSH W/T/O UTERUS ABOVE 250 G            	    17.09	  $865.95	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	58544	LSH W/T/O UTERUS ABOVE 250 G            	     3.42	  $173.29	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58544	LSH W/T/O UTERUS ABOVE 250 G            	   865.95	  $865.95	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	58545	LAPAROSCOPIC MYOMECTOMY                 	   798.74	  $798.74	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	58545	LAPAROSCOPIC MYOMECTOMY                 	     1.86	   $94.25	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58545	LAPAROSCOPIC MYOMECTOMY                 	     9.32	  $472.24	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58546	LAPARO-MYOMECTOMY COMPLEX               	     7.50	  $380.03	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	58546	LAPARO-MYOMECTOMY COMPLEX               	     1.50	   $76.01	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58546	LAPARO-MYOMECTOMY COMPLEX               	   984.88	  $984.88	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	58548	LAP RADICAL HYST                        	  1667.20	 $1667.20	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	58548	LAP RADICAL HYST                        	     5.97	  $302.50	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58548	LAP RADICAL HYST                        	    29.87	 $1513.51	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58550	LAPARO-ASST VAG HYSTERECTOMY            	    11.54	  $584.73	      ---	       --	016	1	0	0.00	    $0.00	Y	
O	58550	LAPARO-ASST VAG HYSTERECTOMY            	     2.17	  $109.95	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58550	LAPARO-ASST VAG HYSTERECTOMY            	   783.50	  $783.50	      ---	       --	009	1	0	0.00	    $0.00	Y	
X	58552	LAPARO-VAG HYST INCL T/O                	   870.81	  $870.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	58552	LAPARO-VAG HYST INCL T/O                	     2.29	  $116.03	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58552	LAPARO-VAG HYST INCL T/O                	    12.17	  $616.65	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58553	LAPARO-VAG HYST COMPLEX                 	    14.02	  $710.39	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	58553	LAPARO-VAG HYST COMPLEX                 	     2.64	  $133.77	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58553	LAPARO-VAG HYST COMPLEX                 	   990.14	  $990.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	58554	LAPARO-VAG HYST W/T/O COMPL             	  1152.61	 $1152.61	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	58554	LAPARO-VAG HYST W/T/O COMPL             	     2.89	  $146.44	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58554	LAPARO-VAG HYST W/T/O COMPL             	    15.32	  $776.26	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58555	HYSTEROSCOPY DX SEP PROC                	     3.18	  $161.13	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58558	HYSTEROSCOPY BIOPSY                     	     3.46	  $175.32	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58558	HYSTEROSCOPY BIOPSY                     	  1278.35	 $1278.35	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	58559	HYSTEROSCOPY LYSIS                      	   262.98	  $262.98	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	58559	HYSTEROSCOPY LYSIS                      	     5.19	  $262.98	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58560	HYSTEROSCOPY RESECT SEPTUM              	     5.42	  $274.63	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58560	HYSTEROSCOPY RESECT SEPTUM              	   274.63	  $274.63	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	58560	HYSTEROSCOPY RESECT SEPTUM              	     1.09	   $55.23	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58561	HYSTEROSCOPY REMOVE MYOMA               	   380.53	  $380.53	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	58561	HYSTEROSCOPY REMOVE MYOMA               	     7.51	  $380.53	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58562	HYSTEROSCOPY REMOVE FB                  	     3.60	  $182.41	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58562	HYSTEROSCOPY REMOVE FB                  	   401.81	  $401.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	58563	HYSTEROSCOPY ABLATION                   	  2043.34	 $2043.34	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	58563	HYSTEROSCOPY ABLATION                   	    33.55	 $1699.98	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58565	HYSTEROSCOPY STERILIZATION              	    14.56	  $737.76	      ---	       --	016	1	0	0.00	    $0.00	Y	
K	58570	TLH UTERUS 250 G OR LESS                	    13.47	  $682.52	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58570	TLH UTERUS 250 G OR LESS                	   719.17	  $719.17	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	58570	TLH UTERUS 250 G OR LESS                	     2.69	  $136.30	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	58571	TLH W/T/O 250 G OR LESS                 	     2.95	  $149.48	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58571	TLH W/T/O 250 G OR LESS                 	   807.81	  $807.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	58571	TLH W/T/O 250 G OR LESS                 	    14.77	  $748.40	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58572	TLH UTERUS OVER 250 G                   	    16.71	  $846.70	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58572	TLH UTERUS OVER 250 G                   	   920.96	  $920.96	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	58572	TLH UTERUS OVER 250 G                   	     3.34	  $169.24	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	58573	TLH W/T/O UTERUS OVER 250 G             	     3.78	  $191.53	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58573	TLH W/T/O UTERUS OVER 250 G             	  1078.58	 $1078.58	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	58573	TLH W/T/O UTERUS OVER 250 G             	    18.88	  $956.65	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58575	LAPS TOT HYST RESJ MAL                  	    31.44	 $1593.06	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58575	LAPS TOT HYST RESJ MAL                  	  1710.98	 $1710.98	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	58575	LAPS TOT HYST RESJ MAL                  	     6.28	  $318.21	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58578	UNLISTED LAPS PX UTERUS                 	     0.00	    $0.00	      ---	       --	016	1	0	0.00	    $0.00	Y	
K	58579	UNLISTED HYSTSC PX UTERUS               	     0.00	    $0.00	      ---	       --	016	1	0	0.00	    $0.00	Y	
K	58580	TRANSCRV ABLTJ UTRN FIBRD RF            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	58600	DIVISION OF FALLOPIAN TUBE              	    13.59	  $757.51	      ---	       --	054	0	0	0.00	    $0.00	Y	
O	58600	DIVISION OF FALLOPIAN TUBE              	     2.72	  $151.61	      ---	       --	054	0	0	0.00	    $0.00	Y	
O	58605	DIVISION OF FALLOPIAN TUBE              	     1.59	   $88.63	      ---	       --	054	0	0	0.00	    $0.00	Y	
K	58605	DIVISION OF FALLOPIAN TUBE              	     7.93	  $442.02	      ---	       --	054	0	0	0.00	    $0.00	Y	
K	58611	LIGATE OVIDUCT(S) ADD-ON                	     0.89	   $49.61	      ---	       --	054	1	0	0.00	    $0.00	Y	
O	58611	LIGATE OVIDUCT(S) ADD-ON                	     0.18	   $10.03	      ---	       --	054	0	0	0.00	    $0.00	Y	
O	58615	OCCLUDE FALLOPIAN TUBE(S)               	     2.00	  $111.48	      ---	       --	054	0	0	0.00	    $0.00	Y	
K	58615	OCCLUDE FALLOPIAN TUBE(S)               	    10.00	  $557.40	      ---	       --	054	0	0	0.00	    $0.00	Y	
K	58660	LAPAROSCOPY LYSIS                       	     7.54	  $280.71	      ---	  $354.00	004	1	0	0.00	    $0.00	Y	
O	58660	LAPAROSCOPY LYSIS                       	     1.51	   $56.22	      ---	   $70.89	004	1	0	0.00	    $0.00	Y	
X	58660	LAPAROSCOPY LYSIS                       	   602.32	  $602.32	      ---	       --	009	1	0	0.00	    $0.00	Y	
O	58661	LAPAROSCOPY REMOVE ADNEXA               	     1.93	   $97.79	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58661	LAPAROSCOPY REMOVE ADNEXA               	     9.65	  $488.97	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58662	LAPAROSCOPY EXCISE LESIONS              	     8.21	  $305.66	      ---	  $385.46	004	1	0	0.00	    $0.00	Y	
O	58662	LAPAROSCOPY EXCISE LESIONS              	     1.64	   $61.06	      ---	   $77.00	004	1	0	0.00	    $0.00	Y	
X	58662	LAPAROSCOPY EXCISE LESIONS              	   632.08	  $632.08	      ---	       --	009	1	0	0.00	    $0.00	Y	
K	58670	LAPAROSCOPY TUBAL CAUTERY               	     7.56	  $421.39	      ---	       --	054	0	0	0.00	    $0.00	Y	
K	58671	LAPAROSCOPY TUBAL BLOCK                 	     8.00	  $445.92	      ---	       --	054	0	0	0.00	    $0.00	Y	
K	58674	LAPS ABLTJ UTERINE FIBROIDS             	    18.77	  $698.81	      ---	       --	004	0	0	0.00	    $0.00	Y	
X	58674	LAPS ABLTJ UTERINE FIBROIDS             	   722.21	  $722.21	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	58674	LAPS ABLTJ UTERINE FIBROIDS             	     3.75	  $139.61	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	58679	UNLISTED LAPS PX OVIDCT OVRY            	     0.00	    $0.00	      ---	       --	016	1	0	0.00	    $0.00	Y	
K	58679	UNLISTED LAPS PX OVIDCT OVRY            	     0.00	    $0.00	      ---	       --	016	1	0	0.00	    $0.00	Y	
K	58700	REMOVAL OF FALLOPIAN TUBE               	    12.00	  $608.04	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	58700	REMOVAL OF FALLOPIAN TUBE               	     2.40	  $121.61	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	58720	REMOVAL OF OVARY/TUBE(S)                	     2.40	  $121.61	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58720	REMOVAL OF OVARY/TUBE(S)                	   676.11	  $676.11	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	58720	REMOVAL OF OVARY/TUBE(S)                	    12.00	  $608.04	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58740	ADHESIOLYSIS TUBE OVARY                 	    14.00	  $709.38	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58740	ADHESIOLYSIS TUBE OVARY                 	   801.18	  $801.18	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	58740	ADHESIOLYSIS TUBE OVARY                 	     2.80	  $141.88	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58800	DRAINAGE OF OVARIAN CYST(S)             	   331.27	  $331.27	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	58800	DRAINAGE OF OVARIAN CYST(S)             	     4.53	  $229.54	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58805	DRAINAGE OF OVARIAN CYST(S)             	    12.00	  $608.04	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58805	DRAINAGE OF OVARIAN CYST(S)             	   608.04	  $608.04	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	58805	DRAINAGE OF OVARIAN CYST(S)             	     2.40	  $121.61	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58820	DRAIN OVARY ABSCESS OPEN                	   307.97	  $307.97	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	58820	DRAIN OVARY ABSCESS OPEN                	     4.53	  $229.54	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58822	DRAIN OVARY ABSCESS PERCUT              	    12.00	  $608.04	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58822	DRAIN OVARY ABSCESS PERCUT              	   638.47	  $638.47	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	58822	DRAIN OVARY ABSCESS PERCUT              	     2.40	  $121.61	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	58900	BIOPSY OF OVARY(S)                      	     2.40	  $121.61	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58900	BIOPSY OF OVARY(S)                      	   608.04	  $608.04	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	58900	BIOPSY OF OVARY(S)                      	    12.00	  $608.04	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58920	PARTIAL REMOVAL OF OVARY(S)             	    12.00	  $608.04	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58920	PARTIAL REMOVAL OF OVARY(S)             	   637.79	  $637.79	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	58920	PARTIAL REMOVAL OF OVARY(S)             	     2.40	  $121.61	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	58925	REMOVAL OF OVARIAN CYST(S)              	     2.40	  $121.61	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58925	REMOVAL OF OVARIAN CYST(S)              	   682.74	  $682.74	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	58925	REMOVAL OF OVARIAN CYST(S)              	    12.00	  $608.04	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58940	REMOVAL OF OVARY(S)                     	    12.00	  $608.04	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58940	REMOVAL OF OVARY(S)                     	   608.04	  $608.04	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	58940	REMOVAL OF OVARY(S)                     	     2.40	  $121.61	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	58943	REMOVAL OF OVARY(S)                     	     3.53	  $178.87	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58943	REMOVAL OF OVARY(S)                     	  1039.38	 $1039.38	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	58943	REMOVAL OF OVARY(S)                     	    17.66	  $894.83	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58950	RESECT OVARIAN MALIGNANCY               	    14.91	  $755.49	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58950	RESECT OVARIAN MALIGNANCY               	  1026.87	 $1026.87	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	58950	RESECT OVARIAN MALIGNANCY               	     2.98	  $151.00	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	58951	RESECT OVARIAN MALIGNANCY               	     4.14	  $209.77	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58951	RESECT OVARIAN MALIGNANCY               	  1278.10	 $1278.10	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	58951	RESECT OVARIAN MALIGNANCY               	    20.68	 $1047.86	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58952	RESECT OVARIAN MALIGNANCY               	    23.50	 $1190.75	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58952	RESECT OVARIAN MALIGNANCY               	  1461.15	 $1461.15	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	58952	RESECT OVARIAN MALIGNANCY               	     4.70	  $238.15	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	58953	TAH RAD DISSECT FOR DEBULK              	     6.08	  $308.07	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58953	TAH RAD DISSECT FOR DEBULK              	  1770.15	 $1770.15	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	58953	TAH RAD DISSECT FOR DEBULK              	    30.40	 $1540.37	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58954	TAH RAD DEBULK/LYMPH REMOVE             	    33.04	 $1674.14	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58954	TAH RAD DEBULK/LYMPH REMOVE             	  1912.75	 $1912.75	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	58954	TAH RAD DEBULK/LYMPH REMOVE             	     6.61	  $334.93	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	58956	BSO OMENTECTOMY W/TAH                   	     2.96	  $149.98	      ---	       --	016	1	0	0.00	    $0.00	Y	
X	58956	BSO OMENTECTOMY W/TAH                   	  1205.29	 $1205.29	      ---	       --	009	1	0	0.00	    $0.00	Y	
K	58956	BSO OMENTECTOMY W/TAH                   	    14.78	  $748.90	      ---	       --	016	1	0	0.00	    $0.00	Y	
K	58958	RESC RECR OVR TBL PP UTR MAL            	    26.70	 $1352.89	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58958	RESC RECR OVR TBL PP UTR MAL            	  1467.57	 $1467.57	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	58958	RESC RECR OVR TBL PP UTR MAL            	     5.34	  $270.58	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	58960	EXPLORATION OF ABDOMEN                  	     2.86	  $144.92	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	58960	EXPLORATION OF ABDOMEN                  	   887.42	  $887.42	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	58960	EXPLORATION OF ABDOMEN                  	    14.31	  $725.09	      ---	       --	016	0	0	0.00	    $0.00	Y	
K	58999	UNLISTED PX FML GENITAL SYS             	     0.00	    $0.00	      ---	       --	016	0	0	0.00	    $0.00	Y	
O	58999	UNLISTED PX FML GENITAL SYS             	     0.00	    $0.00	      ---	       --	016	0	0	0.00	    $0.00	Y	
X	59000	AMNIOCENTESIS DIAGNOSTIC                	   104.75	  $104.75	      ---	       --	009	0	1	0.00	    $0.00	Y	
K	59000	AMNIOCENTESIS DIAGNOSTIC                	     1.13	   $57.26	      ---	       --	040	0	1	0.00	    $0.00	Y	
K	59001	AMNIOCENTESIS THERAPEUTIC               	     2.76	  $139.85	      ---	       --	040	0	1	0.00	    $0.00	Y	
X	59001	AMNIOCENTESIS THERAPEUTIC               	   151.70	  $151.70	      ---	       --	009	0	1	0.00	    $0.00	Y	
X	59012	FETAL CORD PUNCTURE PRENATAL            	   171.10	  $171.10	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	59012	FETAL CORD PUNCTURE PRENATAL            	     2.96	  $149.98	      ---	       --	040	0	0	0.00	    $0.00	Y	
K	59015	CHORION BIOPSY                          	     2.19	  $110.97	      ---	       --	040	1	0	0.00	    $0.00	Y	
X	59015	CHORION BIOPSY                          	   137.76	  $137.76	      ---	       --	009	1	0	0.00	    $0.00	Y	
O	59015	CHORION BIOPSY                          	     0.44	   $22.29	      ---	       --	040	1	0	0.00	    $0.00	Y	
X	59020	FETAL CONTRACT STRESS TEST              	    63.55	   $63.55	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	59020	FETAL CONTRACT STRESS TEST              	     1.00	   $50.67	      ---	       --	040	0	0	0.20	    $0.00	Y	
K	59025	FETAL NON-STRESS TEST                   	     0.45	   $22.80	      ---	       --	040	0	0	0.40	    $0.00	Y	
X	59025	FETAL NON-STRESS TEST                   	    43.87	   $43.87	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	59030	FETAL SCALP BLOOD SAMPLING              	    95.01	   $95.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	59030	FETAL SCALP BLOOD SAMPLING              	     1.13	   $57.26	      ---	       --	040	0	0	0.00	    $0.00	Y	
K	59050	FETAL MONITOR W/REPORT                  	     1.60	   $81.07	      ---	       --	040	0	0	0.00	    $0.00	N	
X	59050	FETAL MONITOR W/REPORT                  	    81.07	   $81.07	      ---	       --	009	0	0	0.00	    $0.00	N	
X	59051	FETAL MONITOR/INTERPRET ONLY            	    74.48	   $74.48	      ---	       --	009	0	0	0.00	    $0.00	N	
K	59051	FETAL MONITOR/INTERPRET ONLY            	     1.47	   $74.48	      ---	       --	040	0	0	0.00	    $0.00	N	
K	59070	TRANSABDOM AMNIOINFUS W/US              	     6.54	  $331.38	      ---	       --	040	1	0	0.00	    $0.00	Y	
X	59070	TRANSABDOM AMNIOINFUS W/US              	   350.83	  $350.83	      ---	       --	009	1	0	0.00	    $0.00	Y	
X	59072	UMBILICAL CORD OCCLUD W/US              	   441.84	  $441.84	      ---	       --	009	1	0	0.00	    $0.00	Y	
K	59072	UMBILICAL CORD OCCLUD W/US              	     5.61	  $284.26	      ---	       --	040	1	0	0.00	    $0.00	Y	
K	59074	FETAL FLUID DRAINAGE W/US               	     6.20	  $314.15	      ---	       --	040	1	0	0.00	    $0.00	Y	
X	59074	FETAL FLUID DRAINAGE W/US               	   335.79	  $335.79	      ---	       --	009	1	0	0.00	    $0.00	Y	
X	59076	FETAL SHUNT PLACEMENT W/US              	   441.84	  $441.84	      ---	       --	009	1	0	0.00	    $0.00	Y	
K	59076	FETAL SHUNT PLACEMENT W/US              	     5.61	  $284.26	      ---	       --	040	1	0	0.00	    $0.00	Y	
K	59100	REMOVE UTERUS LESION                    	    14.00	  $709.38	      ---	       --	040	0	0	0.00	    $0.00	Y	
X	59100	REMOVE UTERUS LESION                    	   743.12	  $743.12	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	59100	REMOVE UTERUS LESION                    	     2.80	  $141.88	      ---	       --	040	0	0	0.00	    $0.00	Y	
O	59120	TREAT ECTOPIC PREGNANCY                 	     2.80	  $141.88	      ---	       --	040	0	0	0.00	    $0.00	Y	
X	59120	TREAT ECTOPIC PREGNANCY                 	   709.86	  $709.86	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	59120	TREAT ECTOPIC PREGNANCY                 	    14.00	  $709.38	      ---	       --	040	0	0	0.00	    $0.00	Y	
K	59121	TREAT ECTOPIC PREGNANCY                 	    14.00	  $709.38	      ---	       --	040	0	0	0.00	    $0.00	Y	
X	59121	TREAT ECTOPIC PREGNANCY                 	   709.74	  $709.74	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	59121	TREAT ECTOPIC PREGNANCY                 	     2.80	  $141.88	      ---	       --	040	0	0	0.00	    $0.00	Y	
O	59130	TREAT ECTOPIC PREGNANCY                 	     2.74	  $138.84	      ---	       --	040	0	0	0.00	    $0.00	Y	
X	59130	TREAT ECTOPIC PREGNANCY                 	   821.90	  $821.90	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	59130	TREAT ECTOPIC PREGNANCY                 	    13.68	  $693.17	      ---	       --	040	0	0	0.00	    $0.00	Y	
K	59136	TREAT ECTOPIC PREGNANCY                 	    16.60	  $841.12	      ---	       --	040	0	0	0.00	    $0.00	Y	
X	59136	TREAT ECTOPIC PREGNANCY                 	   841.12	  $841.12	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	59136	TREAT ECTOPIC PREGNANCY                 	     3.32	  $168.22	      ---	       --	040	0	0	0.00	    $0.00	Y	
O	59140	TREAT ECTOPIC PREGNANCY                 	     1.18	   $59.79	      ---	       --	040	0	0	0.00	    $0.00	Y	
X	59140	TREAT ECTOPIC PREGNANCY                 	   367.13	  $367.13	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	59140	TREAT ECTOPIC PREGNANCY                 	     5.88	  $297.94	      ---	       --	040	0	0	0.00	    $0.00	Y	
K	59150	TREAT ECTOPIC PREGNANCY                 	     7.60	  $385.09	      ---	       --	040	0	0	0.00	    $0.00	Y	
X	59150	TREAT ECTOPIC PREGNANCY                 	   688.93	  $688.93	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	59151	TREAT ECTOPIC PREGNANCY                 	   673.79	  $673.79	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	59151	TREAT ECTOPIC PREGNANCY                 	     7.84	  $397.25	      ---	       --	040	0	0	0.00	    $0.00	Y	
K	59160	D & C AFTER DELIVERY                    	     4.00	  $202.68	      ---	       --	040	0	0	0.00	    $0.00	Y	
X	59160	D & C AFTER DELIVERY                    	   248.64	  $248.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	59300	EPISIOTOMY OR VAGINAL REPAIR            	   208.18	  $208.18	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	59300	EPISIOTOMY OR VAGINAL REPAIR            	     0.61	   $22.71	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	59320	REVISION OF CERVIX                      	     2.11	  $106.91	      ---	       --	040	0	0	0.00	    $0.00	Y	
X	59320	REVISION OF CERVIX                      	   129.38	  $129.38	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	59320	REVISION OF CERVIX                      	     0.42	   $21.28	      ---	       --	040	0	0	0.00	    $0.00	Y	
O	59325	REVISION OF CERVIX                      	     0.87	   $44.08	      ---	       --	040	0	0	0.00	    $0.00	Y	
X	59325	REVISION OF CERVIX                      	   219.91	  $219.91	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	59325	REVISION OF CERVIX                      	     4.34	  $219.91	      ---	       --	040	0	0	0.00	    $0.00	Y	
K	59350	REPAIR OF UTERUS                        	    13.80	  $699.25	      ---	       --	040	0	0	0.00	    $0.00	Y	
X	59350	REPAIR OF UTERUS                        	   699.25	  $699.25	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	59350	REPAIR OF UTERUS                        	     2.80	  $141.88	      ---	       --	040	0	0	0.00	    $0.00	Y	
X	59400	OBSTETRICAL CARE                        	  2091.21	 $2091.21	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	59400	OBSTETRICAL CARE                        	    11.57	 $1390.14	      ---	       --	034	0	0	0.00	    $0.00	Y	
K	59409	OBSTETRICAL CARE                        	     4.53	  $544.28	      ---	       --	034	0	0	0.00	    $0.00	Y	
X	59409	OBSTETRICAL CARE                        	   685.07	  $685.07	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	59409	OBSTETRICAL CARE                        	     1.55	  $186.23	      ---	       --	034	0	0	0.00	    $0.00	Y	
N	59409	OBSTETRICAL CARE                        	     4.53	  $544.28	      ---	       --	034	0	0	0.00	    $0.00	Y	
K	59412	ANTEPARTUM MANIPULATION                 	     0.00	    $0.00	      ---	       --	034	1	0	0.00	    $0.00	N	
K	59414	DELIVER PLACENTA                        	     0.74	   $88.91	      ---	       --	034	0	0	0.00	    $0.00	Y	
O	59414	DELIVER PLACENTA                        	     0.15	   $18.02	      ---	       --	034	0	0	0.00	    $0.00	Y	
X	59414	DELIVER PLACENTA                        	    88.91	   $88.91	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	59510	CESARIAN DELIVERY                       	  2297.54	 $2297.54	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	59510	CESAREAN DELIVERY                       	    16.93	 $1390.97	      ---	       --	003	0	0	0.00	    $0.00	Y	
K	59514	CESAREAN DELIVERY ONLY                  	     6.63	  $544.72	      ---	       --	003	0	0	0.00	    $0.00	Y	
X	59514	CESAREAN DELIVERY ONLY                  	   771.01	  $771.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	59514	CESAREAN DELIVERY ONLY                  	     2.27	  $186.50	      ---	       --	003	0	0	0.00	    $0.00	Y	
O	59525	REMOVE UTERUS AFTER CESAREAN            	     0.45	   $36.97	      ---	       --	003	0	0	0.00	    $0.00	Y	
X	59525	REMOVE UTERUS AFTER CESAREAN            	   407.28	  $407.28	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	59525	REMOVE UTERUS AFTER CESAREAN            	     2.91	  $239.09	      ---	       --	003	0	0	0.00	    $0.00	Y	
K	59610	VBAC DELIVERY                           	    11.57	 $1390.14	      ---	       --	034	0	0	0.00	    $0.00	Y	
X	59610	VBAC DELIVERY                           	  2173.65	 $2173.65	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	59612	VBAC DELIVERY ONLY                      	   768.69	  $768.69	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	59612	VBAC DELIVERY ONLY                      	     1.55	  $186.23	      ---	       --	034	0	0	0.00	    $0.00	Y	
N	59612	VBAC DELIVERY ONLY                      	     4.53	  $544.28	      ---	       --	034	0	0	0.00	    $0.00	Y	
K	59612	VBAC DELIVERY ONLY                      	     4.53	  $544.28	      ---	       --	034	0	0	0.00	    $0.00	Y	
K	59618	ATTEMPTED VBAC DELIVERY                 	    16.93	 $1390.97	      ---	       --	003	0	0	0.00	    $0.00	Y	
X	59618	*96 ATT VAG DEL,CSECT DEL, ROUTINE OB   	  2320.13	 $2320.13	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	59620	ATTEMPTED VBAC DELIVERY ONLY            	   795.73	  $795.73	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	59620	ATTEMPTED VBAC DELIVERY ONLY            	     6.63	  $544.72	      ---	       --	003	0	0	0.00	    $0.00	Y	
O	59620	ATTEMPTED VBAC DELIVERY ONLY            	     2.27	  $186.50	      ---	       --	003	0	0	0.00	    $0.00	Y	
K	59620	ATTEMPTED VBAC DELIVERY ONLY            	     6.63	  $544.72	      ---	       --	003	0	0	0.00	    $0.00	Y	
K	59812	TREATMENT OF MISCARRIAGE                	     4.53	  $168.65	      ---	       --	035	0	0	0.00	    $0.00	Y	
X	59812	TREATMENT OF MISCARRIAGE                	   324.38	  $324.38	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	59820	CARE OF MISCARRIAGE                     	   396.16	  $396.16	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	59820	CARE OF MISCARRIAGE                     	     4.53	  $168.65	      ---	       --	035	0	0	0.00	    $0.00	Y	
K	59821	TREATMENT OF MISCARRIAGE                	     4.53	  $168.65	      ---	       --	035	0	0	0.00	    $0.00	Y	
X	59821	TREATMENT OF MISCARRIAGE                	   388.32	  $388.32	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	59830	TREAT UTERUS INFECTION                  	   408.33	  $408.33	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	59830	TREAT UTERUS INFECTION                  	     8.50	  $316.46	      ---	       --	035	0	0	0.00	    $0.00	Y	
K	59840	INDUCED ABORTION D&C                    	     9.52	  $250.85	      ---	       --	020	0	1	0.00	    $0.00	Y	
N	59840	INDUCED ABORTION D&C                    	     9.52	  $250.85	      ---	       --	020	0	0	0.00	    $0.00	Y	
K	59841	INDUCED ABORTION DILAT&EVAC             	     9.52	  $354.43	      ---	       --	035	0	0	0.00	    $0.00	Y	
K	59850	INDUCED ABORTION 1+ NJX                 	     9.52	  $328.06	      ---	       --	014	0	0	0.00	    $0.00	Y	
K	59851	INDUCED ABORTION 1+NJX D&C              	     9.52	  $328.06	      ---	       --	014	0	0	0.00	    $0.00	Y	
K	59852	INDUCED ABORTION 1+NJX HYST             	    19.60	  $729.71	      ---	       --	035	0	0	0.00	    $0.00	Y	
O	59852	INDUCED ABORTION 1+NJX HYST             	     3.92	  $145.94	      ---	       --	035	0	0	0.00	    $0.00	Y	
K	59855	INDUCED ABORTION 1+VAG SUPP             	     8.23	  $283.61	      ---	       --	014	0	0	0.00	    $0.00	Y	
K	59856	INDUCED AB 1+VAG SUPP D&C               	    11.87	  $409.04	      ---	       --	014	0	0	0.00	    $0.00	Y	
K	59857	INDUCED AB 1+VAG SUPP HYST              	    22.16	  $825.02	      ---	       --	035	0	0	0.00	    $0.00	Y	
K	59870	EVACUATE MOLE OF UTERUS                 	     6.00	  $304.02	      ---	       --	040	0	0	0.00	    $0.00	Y	
X	59870	EVACUATE MOLE OF UTERUS                 	   479.39	  $479.39	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	59871	REMOVE CERCLAGE SUTURE                  	   134.78	  $134.78	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	59871	REMOVE CERCLAGE SUTURE                  	     0.53	   $26.86	      ---	       --	040	0	0	0.00	    $0.00	Y	
K	59871	REMOVE CERCLAGE SUTURE                  	     2.66	  $134.78	      ---	       --	040	0	0	0.00	    $0.00	Y	
K	59897	UNLISTED FETAL INVAS PX W/US            	     0.00	    $0.00	      ---	       --	040	1	0	0.00	    $0.00	Y	
O	59897	UNLISTED FETAL INVAS PX W/US            	     0.00	    $0.00	      ---	       --	040	1	0	0.00	    $0.00	Y	
O	59898	UNLSTD LAPS PX MAT CARE&DLVR            	     0.00	    $0.00	      ---	       --	040	1	0	0.00	    $0.00	Y	
K	59898	UNLSTD LAPS PX MAT CARE&DLVR            	     0.00	    $0.00	      ---	       --	040	1	0	0.00	    $0.00	Y	
K	59899	UNLISTED PX MAT CARE&DLVR               	     0.00	    $0.00	      ---	       --	040	0	0	0.00	    $0.00	Y	
O	59899	UNLISTED PX MAT CARE&DLVR               	     0.00	    $0.00	      ---	       --	040	0	0	0.00	    $0.00	Y	
K	60000	DRAIN THYROID/TONGUE CYST               	     1.82	   $67.76	      ---	   $85.45	004	1	1	0.00	    $0.00	Y	
K	60100	BIOPSY OF THYROID                       	     1.43	   $53.24	      ---	   $67.14	004	1	1	0.00	    $0.00	Y	
K	60200	REMOVE THYROID LESION                   	    10.76	  $400.59	      ---	  $505.18	004	1	0	0.00	    $0.00	Y	
O	60200	REMOVE THYROID LESION                   	     2.15	   $80.04	      ---	  $100.94	004	1	0	0.00	    $0.00	Y	
O	60210	PARTIAL THYROID EXCISION                	     3.03	  $112.81	      ---	  $142.26	004	1	0	0.00	    $0.00	Y	
K	60210	PARTIAL THYROID EXCISION                	    15.19	  $565.52	      ---	  $713.17	004	1	0	0.00	    $0.00	Y	
K	60212	PARTIAL THYROID EXCISION                	    19.66	  $731.94	      ---	  $923.04	004	1	0	0.00	    $0.00	Y	
O	60212	PARTIAL THYROID EXCISION                	     3.93	  $146.31	      ---	  $184.51	004	1	0	0.00	    $0.00	Y	
O	60220	PARTIAL REMOVAL OF THYROID              	     2.98	  $110.95	      ---	  $139.91	004	1	0	0.00	    $0.00	Y	
K	60220	PARTIAL REMOVAL OF THYROID              	    14.88	  $553.98	      ---	  $698.62	004	1	0	0.00	    $0.00	Y	
K	60225	PARTIAL REMOVAL OF THYROID              	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
O	60225	PARTIAL REMOVAL OF THYROID              	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
O	60240	REMOVAL OF THYROID                      	     3.62	  $134.77	      ---	  $169.96	004	1	0	0.00	    $0.00	Y	
K	60240	REMOVAL OF THYROID                      	    18.12	  $674.61	      ---	  $850.73	004	1	0	0.00	    $0.00	Y	
K	60252	REMOVAL OF THYROID                      	    25.06	  $932.98	      ---	 $1176.57	004	1	0	0.00	    $0.00	Y	
O	60252	REMOVAL OF THYROID                      	     5.01	  $186.52	      ---	  $235.22	004	1	0	0.00	    $0.00	Y	
O	60254	EXTENSIVE THYROID SURGERY               	     6.34	  $236.04	      ---	  $297.66	004	1	0	0.00	    $0.00	Y	
K	60254	EXTENSIVE THYROID SURGERY               	    31.71	 $1180.56	      ---	 $1488.78	004	1	0	0.00	    $0.00	Y	
K	60260	REPEAT THYROID SURGERY                  	    16.99	  $632.54	      ---	  $797.68	004	1	0	0.00	    $0.00	Y	
O	60260	REPEAT THYROID SURGERY                  	     3.40	  $126.58	      ---	  $159.63	004	1	0	0.00	    $0.00	Y	
O	60270	REMOVAL OF THYROID                      	     4.87	  $181.31	      ---	  $228.65	004	1	0	0.00	    $0.00	Y	
K	60270	REMOVAL OF THYROID                      	    24.46	  $910.65	      ---	 $1148.40	004	1	0	0.00	    $0.00	Y	
K	60271	REMOVAL OF THYROID                      	    21.23	  $790.39	      ---	  $996.75	004	1	0	0.00	    $0.00	Y	
O	60271	REMOVAL OF THYROID                      	     4.25	  $158.23	      ---	  $199.54	004	1	0	0.00	    $0.00	Y	
O	60280	REMOVE THYROID DUCT LESION              	     2.20	   $81.91	      ---	  $103.29	004	1	0	0.00	    $0.00	Y	
K	60280	REMOVE THYROID DUCT LESION              	    11.00	  $409.53	      ---	  $516.45	004	1	0	0.00	    $0.00	Y	
K	60281	REMOVE THYROID DUCT LESION              	    13.14	  $489.20	      ---	  $616.92	004	1	0	0.00	    $0.00	Y	
O	60281	REMOVE THYROID DUCT LESION              	     2.63	   $97.91	      ---	  $123.48	004	1	0	0.00	    $0.00	Y	
K	60300	ASPIR/INJ THYROID CYST                  	     2.26	   $84.14	      ---	  $106.11	004	1	0	0.00	    $0.00	Y	
K	60500	EXPLORE PARATHYROID GLANDS              	    20.39	  $759.12	      ---	  $957.31	004	1	0	0.00	    $0.00	Y	
O	60500	EXPLORE PARATHYROID GLANDS              	     4.08	  $151.90	      ---	  $191.56	004	1	0	0.00	    $0.00	Y	
O	60502	RE-EXPLORE PARATHYROIDS                 	     5.34	  $198.81	      ---	  $250.71	004	1	0	0.00	    $0.00	Y	
K	60502	RE-EXPLORE PARATHYROIDS                 	    26.72	  $994.79	      ---	 $1254.50	004	1	0	0.00	    $0.00	Y	
K	60505	EXPLORE PARATHYROID GLANDS              	    27.18	 $1011.91	      ---	 $1276.10	004	1	0	0.00	    $0.00	Y	
O	60505	EXPLORE PARATHYROID GLANDS              	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
O	60512	AUTOTRANSPLANT PARATHYROID              	     1.09	   $40.58	      ---	   $51.18	004	1	0	0.00	    $0.00	Y	
K	60512	AUTOTRANSPLANT PARATHYROID              	     5.45	  $202.90	      ---	  $255.88	004	1	0	0.00	    $0.00	Y	
K	60520	REMOVAL OF THYMUS GLAND                 	    20.39	  $759.12	      ---	  $957.31	004	1	0	0.00	    $0.00	Y	
O	60520	REMOVAL OF THYMUS GLAND                 	     4.08	  $151.90	      ---	  $191.56	004	1	0	0.00	    $0.00	Y	
O	60521	REMOVAL OF THYMUS GLAND                 	     5.09	  $189.50	      ---	  $238.98	004	1	0	0.00	    $0.00	Y	
K	60521	REMOVAL OF THYMUS GLAND                 	    25.40	  $945.64	      ---	 $1192.53	004	1	0	0.00	    $0.00	Y	
K	60522	REMOVAL OF THYMUS GLAND                 	    28.33	 $1054.73	      ---	 $1330.09	004	1	0	0.00	    $0.00	Y	
O	60522	REMOVAL OF THYMUS GLAND                 	     5.66	  $210.72	      ---	  $265.74	004	1	0	0.00	    $0.00	Y	
O	60540	EXPLORE ADRENAL GLAND                   	     4.30	  $160.09	      ---	  $201.89	004	1	0	0.00	    $0.00	Y	
K	60540	EXPLORE ADRENAL GLAND                   	    21.52	  $801.19	      ---	 $1010.36	004	1	0	0.00	    $0.00	Y	
K	60545	EXPLORE ADRENAL GLAND                   	    24.92	  $927.77	      ---	 $1169.99	004	1	0	0.00	    $0.00	Y	
O	60545	EXPLORE ADRENAL GLAND                   	     4.98	  $185.41	      ---	  $233.81	004	1	0	0.00	    $0.00	Y	
O	60600	REMOVE CAROTID BODY LESION              	     3.85	  $143.34	      ---	  $180.76	004	1	0	0.00	    $0.00	Y	
K	60600	REMOVE CAROTID BODY LESION              	    19.25	  $716.68	      ---	  $903.79	004	1	0	0.00	    $0.00	Y	
K	60605	REMOVE CAROTID BODY LESION              	    27.18	 $1011.91	      ---	 $1276.10	004	1	0	0.00	    $0.00	Y	
O	60605	REMOVE CAROTID BODY LESION              	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
O	60650	LAPAROSCOPY ADRENALECTOMY               	     4.73	  $176.10	      ---	  $222.07	004	1	0	0.00	    $0.00	Y	
K	60650	LAPAROSCOPY ADRENALECTOMY               	    23.64	  $880.12	      ---	 $1109.90	004	1	0	0.00	    $0.00	Y	
K	60659	UNLISTED LAPS PX ENDOC SYS              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	60659	UNLISTED LAPS PX ENDOC SYS              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	60699	UNLISTED PX ENDOCRINE SYSTEM            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	60699	UNLISTED PX ENDOCRINE SYSTEM            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	61000	REMOVE CRANIAL CAVITY FLUID             	     2.27	   $84.51	      ---	  $106.58	004	1	1	0.00	    $0.00	Y	
K	61001	REMOVE CRANIAL CAVITY FLUID             	     1.59	   $59.20	      ---	   $74.65	004	1	1	0.00	    $0.00	Y	
K	61020	REMOVE BRAIN CAVITY FLUID               	     2.27	   $84.51	      ---	  $106.58	004	1	1	0.00	    $0.00	Y	
K	61026	INJECTION INTO BRAIN CANAL              	     3.50	  $130.31	      ---	  $164.33	004	1	0	0.00	    $0.00	Y	
K	61050	REMOVE BRAIN CANAL FLUID                	     2.04	   $75.95	      ---	   $95.78	004	1	0	0.00	    $0.00	Y	
K	61055	INJECTION INTO BRAIN CANAL              	     3.80	  $141.47	      ---	  $178.41	004	1	0	0.00	    $0.00	Y	
K	61070	BRAIN CANAL SHUNT PROCEDURE             	     3.51	  $130.68	      ---	  $164.79	004	1	1	0.00	    $0.00	Y	
K	61105	TDH SDRL/VENTR PNXR                     	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
K	61107	TDH PNXR IMPLT VENTR CATH               	     8.40	  $312.73	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	61108	TDH PNXR EVAC&/DRG SDRL HMTA            	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	61120	BURR HOLE FOR VENTR PUNCTURE            	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	61120	BURR HOLE FOR VENTR PUNCTURE            	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	61140	BURR HOLE/TREPH BX BRAIN/LES            	     4.30	  $160.09	      ---	  $201.89	004	1	0	0.00	    $0.00	Y	
K	61140	BURR HOLE/TREPH BX BRAIN/LES            	    21.63	  $805.28	      ---	 $1015.53	004	1	0	0.00	    $0.00	Y	
K	61150	BUR HOL/TRPH DRG BRN ABS/CST            	    25.67	  $955.69	      ---	 $1205.21	004	1	0	0.00	    $0.00	Y	
O	61150	BUR HOL/TRPH DRG BRN ABS/CST            	     5.13	  $190.99	      ---	  $240.85	004	1	0	0.00	    $0.00	Y	
K	61151	BURR HOLE/TREPH SBSQ TAPPING            	    10.20	  $379.75	      ---	  $478.89	004	1	0	0.00	    $0.00	Y	
K	61154	BURR HOLE W/EVAC&/DRG HMTMA             	    26.00	  $967.98	      ---	 $1220.70	004	1	0	0.00	    $0.00	Y	
O	61154	BURR HOLE W/EVAC&/DRG HMTMA             	     5.20	  $193.60	      ---	  $244.14	004	1	0	0.00	    $0.00	Y	
O	61156	BURR HOL ASPIR HMTM/CST ICER            	     5.20	  $193.60	      ---	  $244.14	004	1	0	0.00	    $0.00	Y	
K	61156	BURR HOL ASPIR HMTM/CST ICER            	    26.00	  $967.98	      ---	 $1220.70	004	1	0	0.00	    $0.00	Y	
K	61210	BURR HOLE IMPLT VENTR CATH              	     7.53	  $280.34	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	61210	BURR HOLE IMPLT VENTR CATH              	     2.15	   $80.04	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	61215	INS SUBQ RSVR PMP/NFS SYS               	     1.13	   $42.07	      ---	   $53.05	004	1	0	0.00	    $0.00	Y	
K	61215	INS SUBQ RSVR PMP/NFS SYS               	     5.66	  $210.72	      ---	  $265.74	004	1	0	0.00	    $0.00	Y	
K	61250	BURR HOLE/TREPH STTL EXPL               	    14.72	  $548.03	      ---	  $691.10	004	1	0	0.00	    $0.00	Y	
O	61250	BURR HOLE/TREPH STTL EXPL               	     2.94	  $109.46	      ---	  $138.03	004	1	0	0.00	    $0.00	Y	
O	61253	BURR HOLE TREPH ITTL UNI/BI             	     3.93	  $146.31	      ---	  $184.51	004	1	0	0.00	    $0.00	Y	
K	61253	BURR HOLE TREPH ITTL UNI/BI             	    19.63	  $730.82	      ---	  $921.63	004	1	0	0.00	    $0.00	Y	
K	61304	CRNEC/CRNOT EXPL SUPRATNTORL            	    34.00	 $1265.82	      ---	 $1596.30	004	1	0	0.00	    $0.00	Y	
O	61304	CRNEC/CRNOT EXPL SUPRATNTORL            	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
O	61305	CRNEC/CRNOT EXPL INFRATNTORL            	     8.00	  $297.84	      ---	  $375.60	004	1	0	0.00	    $0.00	Y	
K	61305	CRNEC/CRNOT EXPL INFRATNTORL            	    40.00	 $1489.20	      ---	 $1878.00	004	1	0	0.00	    $0.00	Y	
K	61312	CRNEC/CRNOT STTL XDRL/SDRL              	    31.71	 $1180.56	      ---	 $1488.78	004	1	0	0.00	    $0.00	Y	
O	61312	CRNEC/CRNOT STTL XDRL/SDRL              	     6.34	  $236.04	      ---	  $297.66	004	1	0	0.00	    $0.00	Y	
O	61313	CRNEC/CRNOT STTL ICERE                  	     6.34	  $236.04	      ---	  $297.66	004	1	0	0.00	    $0.00	Y	
K	61313	CRNEC/CRNOT STTL ICERE                  	    31.71	 $1180.56	      ---	 $1488.78	004	1	0	0.00	    $0.00	Y	
K	61314	CRNEC/CRNOT ITTL XDRL/SDRL              	    31.71	 $1180.56	      ---	 $1488.78	004	1	0	0.00	    $0.00	Y	
O	61314	CRNEC/CRNOT ITTL XDRL/SDRL              	     6.34	  $236.04	      ---	  $297.66	004	1	0	0.00	    $0.00	Y	
O	61315	CRNEC/CRNOT ITTL NTRACEREBLR            	     6.34	  $236.04	      ---	  $297.66	004	1	0	0.00	    $0.00	Y	
K	61315	CRNEC/CRNOT ITTL NTRACEREBLR            	    31.71	 $1180.56	      ---	 $1488.78	004	1	0	0.00	    $0.00	Y	
K	61316	INC&SUBQ PLMT CRNL BONE GRF             	     1.67	   $62.17	      ---	   $78.41	004	1	0	0.00	    $0.00	Y	
O	61316	INC&SUBQ PLMT CRNL BONE GRF             	     0.28	   $10.42	      ---	   $13.15	004	1	0	0.00	    $0.00	Y	
O	61320	CRNEC/CRNOT DRG ICR ABS STTL            	     6.34	  $236.04	      ---	  $297.66	004	1	0	0.00	    $0.00	Y	
K	61320	CRNEC/CRNOT DRG ICR ABS STTL            	    31.71	 $1180.56	      ---	 $1488.78	004	1	0	0.00	    $0.00	Y	
K	61321	CRNEC/CRNOT DRG ICR ABS ITTL            	    31.71	 $1180.56	      ---	 $1488.78	004	1	0	0.00	    $0.00	Y	
O	61321	CRNEC/CRNOT DRG ICR ABS ITTL            	     6.34	  $236.04	      ---	  $297.66	004	1	0	0.00	    $0.00	Y	
O	61322	CRNEC/CRNOT DCMPRV W/O LOBEC            	     4.92	  $183.17	      ---	  $230.99	004	1	0	0.00	    $0.00	Y	
K	61322	CRNEC/CRNOT DCMPRV W/O LOBEC            	    24.63	  $916.97	      ---	 $1156.38	004	1	0	0.00	    $0.00	Y	
K	61323	CRNEC/CRNOT DCMPRV W/LOBEC              	    28.16	 $1048.40	      ---	 $1322.11	004	1	0	0.00	    $0.00	Y	
O	61323	CRNEC/CRNOT DCMPRV W/LOBEC              	     5.64	  $209.98	      ---	  $264.80	004	1	0	0.00	    $0.00	Y	
O	61330	DCMPRN ORBIT ONLY TRANSCRNL             	     5.89	  $219.28	      ---	  $276.54	004	1	0	0.00	    $0.00	Y	
K	61330	DCMPRN ORBIT ONLY TRANSCRNL             	    29.45	 $1096.42	      ---	 $1382.68	004	1	0	0.00	    $0.00	Y	
K	61333	EXPL ORBIT W/REMOVAL LESION             	    39.91	 $1485.85	      ---	 $1873.77	004	1	0	0.00	    $0.00	Y	
O	61333	EXPL ORBIT W/REMOVAL LESION             	     7.98	  $297.10	      ---	  $374.66	004	1	0	0.00	    $0.00	Y	
O	61340	SUBTEMPORAL CRANIAL DCMPRN              	     3.62	  $134.77	      ---	  $169.96	004	1	0	0.00	    $0.00	Y	
K	61340	SUBTEMPORAL CRANIAL DCMPRN              	    18.12	  $674.61	      ---	  $850.73	004	1	0	0.00	    $0.00	Y	
K	61343	CRNEC SOPL CRV LAM DCMPRN               	    23.41	  $871.55	      ---	 $1099.10	004	1	0	0.00	    $0.00	Y	
O	61343	CRNEC SOPL CRV LAM DCMPRN               	     4.66	  $173.49	      ---	  $218.79	004	1	0	0.00	    $0.00	Y	
O	61345	OTH CRANIAL DCMPRN PST FOSSA            	     4.32	  $160.83	      ---	  $202.82	004	1	0	0.00	    $0.00	Y	
K	61345	OTH CRANIAL DCMPRN PST FOSSA            	    21.70	  $807.89	      ---	 $1018.82	004	1	0	0.00	    $0.00	Y	
K	61450	CRNEC STPL SCTJ CMPRN/DCMPRN            	    31.71	 $1180.56	      ---	 $1488.78	004	1	0	0.00	    $0.00	Y	
O	61450	CRNEC STPL SCTJ CMPRN/DCMPRN            	     6.34	  $236.04	      ---	  $297.66	004	1	0	0.00	    $0.00	Y	
O	61458	CRNEC SOPL XPL/DCMPR CRL NRV            	     7.70	  $286.67	      ---	  $361.52	004	1	0	0.00	    $0.00	Y	
K	61458	CRNEC SOPL XPL/DCMPR CRL NRV            	    38.51	 $1433.73	      ---	 $1808.04	004	1	0	0.00	    $0.00	Y	
K	61460	CRNEC SOPL SCTJ 1+CRNL NRV              	    38.51	 $1433.73	      ---	 $1808.04	004	1	0	0.00	    $0.00	Y	
O	61460	CRNEC SOPL SCTJ 1+CRNL NRV              	     7.70	  $286.67	      ---	  $361.52	004	1	0	0.00	    $0.00	Y	
O	61500	CRNEC EXC TUM/BONE LES SKULL            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	61500	CRNEC EXC TUM/BONE LES SKULL            	   676.57	  $676.57	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	61501	CRANIECTOMY F/OSTEOMYELITIS             	    25.60	  $953.09	      ---	 $1201.92	004	1	0	0.00	    $0.00	Y	
O	61501	CRANIECTOMY F/OSTEOMYELITIS             	     5.12	  $190.62	      ---	  $240.38	004	1	0	0.00	    $0.00	Y	
O	61510	CRNEC TREPH EXC BRN TUM STTL            	     7.70	  $286.67	      ---	  $361.52	004	1	0	0.00	    $0.00	Y	
K	61510	CRNEC TREPH EXC BRN TUM STTL            	    38.51	 $1433.73	      ---	 $1808.04	004	1	0	0.00	    $0.00	Y	
K	61512	CRNEC TREPH EXC MNGIOMA STTL            	    38.51	 $1433.73	      ---	 $1808.04	004	1	0	0.00	    $0.00	Y	
O	61512	CRNEC TREPH EXC MNGIOMA STTL            	     7.70	  $286.67	      ---	  $361.52	004	1	0	0.00	    $0.00	Y	
O	61514	CRNEC TREPH EXC BRN ABS STTL            	     7.36	  $274.01	      ---	  $345.55	004	1	0	0.00	    $0.00	Y	
K	61514	CRNEC TREPH EXC BRN ABS STTL            	    36.79	 $1369.69	      ---	 $1727.29	004	1	0	0.00	    $0.00	Y	
K	61516	CRNEC TREPH EXC CYST STTL               	    36.19	 $1347.35	      ---	 $1699.12	004	1	0	0.00	    $0.00	Y	
O	61516	CRNEC TREPH EXC CYST STTL               	     7.24	  $269.55	      ---	  $339.92	004	1	0	0.00	    $0.00	Y	
O	61517	IMPLT BRN INTRCV CHEMOTX AGT            	     0.23	    $8.56	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	61517	IMPLT BRN INTRCV CHEMOTX AGT            	     1.16	   $43.19	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	61518	REMOVAL OF BRAIN LESION                 	    45.30	 $1686.52	      ---	 $2126.84	004	1	0	0.00	    $0.00	Y	
O	61518	REMOVAL OF BRAIN LESION                 	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	61519	REMOVE BRAIN LINING LESION              	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
K	61519	REMOVE BRAIN LINING LESION              	    45.30	 $1686.52	      ---	 $2126.84	004	1	0	0.00	    $0.00	Y	
K	61520	REMOVAL OF BRAIN LESION                 	    45.30	 $1686.52	      ---	 $2126.84	004	1	0	0.00	    $0.00	Y	
O	61520	REMOVAL OF BRAIN LESION                 	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	61521	REMOVAL OF BRAIN LESION                 	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
K	61521	REMOVAL OF BRAIN LESION                 	    45.30	 $1686.52	      ---	 $2126.84	004	1	0	0.00	    $0.00	Y	
K	61522	REMOVAL OF BRAIN ABSCESS                	    43.18	 $1607.59	      ---	 $2027.30	004	1	0	0.00	    $0.00	Y	
O	61522	REMOVAL OF BRAIN ABSCESS                	     8.64	  $321.67	      ---	  $405.65	004	1	0	0.00	    $0.00	Y	
O	61524	REMOVAL OF BRAIN LESION                 	     8.17	  $304.17	      ---	  $383.58	004	1	0	0.00	    $0.00	Y	
K	61524	REMOVAL OF BRAIN LESION                 	    40.84	 $1520.47	      ---	 $1917.44	004	1	0	0.00	    $0.00	Y	
K	61526	REMOVAL OF BRAIN LESION                 	    45.30	 $1686.52	      ---	 $2126.84	004	1	0	0.00	    $0.00	Y	
O	61526	REMOVAL OF BRAIN LESION                 	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	61530	REMOVAL OF BRAIN LESION                 	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
K	61530	REMOVAL OF BRAIN LESION                 	    45.30	 $1686.52	      ---	 $2126.84	004	1	0	0.00	    $0.00	Y	
K	61531	IMPLANT BRAIN ELECTRODES                	    25.24	  $939.69	      ---	 $1185.02	004	1	0	0.00	    $0.00	Y	
O	61531	IMPLANT BRAIN ELECTRODES                	     5.05	  $188.01	      ---	  $237.10	004	1	0	0.00	    $0.00	Y	
O	61533	IMPLANT BRAIN ELECTRODES                	     6.24	  $232.32	      ---	  $292.97	004	1	0	0.00	    $0.00	Y	
K	61533	IMPLANT BRAIN ELECTRODES                	    31.19	 $1161.20	      ---	 $1464.37	004	1	0	0.00	    $0.00	Y	
K	61534	REMOVAL OF BRAIN LESION                 	    32.07	 $1193.97	      ---	 $1505.69	004	1	0	0.00	    $0.00	Y	
O	61534	REMOVAL OF BRAIN LESION                 	     6.41	  $238.64	      ---	  $300.95	004	1	0	0.00	    $0.00	Y	
O	61535	REMOVE BRAIN ELECTRODES                 	     3.75	  $139.61	      ---	  $176.06	004	1	0	0.00	    $0.00	Y	
K	61535	REMOVE BRAIN ELECTRODES                 	    18.75	  $698.06	      ---	  $880.31	004	1	0	0.00	    $0.00	Y	
K	61536	REMOVAL OF BRAIN LESION                 	    54.54	 $2030.52	      ---	 $2560.65	004	1	0	0.00	    $0.00	Y	
O	61536	REMOVAL OF BRAIN LESION                 	    10.91	  $406.18	      ---	  $512.22	004	1	0	0.00	    $0.00	Y	
O	61537	REMOVAL OF BRAIN TISSUE                 	     4.84	  $180.19	      ---	  $227.24	004	1	0	0.00	    $0.00	Y	
K	61537	REMOVAL OF BRAIN TISSUE                 	    24.18	  $900.22	      ---	 $1135.25	004	1	0	0.00	    $0.00	Y	
K	61538	REMOVAL OF BRAIN TISSUE                 	    39.61	 $1474.68	      ---	 $1859.69	004	1	0	0.00	    $0.00	Y	
O	61538	REMOVAL OF BRAIN TISSUE                 	     7.92	  $294.86	      ---	  $371.84	004	1	0	0.00	    $0.00	Y	
O	61539	REMOVAL OF BRAIN TISSUE                 	     8.61	  $320.55	      ---	  $404.24	004	1	0	0.00	    $0.00	Y	
K	61539	REMOVAL OF BRAIN TISSUE                 	    43.04	 $1602.38	      ---	 $2020.73	004	1	0	0.00	    $0.00	Y	
K	61540	REMOVAL OF BRAIN TISSUE                 	    29.13	 $1084.51	      ---	 $1367.65	004	1	0	0.00	    $0.00	Y	
O	61540	REMOVAL OF BRAIN TISSUE                 	     5.83	  $217.05	      ---	  $273.72	004	1	0	0.00	    $0.00	Y	
O	61541	INCISION OF BRAIN TISSUE                	     8.82	  $328.37	      ---	  $414.10	004	1	0	0.00	    $0.00	Y	
K	61541	INCISION OF BRAIN TISSUE                	    44.11	 $1642.22	      ---	 $2070.96	004	1	0	0.00	    $0.00	Y	
K	61543	REMOVAL OF BRAIN TISSUE                 	    42.37	 $1577.44	      ---	 $1989.27	004	1	0	0.00	    $0.00	Y	
O	61543	REMOVAL OF BRAIN TISSUE                 	     8.47	  $315.34	      ---	  $397.67	004	1	0	0.00	    $0.00	Y	
O	61544	REMOVE & TREAT BRAIN LESION             	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
K	61544	REMOVE & TREAT BRAIN LESION             	    33.98	 $1265.08	      ---	 $1595.36	004	1	0	0.00	    $0.00	Y	
K	61545	EXCISION OF BRAIN TUMOR                 	    34.23	 $1274.38	      ---	 $1607.10	004	1	0	0.00	    $0.00	Y	
O	61545	EXCISION OF BRAIN TUMOR                 	     6.85	  $255.03	      ---	  $321.61	004	1	0	0.00	    $0.00	Y	
O	61546	REMOVAL OF PITUITARY GLAND              	     7.70	  $286.67	      ---	  $361.52	004	1	0	0.00	    $0.00	Y	
K	61546	REMOVAL OF PITUITARY GLAND              	    38.51	 $1433.73	      ---	 $1808.04	004	1	0	0.00	    $0.00	Y	
K	61548	REMOVAL OF PITUITARY GLAND              	    39.48	 $1469.84	      ---	 $1853.59	004	1	0	0.00	    $0.00	Y	
O	61548	REMOVAL OF PITUITARY GLAND              	     7.90	  $294.12	      ---	  $370.91	004	1	0	0.00	    $0.00	Y	
O	61550	RELEASE OF SKULL SEAMS                  	     4.80	  $178.70	      ---	  $225.36	004	1	0	0.00	    $0.00	Y	
K	61550	RELEASE OF SKULL SEAMS                  	    24.00	  $893.52	      ---	 $1126.80	004	1	0	0.00	    $0.00	Y	
K	61552	RELEASE OF SKULL SEAMS                  	    30.00	 $1116.90	      ---	 $1408.50	004	1	0	0.00	    $0.00	Y	
O	61552	RELEASE OF SKULL SEAMS                  	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
O	61556	INCISE SKULL/SUTURES                    	     5.46	  $203.28	      ---	  $256.35	004	1	0	0.00	    $0.00	Y	
K	61556	INCISE SKULL/SUTURES                    	    27.30	 $1016.38	      ---	 $1281.74	004	1	0	0.00	    $0.00	Y	
K	61557	INCISE SKULL/SUTURES                    	    27.18	 $1011.91	      ---	 $1276.10	004	1	0	0.00	    $0.00	Y	
O	61557	INCISE SKULL/SUTURES                    	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
O	61558	EXCISION OF SKULL/SUTURES               	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
K	61558	EXCISION OF SKULL/SUTURES               	    33.98	 $1265.08	      ---	 $1595.36	004	1	0	0.00	    $0.00	Y	
K	61559	EXCISION OF SKULL/SUTURES               	    47.55	 $1770.29	      ---	 $2232.47	004	1	0	0.00	    $0.00	Y	
O	61559	EXCISION OF SKULL/SUTURES               	     9.51	  $354.06	      ---	  $446.49	004	1	0	0.00	    $0.00	Y	
O	61563	EXCISION OF SKULL TUMOR                 	     4.36	  $162.32	      ---	  $204.70	004	1	0	0.00	    $0.00	Y	
K	61563	EXCISION OF SKULL TUMOR                 	    21.81	  $811.99	      ---	 $1023.98	004	1	0	0.00	    $0.00	Y	
K	61564	EXCISION OF SKULL TUMOR                 	    33.86	 $1260.61	      ---	 $1589.73	004	1	0	0.00	    $0.00	Y	
O	61564	EXCISION OF SKULL TUMOR                 	     6.77	  $252.05	      ---	  $317.85	004	1	0	0.00	    $0.00	Y	
O	61566	REMOVAL OF BRAIN TISSUE                 	     5.79	  $215.56	      ---	  $271.84	004	1	0	0.00	    $0.00	Y	
K	61566	REMOVAL OF BRAIN TISSUE                 	    28.97	 $1078.55	      ---	 $1360.14	004	1	0	0.00	    $0.00	Y	
K	61567	INCISION OF BRAIN TISSUE                	    32.57	 $1212.58	      ---	 $1529.16	004	1	0	0.00	    $0.00	Y	
O	61567	INCISION OF BRAIN TISSUE                	     6.51	  $242.37	      ---	  $305.64	004	1	0	0.00	    $0.00	Y	
O	61570	REMOVE FOREIGN BODY BRAIN               	     7.00	  $260.61	      ---	  $328.65	004	1	0	0.00	    $0.00	Y	
K	61570	REMOVE FOREIGN BODY BRAIN               	    34.98	 $1302.31	      ---	 $1642.31	004	1	0	0.00	    $0.00	Y	
K	61571	INCISE SKULL FOR BRAIN WOUND            	    38.00	 $1414.74	      ---	 $1784.10	004	1	0	0.00	    $0.00	Y	
O	61571	INCISE SKULL FOR BRAIN WOUND            	     7.60	  $282.95	      ---	  $356.82	004	1	0	0.00	    $0.00	Y	
O	61575	SKULL BASE/BRAINSTEM SURGERY            	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
K	61575	SKULL BASE/BRAINSTEM SURGERY            	    49.98	 $1860.76	      ---	 $2346.56	004	1	0	0.00	    $0.00	Y	
K	61576	SKULL BASE/BRAINSTEM SURGERY            	    79.33	 $2953.46	      ---	 $3724.54	004	1	0	0.00	    $0.00	Y	
O	61576	SKULL BASE/BRAINSTEM SURGERY            	    15.87	  $590.84	      ---	  $745.10	004	1	0	0.00	    $0.00	Y	
O	61580	CRANIOFACIAL APPROACH SKULL             	     8.04	  $299.33	      ---	  $377.48	004	1	0	0.00	    $0.00	Y	
K	61580	CRANIOFACIAL APPROACH SKULL             	    40.20	 $1496.65	      ---	 $1887.39	004	1	0	0.00	    $0.00	Y	
K	61581	CRANIOFACIAL APPROACH SKULL             	    45.62	 $1698.43	      ---	 $2141.86	004	1	0	0.00	    $0.00	Y	
O	61581	CRANIOFACIAL APPROACH SKULL             	     9.13	  $339.91	      ---	  $428.65	004	1	0	0.00	    $0.00	Y	
O	61582	CRANIOFACIAL APPROACH SKULL             	     8.28	  $308.26	      ---	  $388.75	004	1	0	0.00	    $0.00	Y	
K	61582	CRANIOFACIAL APPROACH SKULL             	    41.39	 $1540.95	      ---	 $1943.26	004	1	0	0.00	    $0.00	Y	
K	61583	CRANIOFACIAL APPROACH SKULL             	    47.22	 $1758.00	      ---	 $2216.98	004	1	0	0.00	    $0.00	Y	
O	61583	CRANIOFACIAL APPROACH SKULL             	     9.45	  $351.82	      ---	  $443.68	004	1	0	0.00	    $0.00	Y	
O	61584	ORBITOCRANIAL APPROACH/SKULL            	     9.14	  $340.28	      ---	  $429.12	004	1	0	0.00	    $0.00	Y	
K	61584	ORBITOCRANIAL APPROACH/SKULL            	    45.71	 $1701.78	      ---	 $2146.08	004	1	0	0.00	    $0.00	Y	
K	61585	ORBITOCRANIAL APPROACH/SKULL            	    51.20	 $1906.18	      ---	 $2403.84	004	1	0	0.00	    $0.00	Y	
O	61585	ORBITOCRANIAL APPROACH/SKULL            	    10.24	  $381.24	      ---	  $480.77	004	1	0	0.00	    $0.00	Y	
O	61586	RESECT NASOPHARYNX SKULL                	     7.26	  $270.29	      ---	  $340.86	004	1	0	0.00	    $0.00	Y	
K	61586	RESECT NASOPHARYNX SKULL                	    36.31	 $1351.82	      ---	 $1704.75	004	1	0	0.00	    $0.00	Y	
K	61590	INFRATEMPORAL APPROACH/SKULL            	    55.67	 $2072.59	      ---	 $2613.71	004	1	0	0.00	    $0.00	Y	
O	61590	INFRATEMPORAL APPROACH/SKULL            	    11.13	  $414.37	      ---	  $522.55	004	1	0	0.00	    $0.00	Y	
O	61591	INFRATEMPORAL APPROACH/SKULL            	    11.68	  $434.85	      ---	  $548.38	004	1	0	0.00	    $0.00	Y	
K	61591	INFRATEMPORAL APPROACH/SKULL            	    58.39	 $2173.86	      ---	 $2741.41	004	1	0	0.00	    $0.00	Y	
K	61592	ORBITOCRANIAL APPROACH/SKULL            	    52.89	 $1969.09	      ---	 $2483.19	004	1	0	0.00	    $0.00	Y	
O	61592	ORBITOCRANIAL APPROACH/SKULL            	    10.58	  $393.89	      ---	  $496.73	004	1	0	0.00	    $0.00	Y	
O	61595	TRANSTEMPORAL APPROACH/SKULL            	     7.82	  $291.14	      ---	  $367.15	004	1	0	0.00	    $0.00	Y	
K	61595	TRANSTEMPORAL APPROACH/SKULL            	    39.09	 $1455.32	      ---	 $1835.28	004	1	0	0.00	    $0.00	Y	
K	61596	TRANSCOCHLEAR APPROACH/SKULL            	    47.55	 $1770.29	      ---	 $2232.47	004	1	0	0.00	    $0.00	Y	
O	61596	TRANSCOCHLEAR APPROACH/SKULL            	     9.51	  $354.06	      ---	  $446.49	004	1	0	0.00	    $0.00	Y	
O	61597	TRANSCONDYLAR APPROACH/SKULL            	    10.05	  $374.16	      ---	  $471.85	004	1	0	0.00	    $0.00	Y	
K	61597	TRANSCONDYLAR APPROACH/SKULL            	    50.25	 $1870.81	      ---	 $2359.24	004	1	0	0.00	    $0.00	Y	
K	61598	TRANSPETROSAL APPROACH/SKULL            	    44.19	 $1645.19	      ---	 $2074.72	004	1	0	0.00	    $0.00	Y	
O	61598	TRANSPETROSAL APPROACH/SKULL            	     8.83	  $328.74	      ---	  $414.57	004	1	0	0.00	    $0.00	Y	
O	61600	RESECT/EXCISE CRANIAL LESION            	     6.78	  $252.42	      ---	  $318.32	004	1	0	0.00	    $0.00	Y	
K	61600	RESECT/EXCISE CRANIAL LESION            	    33.90	 $1262.10	      ---	 $1591.61	004	1	0	0.00	    $0.00	Y	
K	61601	RESECT/EXCISE CRANIAL LESION            	    36.38	 $1354.43	      ---	 $1708.04	004	1	0	0.00	    $0.00	Y	
O	61601	RESECT/EXCISE CRANIAL LESION            	     7.27	  $270.66	      ---	  $341.33	004	1	0	0.00	    $0.00	Y	
O	61605	RESECT/EXCISE CRANIAL LESION            	     7.69	  $286.30	      ---	  $361.05	004	1	0	0.00	    $0.00	Y	
K	61605	RESECT/EXCISE CRANIAL LESION            	    38.45	 $1431.49	      ---	 $1805.23	004	1	0	0.00	    $0.00	Y	
K	61606	RESECT/EXCISE CRANIAL LESION            	    51.52	 $1918.09	      ---	 $2418.86	004	1	0	0.00	    $0.00	Y	
O	61606	RESECT/EXCISE CRANIAL LESION            	    10.31	  $383.84	      ---	  $484.05	004	1	0	0.00	    $0.00	Y	
O	61607	RESECT/EXCISE CRANIAL LESION            	     9.62	  $358.15	      ---	  $451.66	004	1	0	0.00	    $0.00	Y	
K	61607	RESECT/EXCISE CRANIAL LESION            	    48.09	 $1790.39	      ---	 $2257.83	004	1	0	0.00	    $0.00	Y	
K	61608	RESECT/EXCISE CRANIAL LESION            	    55.91	 $2081.53	      ---	 $2624.97	004	1	0	0.00	    $0.00	Y	
O	61608	RESECT/EXCISE CRANIAL LESION            	    11.18	  $416.23	      ---	  $524.90	004	1	0	0.00	    $0.00	Y	
O	61611	TRANSECT ARTERY SINUS                   	     1.63	   $60.68	      ---	   $76.53	004	1	0	0.00	    $0.00	Y	
K	61611	TRANSECT ARTERY SINUS                   	     8.15	  $303.42	      ---	  $382.64	004	1	0	0.00	    $0.00	Y	
K	61613	REMOVE ANEURYSM SINUS                   	    54.81	 $2040.58	      ---	 $2573.33	004	1	0	0.00	    $0.00	Y	
O	61613	REMOVE ANEURYSM SINUS                   	    10.96	  $408.04	      ---	  $514.57	004	1	0	0.00	    $0.00	Y	
O	61615	RESECT/EXCISE LESION SKULL              	     8.45	  $314.59	      ---	  $396.73	004	1	0	0.00	    $0.00	Y	
K	61615	RESECT/EXCISE LESION SKULL              	    42.27	 $1573.71	      ---	 $1984.58	004	1	0	0.00	    $0.00	Y	
K	61616	RESECT/EXCISE LESION SKULL              	    57.43	 $2138.12	      ---	 $2696.34	004	1	0	0.00	    $0.00	Y	
O	61616	RESECT/EXCISE LESION SKULL              	    11.48	  $427.40	      ---	  $538.99	004	1	0	0.00	    $0.00	Y	
O	61618	REPAIR DURA                             	     4.33	  $161.21	      ---	  $203.29	004	1	0	0.00	    $0.00	Y	
K	61618	REPAIR DURA                             	    21.62	  $804.91	      ---	 $1015.06	004	1	0	0.00	    $0.00	Y	
K	61619	REPAIR DURA                             	    27.11	 $1009.31	      ---	 $1272.81	004	1	0	0.00	    $0.00	Y	
O	61619	REPAIR DURA                             	     5.43	  $202.16	      ---	  $254.94	004	1	0	0.00	    $0.00	Y	
O	61623	ENDOVASC TEMPORY VESSEL OCCL            	     1.61	   $59.94	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	61623	ENDOVASC TEMPORY VESSEL OCCL            	     8.06	  $300.07	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	61624	TRANSCATH OCCLUSION CNS                 	    22.42	  $834.70	      ---	 $1052.62	004	1	0	0.00	    $0.00	Y	
O	61624	TRANSCATH OCCLUSION CNS                 	     4.48	  $166.79	      ---	  $210.34	004	1	0	0.00	    $0.00	Y	
O	61626	TRANSCATH OCCLUSION NON-CNS             	     3.64	  $135.52	      ---	  $170.90	004	1	0	0.00	    $0.00	Y	
K	61626	TRANSCATH OCCLUSION NON-CNS             	    18.22	  $678.33	      ---	  $855.43	004	1	0	0.00	    $0.00	Y	
K	61630	INTRACRANIAL ANGIOPLASTY                	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	61630	INTRACRANIAL ANGIOPLASTY                	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	61635	INTRACRAN ANGIOPLSTY W/STENT            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	61635	INTRACRAN ANGIOPLSTY W/STENT            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	61640	DILATE IC VASOSPASM INIT                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	61640	DILATE IC VASOSPASM INIT                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	61641	DILAT IC VSPSM EA VSL SM TER            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	61641	DILAT IC VSPSM EA VSL SM TER            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	61642	DILAT IC VSPSM EA DIFF TER              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	61642	DILAT IC VSPSM EA DIFF TER              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	61645	PERQ ART M-THROMBECT &/NFS              	    17.79	  $662.32	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	61650	EVASC PRLNG ADMN RX AGNT 1ST            	    11.93	  $444.15	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	61651	EVASC PRLNG ADMN RX AGNT ADD            	     5.06	  $188.38	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	61680	INTRACRANIAL VESSEL SURGERY             	    45.01	 $1675.72	      ---	 $2113.22	004	1	0	0.00	    $0.00	Y	
O	61680	INTRACRANIAL VESSEL SURGERY             	     9.00	  $335.07	      ---	  $422.55	004	1	0	0.00	    $0.00	Y	
O	61682	INTRACRANIAL VESSEL SURGERY             	    17.56	  $653.76	      ---	  $824.44	004	1	0	0.00	    $0.00	Y	
K	61682	INTRACRANIAL VESSEL SURGERY             	    87.78	 $3268.05	      ---	 $4121.27	004	1	0	0.00	    $0.00	Y	
K	61684	INTRACRANIAL VESSEL SURGERY             	    58.53	 $2179.07	      ---	 $2747.98	004	1	0	0.00	    $0.00	Y	
O	61684	INTRACRANIAL VESSEL SURGERY             	    11.71	  $435.96	      ---	  $549.78	004	1	0	0.00	    $0.00	Y	
O	61686	INTRACRANIAL VESSEL SURGERY             	    18.51	  $689.13	      ---	  $869.04	004	1	0	0.00	    $0.00	Y	
K	61686	INTRACRANIAL VESSEL SURGERY             	    92.55	 $3445.64	      ---	 $4345.22	004	1	0	0.00	    $0.00	Y	
K	61690	INTRACRANIAL VESSEL SURGERY             	    45.11	 $1679.45	      ---	 $2117.91	004	1	0	0.00	    $0.00	Y	
O	61690	INTRACRANIAL VESSEL SURGERY             	     9.02	  $335.81	      ---	  $423.49	004	1	0	0.00	    $0.00	Y	
O	61692	INTRACRANIAL VESSEL SURGERY             	    14.72	  $548.03	      ---	  $691.10	004	1	0	0.00	    $0.00	Y	
K	61692	INTRACRANIAL VESSEL SURGERY             	    73.59	 $2739.76	      ---	 $3455.05	004	1	0	0.00	    $0.00	Y	
K	61697	BRAIN ANEURYSM REPR COMPLX              	    74.94	 $2790.02	      ---	 $3518.43	004	1	0	0.00	    $0.00	Y	
O	61697	BRAIN ANEURYSM REPR COMPLX              	    14.99	  $558.08	      ---	  $703.78	004	1	0	0.00	    $0.00	Y	
O	61698	BRAIN ANEURYSM REPR COMPLX              	    14.43	  $537.23	      ---	  $677.49	004	1	0	0.00	    $0.00	Y	
K	61698	BRAIN ANEURYSM REPR COMPLX              	    72.13	 $2685.40	      ---	 $3386.50	004	1	0	0.00	    $0.00	Y	
K	61700	BRAIN ANEURYSM REPR SIMPLE              	    45.30	 $1686.52	      ---	 $2126.84	004	1	0	0.00	    $0.00	Y	
O	61700	BRAIN ANEURYSM REPR SIMPLE              	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	61702	INNER SKULL VESSEL SURGERY              	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
K	61702	INNER SKULL VESSEL SURGERY              	    45.30	 $1686.52	      ---	 $2126.84	004	1	0	0.00	    $0.00	Y	
K	61703	CLAMP NECK ARTERY                       	    27.07	 $1007.82	      ---	 $1270.94	004	1	0	0.00	    $0.00	Y	
O	61703	CLAMP NECK ARTERY                       	     5.41	  $201.41	      ---	  $254.00	004	1	0	0.00	    $0.00	Y	
O	61705	REVISE CIRCULATION TO HEAD              	    10.19	  $379.37	      ---	  $478.42	004	1	0	0.00	    $0.00	Y	
K	61705	REVISE CIRCULATION TO HEAD              	    50.94	 $1896.50	      ---	 $2391.63	004	1	0	0.00	    $0.00	Y	
K	61708	REVISE CIRCULATION TO HEAD              	    46.57	 $1733.80	      ---	 $2186.46	004	1	0	0.00	    $0.00	Y	
O	61708	REVISE CIRCULATION TO HEAD              	     9.31	  $346.61	      ---	  $437.10	004	1	0	0.00	    $0.00	Y	
O	61710	REVISE CIRCULATION TO HEAD              	     7.43	  $276.62	      ---	  $348.84	004	1	0	0.00	    $0.00	Y	
K	61710	REVISE CIRCULATION TO HEAD              	    37.14	 $1382.72	      ---	 $1743.72	004	1	0	0.00	    $0.00	Y	
K	61711	FUSION OF SKULL ARTERIES                	    43.27	 $1610.94	      ---	 $2031.53	004	1	0	0.00	    $0.00	Y	
O	61711	FUSION OF SKULL ARTERIES                	     8.61	  $320.55	      ---	  $404.24	004	1	0	0.00	    $0.00	Y	
O	61715	MRGFUS STRTCTC ABLT TRGT ICR            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	61715	MRGFUS STRTCTC ABLT TRGT ICR            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	61720	INCISE SKULL/BRAIN SURGERY              	    38.00	 $1414.74	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	61720	INCISE SKULL/BRAIN SURGERY              	     7.60	  $282.95	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	61735	INCISE SKULL/BRAIN SURGERY              	     7.60	  $282.95	      ---	  $356.82	004	1	0	0.00	    $0.00	Y	
K	61735	INCISE SKULL/BRAIN SURGERY              	    38.00	 $1414.74	      ---	 $1784.10	004	1	0	0.00	    $0.00	Y	
K	61736	LITT ICR 1 TRAJ 1 SMPL LES              	    20.62	  $767.68	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	61737	LITT ICR MLT TRJ MLT/CPLX LS            	    24.52	  $912.88	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	61750	INCISE SKULL/BRAIN BIOPSY               	    28.00	 $1042.44	      ---	 $1314.60	004	1	0	0.00	    $0.00	Y	
O	61750	INCISE SKULL/BRAIN BIOPSY               	     5.60	  $208.49	      ---	  $262.92	004	1	0	0.00	    $0.00	Y	
O	61751	BRAIN BIOPSY W/CT/MR GUIDE              	     6.50	  $242.00	      ---	  $305.18	004	1	0	0.00	    $0.00	Y	
K	61751	BRAIN BIOPSY W/CT/MR GUIDE              	    32.50	 $1209.98	      ---	 $1525.88	004	1	0	0.00	    $0.00	Y	
K	61760	IMPLANT BRAIN ELECTRODES                	    26.63	  $991.43	      ---	 $1250.28	004	1	0	0.00	    $0.00	Y	
O	61760	IMPLANT BRAIN ELECTRODES                	     5.33	  $198.44	      ---	  $250.24	004	1	0	0.00	    $0.00	Y	
O	61770	INCISE SKULL FOR TREATMENT              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	61770	INCISE SKULL FOR TREATMENT              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	61781	SCAN PROC CRANIAL INTRA                 	     5.22	  $194.34	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	61781	SCAN PROC CRANIAL INTRA                 	     1.04	   $38.72	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	61782	SCAN PROC CRANIAL EXTRA                 	     0.87	   $32.39	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	61782	SCAN PROC CRANIAL EXTRA                 	     4.34	  $161.58	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	61783	SCAN PROC SPINAL                        	     5.22	  $194.34	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	61783	SCAN PROC SPINAL                        	     1.04	   $38.72	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	61790	TREAT TRIGEMINAL NERVE                  	     3.00	  $111.69	      ---	  $140.85	004	1	0	0.00	    $0.00	Y	
K	61790	TREAT TRIGEMINAL NERVE                  	    14.90	  $554.73	      ---	  $699.56	004	1	0	0.00	    $0.00	Y	
K	61791	TREAT TRIGEMINAL TRACT                  	    24.00	  $893.52	      ---	 $1126.80	004	1	0	0.00	    $0.00	Y	
O	61791	TREAT TRIGEMINAL TRACT                  	     4.80	  $178.70	      ---	  $225.36	004	1	0	0.00	    $0.00	Y	
O	61796	SRS CRANIAL LESION SIMPLE               	     2.85	  $106.11	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	61796	SRS CRANIAL LESION SIMPLE               	    14.27	  $531.27	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	61797	SRS CRAN LES SIMPLE ADDL                	     3.85	  $143.34	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	61797	SRS CRAN LES SIMPLE ADDL                	     0.77	   $28.67	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	61798	SRS CRANIAL LESION COMPLEX              	     2.85	  $106.11	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	61798	SRS CRANIAL LESION COMPLEX              	    14.27	  $531.27	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	61799	SRS CRAN LES COMPLEX ADDL               	     5.32	  $198.06	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	61799	SRS CRAN LES COMPLEX ADDL               	     1.06	   $39.46	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	61800	APPLY SRS HEADFRAME ADD-ON              	     0.55	   $20.48	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	61800	APPLY SRS HEADFRAME ADD-ON              	     2.73	  $101.64	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	61867	IMPLANT NEUROELECTRODE                  	    21.45	  $798.58	      ---	 $1007.08	004	1	0	0.00	    $0.00	Y	
O	61867	IMPLANT NEUROELECTRODE                  	     4.29	  $159.72	      ---	  $201.42	004	1	0	0.00	    $0.00	Y	
O	61868	IMPLANT NEUROELECTRDE ADDL              	     1.42	   $52.87	      ---	   $66.67	004	1	0	0.00	    $0.00	Y	
K	61868	IMPLANT NEUROELECTRDE ADDL              	     7.11	  $264.71	      ---	  $333.81	004	1	0	0.00	    $0.00	Y	
K	61880	REVISE/REMOVE NEUROELECTRODE            	    10.46	  $389.43	      ---	  $491.10	004	1	0	0.00	    $0.00	Y	
O	61880	REVISE/REMOVE NEUROELECTRODE            	     2.09	   $77.81	      ---	   $98.13	004	1	0	0.00	    $0.00	Y	
O	61885	INSRT/REDO NEUROSTIM 1 ARRAY            	     2.08	   $77.44	      ---	   $97.66	004	1	0	0.00	    $0.00	Y	
K	61885	INSRT/REDO NEUROSTIM 1 ARRAY            	    10.43	  $388.31	      ---	  $489.69	004	1	0	0.00	    $0.00	Y	
K	61886	IMPLANT NEUROSTIM ARRAYS                	    10.17	  $378.63	      ---	  $477.48	004	1	0	0.00	    $0.00	Y	
K	61888	REVISE/REMOVE NEURORECEIVER             	     8.18	  $304.54	      ---	  $384.05	004	1	0	0.00	    $0.00	Y	
O	61888	REVISE/REMOVE NEURORECEIVER             	     1.63	   $60.68	      ---	   $76.53	004	1	0	0.00	    $0.00	Y	
O	61889	INS SK-MNT CRNL NSTM PG/RCVR            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	61889	INS SK-MNT CRNL NSTM PG/RCVR            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	61891	REV/RPLCMT SK-MNT CRNL NSTM             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	61891	REV/RPLCMT SK-MNT CRNL NSTM             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	61892	RMV SK-MNT CRNL NSTM PG/RCVR            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	61892	RMV SK-MNT CRNL NSTM PG/RCVR            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	62000	TREAT SKULL FRACTURE                    	    18.00	  $670.14	      ---	  $845.10	004	1	0	0.00	    $0.00	Y	
O	62000	TREAT SKULL FRACTURE                    	     3.60	  $134.03	      ---	  $169.02	004	1	0	0.00	    $0.00	Y	
O	62005	TREAT SKULL FRACTURE                    	     4.80	  $178.70	      ---	  $225.36	004	1	0	0.00	    $0.00	Y	
K	62005	TREAT SKULL FRACTURE                    	    24.00	  $893.52	      ---	 $1126.80	004	1	0	0.00	    $0.00	Y	
K	62010	TREATMENT OF HEAD INJURY                	    29.00	 $1079.67	      ---	 $1361.55	004	1	0	0.00	    $0.00	Y	
O	62010	TREATMENT OF HEAD INJURY                	     5.80	  $215.93	      ---	  $272.31	004	1	0	0.00	    $0.00	Y	
O	62100	REPAIR BRAIN FLUID LEAKAGE              	     6.55	  $243.86	      ---	  $307.52	004	1	0	0.00	    $0.00	Y	
K	62100	REPAIR BRAIN FLUID LEAKAGE              	    32.75	 $1219.28	      ---	 $1537.61	004	1	0	0.00	    $0.00	Y	
K	62115	REDUCTION OF SKULL DEFECT               	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
O	62115	REDUCTION OF SKULL DEFECT               	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
O	62117	REDUCTION OF SKULL DEFECT               	     7.91	  $294.49	      ---	  $371.37	004	1	0	0.00	    $0.00	Y	
K	62117	REDUCTION OF SKULL DEFECT               	    39.56	 $1472.82	      ---	 $1857.34	004	1	0	0.00	    $0.00	Y	
K	62120	REPAIR SKULL CAVITY LESION              	    30.01	 $1117.27	      ---	 $1408.97	004	1	0	0.00	    $0.00	Y	
O	62120	REPAIR SKULL CAVITY LESION              	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
O	62121	INCISE SKULL REPAIR                     	     6.37	  $237.16	      ---	  $299.07	004	1	0	0.00	    $0.00	Y	
K	62121	INCISE SKULL REPAIR                     	    31.84	 $1185.40	      ---	 $1494.89	004	1	0	0.00	    $0.00	Y	
K	62140	CRNOP SKULL DEFECT<5 CM DIAM            	    20.35	  $757.63	      ---	  $955.43	004	1	0	0.00	    $0.00	Y	
O	62140	CRNOP SKULL DEFECT<5 CM DIAM            	     4.07	  $151.53	      ---	  $191.09	004	1	0	0.00	    $0.00	Y	
O	62141	CRNOP SKULL DEFECT>5 CM DIAM            	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	62141	CRNOP SKULL DEFECT>5 CM DIAM            	    22.54	  $839.16	      ---	 $1058.25	004	1	0	0.00	    $0.00	Y	
K	62142	RMVL B1 FLP/PROSTC PLATE SKL            	    16.59	  $617.65	      ---	  $778.90	004	1	0	0.00	    $0.00	Y	
O	62142	RMVL B1 FLP/PROSTC PLATE SKL            	     3.32	  $123.60	      ---	  $155.87	004	1	0	0.00	    $0.00	Y	
O	62143	RPL B1 FLP/PROSTC PLATE SKL             	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
K	62143	RPL B1 FLP/PROSTC PLATE SKL             	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
K	62145	REPAIR OF SKULL & BRAIN                 	    34.00	 $1265.82	      ---	 $1596.30	004	1	0	0.00	    $0.00	Y	
O	62145	REPAIR OF SKULL & BRAIN                 	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
O	62146	CRNOP W/AUTOGRAFT<5 CM DIAM             	     4.81	  $179.08	      ---	  $225.83	004	1	0	0.00	    $0.00	Y	
K	62146	CRNOP W/AUTOGRAFT<5 CM DIAM             	    24.05	  $895.38	      ---	 $1129.15	004	1	0	0.00	    $0.00	Y	
K	62147	CRNOP W/AUTOGRAFT>5 CM DIAM             	    28.18	 $1049.14	      ---	 $1323.05	004	1	0	0.00	    $0.00	Y	
O	62147	CRNOP W/AUTOGRAFT>5 CM DIAM             	     5.64	  $209.98	      ---	  $264.80	004	1	0	0.00	    $0.00	Y	
O	62148	RETR BONE FLAP TO FIX SKULL             	     0.38	   $14.15	      ---	   $17.84	004	1	0	0.00	    $0.00	Y	
K	62148	RETR BONE FLAP TO FIX SKULL             	     1.89	   $70.36	      ---	   $88.74	004	1	0	0.00	    $0.00	Y	
K	62160	NEUROENDOSCOPY ADD-ON                   	     2.75	  $102.38	      ---	  $129.11	004	1	0	0.00	    $0.00	Y	
O	62160	NEUROENDOSCOPY ADD-ON                   	     0.55	   $20.48	      ---	   $25.82	004	1	0	0.00	    $0.00	Y	
O	62161	DISSECT BRAIN W/SCOPE                   	     3.70	  $137.75	      ---	  $173.72	004	1	0	0.00	    $0.00	Y	
K	62161	DISSECT BRAIN W/SCOPE                   	    18.48	  $688.01	      ---	  $867.64	004	1	0	0.00	    $0.00	Y	
K	62162	REMOVE COLLOID CYST W/SCOPE             	    24.05	  $895.38	      ---	 $1129.15	004	1	0	0.00	    $0.00	Y	
O	62162	REMOVE COLLOID CYST W/SCOPE             	     4.81	  $179.08	      ---	  $225.83	004	1	0	0.00	    $0.00	Y	
O	62164	REMOVE BRAIN TUMOR W/SCOPE              	     5.17	  $192.48	      ---	  $242.73	004	1	0	0.00	    $0.00	Y	
K	62164	REMOVE BRAIN TUMOR W/SCOPE              	    25.86	  $962.77	      ---	 $1214.13	004	1	0	0.00	    $0.00	Y	
K	62165	REMOVE PITUIT TUMOR W/SCOPE             	    20.04	  $746.09	      ---	  $940.88	004	1	0	0.00	    $0.00	Y	
O	62165	REMOVE PITUIT TUMOR W/SCOPE             	     4.01	  $149.29	      ---	  $188.27	004	1	0	0.00	    $0.00	Y	
O	62180	ESTABLISH BRAIN CAVITY SHUNT            	     6.40	  $238.27	      ---	  $300.48	004	1	0	0.00	    $0.00	Y	
K	62180	ESTABLISH BRAIN CAVITY SHUNT            	    32.00	 $1191.36	      ---	 $1502.40	004	1	0	0.00	    $0.00	Y	
K	62190	ESTABLISH BRAIN CAVITY SHUNT            	    26.00	  $967.98	      ---	 $1220.70	004	1	0	0.00	    $0.00	Y	
O	62190	ESTABLISH BRAIN CAVITY SHUNT            	     5.20	  $193.60	      ---	  $244.14	004	1	0	0.00	    $0.00	Y	
O	62192	ESTABLISH BRAIN CAVITY SHUNT            	     5.20	  $193.60	      ---	  $244.14	004	1	0	0.00	    $0.00	Y	
K	62192	ESTABLISH BRAIN CAVITY SHUNT            	    26.00	  $967.98	      ---	 $1220.70	004	1	0	0.00	    $0.00	Y	
K	62194	REPLACE/IRRIGATE CATHETER               	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
O	62194	REPLACE/IRRIGATE CATHETER               	     2.00	   $74.46	      ---	   $93.90	004	1	0	0.00	    $0.00	Y	
O	62200	ESTABLISH BRAIN CAVITY SHUNT            	     6.40	  $238.27	      ---	  $300.48	004	1	0	0.00	    $0.00	Y	
K	62200	ESTABLISH BRAIN CAVITY SHUNT            	    32.00	 $1191.36	      ---	 $1502.40	004	1	0	0.00	    $0.00	Y	
K	62201	BRAIN CAVITY SHUNT W/SCOPE              	    32.00	 $1191.36	      ---	 $1502.40	004	1	0	0.00	    $0.00	Y	
O	62201	BRAIN CAVITY SHUNT W/SCOPE              	     6.40	  $238.27	      ---	  $300.48	004	1	0	0.00	    $0.00	Y	
O	62220	ESTABLISH BRAIN CAVITY SHUNT            	     5.20	  $193.60	      ---	  $244.14	004	1	0	0.00	    $0.00	Y	
K	62220	ESTABLISH BRAIN CAVITY SHUNT            	    26.00	  $967.98	      ---	 $1220.70	004	1	0	0.00	    $0.00	Y	
K	62223	ESTABLISH BRAIN CAVITY SHUNT            	    26.00	  $967.98	      ---	 $1220.70	004	1	0	0.00	    $0.00	Y	
O	62223	ESTABLISH BRAIN CAVITY SHUNT            	     5.20	  $193.60	      ---	  $244.14	004	1	0	0.00	    $0.00	Y	
O	62225	REPLACE/IRRIGATE CATHETER               	     2.00	   $74.46	      ---	   $93.90	004	1	0	0.00	    $0.00	Y	
K	62225	REPLACE/IRRIGATE CATHETER               	    10.00	  $372.30	      ---	  $469.50	004	1	1	0.00	    $0.00	Y	
K	62230	REPLACE/REVISE BRAIN SHUNT              	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
O	62230	REPLACE/REVISE BRAIN SHUNT              	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
K	62252	CSF SHUNT REPROGRAM                     	     1.95	   $72.60	      ---	   $91.55	004	1	0	0.47	    $0.00	Y	
K	62256	REMOVE BRAIN CAVITY SHUNT               	    10.89	  $405.43	      ---	  $511.29	004	1	1	0.00	    $0.00	Y	
O	62256	REMOVE BRAIN CAVITY SHUNT               	     2.18	   $81.16	      ---	  $102.35	004	1	0	0.00	    $0.00	Y	
O	62258	REPLACE BRAIN CAVITY SHUNT              	     2.67	   $99.40	      ---	  $125.36	004	1	0	0.00	    $0.00	Y	
K	62258	REPLACE BRAIN CAVITY SHUNT              	    13.36	  $497.39	      ---	  $627.25	004	1	0	0.00	    $0.00	Y	
K	62263	EPIDURAL LYSIS MULT SESSIONS            	     7.64	  $284.44	      ---	  $358.70	004	1	0	0.00	    $0.00	Y	
K	62264	EPIDURAL LYSIS ON SINGLE DAY            	     5.13	  $190.99	      ---	  $240.85	004	1	0	0.00	    $0.00	Y	
K	62267	INTERDISCAL PERQ ASPIR DX               	     3.13	  $116.53	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	62268	DRAIN SPINAL CORD CYST                  	     8.60	  $320.18	      ---	  $403.77	004	1	0	0.00	    $0.00	Y	
K	62269	NEEDLE BIOPSY SPINAL CORD               	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
K	62270	DX LMBR SPI PNXR                        	     2.20	   $81.91	      ---	  $103.29	004	1	1	0.00	    $0.00	Y	
X	62270	DX LMBR SPI PNXR                        	   121.83	  $121.83	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	62272	THER SPI PNXR DRG CSF                   	     2.21	   $82.28	      ---	  $103.76	004	1	0	0.00	    $0.00	Y	
K	62273	INJECT EPIDURAL PATCH                   	     2.04	   $75.95	      ---	   $95.78	004	1	0	0.00	    $0.00	Y	
K	62280	TREAT SPINAL CORD LESION                	     3.32	  $123.60	      ---	  $155.87	004	1	0	0.00	    $0.00	Y	
K	62281	TREAT SPINAL CORD LESION                	     2.88	  $107.22	      ---	  $135.22	004	1	0	0.00	    $0.00	Y	
K	62282	TREAT SPINAL CANAL LESION               	     3.61	  $134.40	      ---	  $169.49	004	1	0	0.00	    $0.00	Y	
K	62284	INJECTION FOR MYELOGRAM                 	     2.38	   $88.61	      ---	  $111.74	004	1	0	0.00	    $0.00	Y	
K	62287	DCMPRN PX PERQ 1/MLT LUMBAR             	    20.00	  $744.60	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	62290	NJX PX DISCOGRAPHY LUMBAR               	     3.43	  $127.70	      ---	  $161.04	004	1	0	0.00	    $0.00	Y	
O	62290	NJX PX DISCOGRAPHY LUMBAR               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	62291	NJX PX DISCOGRAPHY CRV/THRC             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	62291	NJX PX DISCOGRAPHY CRV/THRC             	     3.45	  $128.44	      ---	  $161.98	004	1	0	0.00	    $0.00	Y	
K	62292	NJX CHEMONUCLEOLYSIS LMBR               	    12.41	  $462.02	      ---	  $582.65	004	1	0	0.00	    $0.00	Y	
K	62294	INJECTION INTO SPINAL ARTERY            	    16.57	  $616.90	      ---	  $777.96	004	1	0	0.00	    $0.00	Y	
O	62294	INJECTION INTO SPINAL ARTERY            	     3.31	  $123.23	      ---	  $155.40	004	1	0	0.00	    $0.00	Y	
K	62302	MYELOGRAPHY LUMBAR INJECTION            	     2.91	  $108.34	      ---	       --	004	0	0	0.00	    $0.00	N	
K	62303	MYELOGRAPHY LUMBAR INJECTION            	     2.95	  $109.83	      ---	       --	004	0	0	0.00	    $0.00	N	
K	62304	MYELOGRAPHY LUMBAR INJECTION            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	N	
K	62305	MYELOGRAPHY LUMBAR INJECTION            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	N	
K	62320	NJX INTERLAMINAR CRV/THRC               	     3.97	  $147.80	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	62321	NJX INTERLAMINAR CRV/THRC               	     6.00	  $223.38	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	62322	NJX INTERLAMINAR LMBR/SAC               	     3.72	  $138.50	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	62323	NJX INTERLAMINAR LMBR/SAC               	     5.91	  $220.03	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	62324	NJX INTERLAMINAR CRV/THRC               	     3.42	  $127.33	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	62325	NJX INTERLAMINAR CRV/THRC               	     5.25	  $195.46	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	62326	NJX INTERLAMINAR LMBR/SAC               	     3.63	  $135.14	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	62327	NJX INTERLAMINAR LMBR/SAC               	     5.40	  $201.04	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	62328	DX LMBR SPI PNXR W/FLUOR/CT             	     6.39	  $237.90	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	62329	THER SPI PNXR CSF FLUOR/CT              	     7.90	  $294.12	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	62350	IMPLANT SPINAL CANAL CATH               	     7.01	  $260.98	      ---	  $329.12	004	1	0	0.00	    $0.00	Y	
O	62350	IMPLANT SPINAL CANAL CATH               	     1.40	   $52.12	      ---	   $65.73	004	1	0	0.00	    $0.00	Y	
O	62351	IMPLANT SPINAL CANAL CATH               	     2.07	   $77.07	      ---	   $97.19	004	1	0	0.00	    $0.00	Y	
K	62351	IMPLANT SPINAL CANAL CATH               	    10.36	  $385.70	      ---	  $486.40	004	1	0	0.00	    $0.00	Y	
K	62355	REMOVE SPINAL CANAL CATHETER            	     5.84	  $217.42	      ---	  $274.19	004	1	0	0.00	    $0.00	Y	
O	62355	REMOVE SPINAL CANAL CATHETER            	     1.17	   $43.56	      ---	   $54.93	004	1	0	0.00	    $0.00	Y	
O	62360	INSERT SPINE INFUSION DEVICE            	     0.45	   $16.75	      ---	   $21.13	004	1	0	0.00	    $0.00	Y	
K	62360	INSERT SPINE INFUSION DEVICE            	     2.24	   $83.40	      ---	  $105.17	004	1	0	0.00	    $0.00	Y	
K	62361	IMPLANT SPINE INFUSION PUMP             	     5.38	  $200.30	      ---	  $252.59	004	1	0	0.00	    $0.00	Y	
O	62361	IMPLANT SPINE INFUSION PUMP             	     1.08	   $40.21	      ---	   $50.71	004	1	0	0.00	    $0.00	Y	
O	62362	IMPLANT SPINE INFUSION PUMP             	     1.40	   $52.12	      ---	   $65.73	004	1	0	0.00	    $0.00	Y	
K	62362	IMPLANT SPINE INFUSION PUMP             	     7.04	  $262.10	      ---	  $330.53	004	1	0	0.00	    $0.00	Y	
K	62365	REMOVE SPINE INFUSION DEVICE            	     5.81	  $216.31	      ---	  $272.78	004	1	0	0.00	    $0.00	Y	
O	62365	REMOVE SPINE INFUSION DEVICE            	     1.17	   $43.56	      ---	   $54.93	004	1	0	0.00	    $0.00	Y	
K	62367	ANALYZE SPINE INFUS PUMP                	     0.59	   $21.97	      ---	   $27.70	004	1	0	1.00	    $0.00	N	
K	62368	ANALYZE SP INF PUMP W/REPROG            	     0.92	   $34.25	      ---	   $43.19	004	1	0	1.00	    $0.00	N	
K	62369	ANAL SP INF PMP W/REPRG&FILL            	     0.79	   $29.41	      ---	   $37.09	004	1	0	0.00	    $0.00	Y	
K	62370	ANL SP INF PMP W/MDREPRG&FIL            	     1.06	   $39.46	      ---	   $49.77	004	1	0	0.00	    $0.00	Y	
K	62380	NDSC DCMPRN 1 NTRSPC LUMBAR             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	62380	NDSC DCMPRN 1 NTRSPC LUMBAR             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	63001	REMOVE SPINE LAMINA 1/2 CRVL            	     6.40	  $238.27	      ---	  $300.48	004	1	0	0.00	    $0.00	Y	
K	63001	REMOVE SPINE LAMINA 1/2 CRVL            	    32.00	 $1191.36	      ---	 $1502.40	004	1	0	0.00	    $0.00	Y	
K	63003	REMOVE SPINE LAMINA 1/2 THRC            	    32.00	 $1191.36	      ---	 $1502.40	004	1	0	0.00	    $0.00	Y	
O	63003	REMOVE SPINE LAMINA 1/2 THRC            	     6.40	  $238.27	      ---	  $300.48	004	1	0	0.00	    $0.00	Y	
O	63005	REMOVE SPINE LAMINA 1/2 LMBR            	     5.20	  $193.60	      ---	  $244.14	004	1	0	0.00	    $0.00	Y	
K	63005	REMOVE SPINE LAMINA 1/2 LMBR            	    26.00	  $967.98	      ---	 $1220.70	004	1	0	0.00	    $0.00	Y	
K	63011	REMOVE SPINE LAMINA 1/2 SCRL            	    22.00	  $819.06	      ---	 $1032.90	004	1	0	0.00	    $0.00	Y	
O	63011	REMOVE SPINE LAMINA 1/2 SCRL            	     4.40	  $163.81	      ---	  $206.58	004	1	0	0.00	    $0.00	Y	
O	63012	REMOVE LAMINA/FACETS LUMBAR             	     5.60	  $208.49	      ---	  $262.92	004	1	0	0.00	    $0.00	Y	
K	63012	REMOVE LAMINA/FACETS LUMBAR             	    28.00	 $1042.44	      ---	 $1314.60	004	1	0	0.00	    $0.00	Y	
K	63015	REMOVE SPINE LAMINA >2 CRVCL            	    32.00	 $1191.36	      ---	 $1502.40	004	1	0	0.00	    $0.00	Y	
O	63015	REMOVE SPINE LAMINA >2 CRVCL            	     1.02	   $37.97	      ---	   $47.89	004	1	0	0.00	    $0.00	Y	
O	63016	REMOVE SPINE LAMINA >2 THRC             	     6.28	  $233.80	      ---	  $294.85	004	1	0	0.00	    $0.00	Y	
K	63016	REMOVE SPINE LAMINA >2 THRC             	    31.39	 $1168.65	      ---	 $1473.76	004	1	0	0.00	    $0.00	Y	
K	63017	REMOVE SPINE LAMINA >2 LMBR             	    27.62	 $1028.29	      ---	 $1296.76	004	1	0	0.00	    $0.00	Y	
O	63017	REMOVE SPINE LAMINA >2 LMBR             	     5.52	  $205.51	      ---	  $259.16	004	1	0	0.00	    $0.00	Y	
O	63020	NECK SPINE DISK SURGERY                 	     5.20	  $193.60	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	63020	NECK SPINE DISK SURGERY                 	    26.00	  $967.98	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	63030	LOW BACK DISK SURGERY                   	    24.00	  $893.52	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	63030	LOW BACK DISK SURGERY                   	     4.80	  $178.70	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	63035	SPINAL DISK SURGERY ADD-ON              	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	63035	SPINAL DISK SURGERY ADD-ON              	     5.30	  $197.32	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	63040	LAMINOTOMY SINGLE CERVICAL              	    28.81	 $1072.60	      ---	 $1352.63	004	1	0	0.00	    $0.00	Y	
O	63040	LAMINOTOMY SINGLE CERVICAL              	     5.76	  $214.44	      ---	  $270.43	004	1	0	0.00	    $0.00	Y	
O	63042	LAMINOTOMY SINGLE LUMBAR                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	63042	LAMINOTOMY SINGLE LUMBAR                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	63043	LAMINOTOMY ADDL CERVICAL                	     6.95	  $258.75	      ---	  $326.30	004	1	0	0.00	    $0.00	Y	
O	63043	LAMINOTOMY ADDL CERVICAL                	     1.39	   $51.75	      ---	   $65.26	004	1	0	0.00	    $0.00	Y	
O	63044	LAMINOTOMY ADDL LUMBAR                  	     1.31	   $48.77	      ---	   $61.50	004	1	0	0.00	    $0.00	Y	
K	63044	LAMINOTOMY ADDL LUMBAR                  	     6.57	  $244.60	      ---	  $308.46	004	1	0	0.00	    $0.00	Y	
K	63045	LAM FACETEC & FORAMOT CRV               	    25.77	  $959.42	      ---	 $1209.90	004	1	0	0.00	    $0.00	Y	
O	63045	LAM FACETEC & FORAMOT CRV               	     5.15	  $191.73	      ---	  $241.79	004	1	0	0.00	    $0.00	Y	
O	63046	LAM FACETEC & FORAMOT THRC              	     5.34	  $198.81	      ---	  $250.71	004	1	0	0.00	    $0.00	Y	
K	63046	LAM FACETEC & FORAMOT THRC              	    26.72	  $994.79	      ---	 $1254.50	004	1	0	0.00	    $0.00	Y	
K	63047	LAM FACETEC & FORAMOT LUMBAR            	    24.52	  $912.88	      ---	 $1151.21	004	1	0	0.00	    $0.00	Y	
O	63047	LAM FACETEC & FORAMOT LUMBAR            	     4.90	  $182.43	      ---	  $230.06	004	1	0	0.00	    $0.00	Y	
O	63048	LAM FACETEC &FORAMOT EA ADDL            	     1.10	   $40.95	      ---	   $51.65	004	1	0	0.00	    $0.00	Y	
K	63048	LAM FACETEC &FORAMOT EA ADDL            	     5.52	  $205.51	      ---	  $259.16	004	1	0	0.00	    $0.00	Y	
K	63050	CERVICAL LAMINOPLSTY 2/> SEG            	    20.54	  $764.70	      ---	  $964.35	004	1	0	0.00	    $0.00	Y	
O	63050	CERVICAL LAMINOPLSTY 2/> SEG            	     4.11	  $153.02	      ---	  $192.96	004	1	0	0.00	    $0.00	Y	
O	63051	C-LAMINOPLASTY W/GRAFT/PLATE            	     4.70	  $174.98	      ---	  $220.67	004	1	0	0.00	    $0.00	Y	
K	63051	C-LAMINOPLASTY W/GRAFT/PLATE            	    23.48	  $874.16	      ---	 $1102.39	004	1	0	0.00	    $0.00	Y	
K	63052	LAM FACETC/FRMT ARTHRD LUM 1            	     5.74	  $213.70	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	63052	LAM FACETC/FRMT ARTHRD LUM 1            	     1.14	   $42.44	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	63053	LAM FACTC/FRMT ARTHRD LUM EA            	     0.86	   $32.02	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	63053	LAM FACTC/FRMT ARTHRD LUM EA            	     4.30	  $160.09	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	63055	DECOMPRESS SPINAL CORD THRC             	    35.45	 $1319.80	      ---	 $1664.38	004	1	0	0.00	    $0.00	Y	
O	63055	DECOMPRESS SPINAL CORD THRC             	     7.09	  $263.96	      ---	  $332.88	004	1	0	0.00	    $0.00	Y	
O	63056	DECOMPRESS SPINAL CORD LMBR             	     6.10	  $227.10	      ---	  $286.40	004	1	0	0.00	    $0.00	Y	
K	63056	DECOMPRESS SPINAL CORD LMBR             	    30.52	 $1136.26	      ---	 $1432.91	004	1	0	0.00	    $0.00	Y	
K	63057	DECOMPRESS SPINE CORD ADD-ON            	     8.14	  $303.05	      ---	  $382.17	004	1	0	0.00	    $0.00	Y	
O	63057	DECOMPRESS SPINE CORD ADD-ON            	     1.63	   $60.68	      ---	   $76.53	004	1	0	0.00	    $0.00	Y	
O	63064	DECOMPRESS SPINAL CORD THRC             	     7.25	  $269.92	      ---	  $340.39	004	1	0	0.00	    $0.00	Y	
K	63064	DECOMPRESS SPINAL CORD THRC             	    36.24	 $1349.22	      ---	 $1701.47	004	1	0	0.00	    $0.00	Y	
K	63066	DECOMPRESS SPINE CORD ADD-ON            	     5.25	  $195.46	      ---	  $246.49	004	1	0	0.00	    $0.00	Y	
O	63066	DECOMPRESS SPINE CORD ADD-ON            	     1.05	   $39.09	      ---	   $49.30	004	1	0	0.00	    $0.00	Y	
O	63075	NECK SPINE DISK SURGERY                 	     5.21	  $193.97	      ---	  $244.61	004	1	0	0.00	    $0.00	Y	
K	63075	NECK SPINE DISK SURGERY                 	    26.28	  $978.40	      ---	 $1233.85	004	1	0	0.00	    $0.00	Y	
K	63076	NECK SPINE DISK SURGERY                 	     5.63	  $209.60	      ---	  $264.33	004	1	0	0.00	    $0.00	Y	
O	63076	NECK SPINE DISK SURGERY                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	63077	SPINE DISK SURGERY THORAX               	     6.46	  $240.51	      ---	  $303.30	004	1	0	0.00	    $0.00	Y	
K	63077	SPINE DISK SURGERY THORAX               	    32.29	 $1202.16	      ---	 $1516.02	004	1	0	0.00	    $0.00	Y	
K	63078	SPINE DISK SURGERY THORAX               	     5.24	  $195.09	      ---	  $246.02	004	1	0	0.00	    $0.00	Y	
O	63078	SPINE DISK SURGERY THORAX               	     1.05	   $39.09	      ---	   $49.30	004	1	0	0.00	    $0.00	Y	
O	63081	REMOVE VERT BODY DCMPRN CRVL            	     7.24	  $269.55	      ---	  $339.92	004	1	0	0.00	    $0.00	Y	
K	63081	REMOVE VERT BODY DCMPRN CRVL            	    36.22	 $1348.47	      ---	 $1700.53	004	1	0	0.00	    $0.00	Y	
K	63082	REMOVE VERTEBRAL BODY ADD-ON            	     7.28	  $271.03	      ---	  $341.80	004	1	0	0.00	    $0.00	Y	
O	63082	REMOVE VERTEBRAL BODY ADD-ON            	     1.46	   $54.36	      ---	   $68.55	004	1	0	0.00	    $0.00	Y	
O	63085	REMOVE VERT BODY DCMPRN THRC            	     8.09	  $301.19	      ---	  $379.83	004	1	0	0.00	    $0.00	Y	
K	63085	REMOVE VERT BODY DCMPRN THRC            	    40.47	 $1506.70	      ---	 $1900.07	004	1	0	0.00	    $0.00	Y	
K	63086	REMOVE VERTEBRAL BODY ADD-ON            	     5.43	  $202.16	      ---	  $254.94	004	1	0	0.00	    $0.00	Y	
O	63086	REMOVE VERTEBRAL BODY ADD-ON            	     1.09	   $40.58	      ---	   $51.18	004	1	0	0.00	    $0.00	Y	
O	63087	REMOV VERTBR DCMPRN THRCLMBR            	    10.29	  $383.10	      ---	  $483.12	004	1	0	0.00	    $0.00	Y	
K	63087	REMOV VERTBR DCMPRN THRCLMBR            	    51.45	 $1915.48	      ---	 $2415.58	004	1	0	0.00	    $0.00	Y	
K	63088	REMOVE VERTEBRAL BODY ADD-ON            	     7.15	  $266.19	      ---	  $335.69	004	1	0	0.00	    $0.00	Y	
O	63088	REMOVE VERTEBRAL BODY ADD-ON            	     1.43	   $53.24	      ---	   $67.14	004	1	0	0.00	    $0.00	Y	
O	63090	REMOVE VERT BODY DCMPRN LMBR            	     8.21	  $305.66	      ---	  $385.46	004	1	0	0.00	    $0.00	Y	
K	63090	REMOVE VERT BODY DCMPRN LMBR            	    41.04	 $1527.92	      ---	 $1926.83	004	1	0	0.00	    $0.00	Y	
K	63091	REMOVE VERTEBRAL BODY ADD-ON            	     4.84	  $180.19	      ---	  $227.24	004	1	0	0.00	    $0.00	Y	
O	63091	REMOVE VERTEBRAL BODY ADD-ON            	     0.97	   $36.11	      ---	   $45.54	004	1	0	0.00	    $0.00	Y	
O	63101	REMOVE VERT BODY DCMPRN THRC            	     5.85	  $217.80	      ---	  $274.66	004	1	0	0.00	    $0.00	Y	
K	63101	REMOVE VERT BODY DCMPRN THRC            	    29.26	 $1089.35	      ---	 $1373.76	004	1	0	0.00	    $0.00	Y	
K	63102	REMOVE VERT BODY DCMPRN LMBR            	    29.26	 $1089.35	      ---	 $1373.76	004	1	0	0.00	    $0.00	Y	
O	63102	REMOVE VERT BODY DCMPRN LMBR            	     5.85	  $217.80	      ---	  $274.66	004	1	0	0.00	    $0.00	Y	
O	63103	REMOVE VERTEBRAL BODY ADD-ON            	     0.72	   $26.81	      ---	   $33.80	004	1	0	0.00	    $0.00	Y	
K	63103	REMOVE VERTEBRAL BODY ADD-ON            	     3.61	  $134.40	      ---	  $169.49	004	1	0	0.00	    $0.00	Y	
K	63170	INCISE SPINAL CORD TRACT(S)             	    30.45	 $1133.65	      ---	 $1429.63	004	1	0	0.00	    $0.00	Y	
O	63170	INCISE SPINAL CORD TRACT(S)             	     6.09	  $226.73	      ---	  $285.93	004	1	0	0.00	    $0.00	Y	
O	63172	DRAINAGE OF SPINAL CYST                 	     5.58	  $207.74	      ---	  $261.98	004	1	0	0.00	    $0.00	Y	
K	63172	DRAINAGE OF SPINAL CYST                 	    27.89	 $1038.34	      ---	 $1309.44	004	1	0	0.00	    $0.00	Y	
K	63173	DRAINAGE OF SPINAL CYST                 	    33.72	 $1255.40	      ---	 $1583.15	004	1	0	0.00	    $0.00	Y	
O	63173	DRAINAGE OF SPINAL CYST                 	     6.74	  $250.93	      ---	  $316.44	004	1	0	0.00	    $0.00	Y	
O	63185	INCISE SPINE NRV HALF SEGMNT            	     5.60	  $208.49	      ---	  $262.92	004	1	0	0.00	    $0.00	Y	
K	63185	INCISE SPINE NRV HALF SEGMNT            	    28.00	 $1042.44	      ---	 $1314.60	004	1	0	0.00	    $0.00	Y	
K	63190	INCISE SPINE NRV >2 SEGMNTS             	    27.97	 $1041.32	      ---	 $1313.19	004	1	0	0.00	    $0.00	Y	
O	63190	INCISE SPINE NRV >2 SEGMNTS             	     5.59	  $208.12	      ---	  $262.45	004	1	0	0.00	    $0.00	Y	
O	63191	INCISE SPINE ACCESSORY NERVE            	     5.48	  $204.02	      ---	  $257.29	004	1	0	0.00	    $0.00	Y	
K	63191	INCISE SPINE ACCESSORY NERVE            	    27.42	 $1020.85	      ---	 $1287.37	004	1	0	0.00	    $0.00	Y	
K	63197	LAM W/CORDOTOMY 1STG THRC               	    32.00	 $1191.36	      ---	 $1502.40	004	1	0	0.00	    $0.00	Y	
O	63197	LAM W/CORDOTOMY 1STG THRC               	     6.40	  $238.27	      ---	  $300.48	004	1	0	0.00	    $0.00	Y	
O	63200	RELEASE SPINAL CORD LUMBAR              	     6.69	  $249.07	      ---	  $314.10	004	1	0	0.00	    $0.00	Y	
K	63200	RELEASE SPINAL CORD LUMBAR              	    33.45	 $1245.34	      ---	 $1570.48	004	1	0	0.00	    $0.00	Y	
K	63250	REVISE SPINAL CORD VSLS CRVL            	    56.21	 $2092.70	      ---	 $2639.06	004	1	0	0.00	    $0.00	Y	
O	63250	REVISE SPINAL CORD VSLS CRVL            	    11.24	  $418.47	      ---	  $527.72	004	1	0	0.00	    $0.00	Y	
O	63251	REVISE SPINAL CORD VSLS THRC            	    11.76	  $437.82	      ---	  $552.13	004	1	0	0.00	    $0.00	Y	
K	63251	REVISE SPINAL CORD VSLS THRC            	    58.79	 $2188.75	      ---	 $2760.19	004	1	0	0.00	    $0.00	Y	
K	63252	REVISE SPINE CORD VSL THRLMB            	    62.30	 $2319.43	      ---	 $2924.99	004	1	0	0.00	    $0.00	Y	
O	63252	REVISE SPINE CORD VSL THRLMB            	    12.46	  $463.89	      ---	  $585.00	004	1	0	0.00	    $0.00	Y	
O	63265	EXCISE INTRASPINL LESION CRV            	     7.28	  $271.03	      ---	  $341.80	004	1	0	0.00	    $0.00	Y	
K	63265	EXCISE INTRASPINL LESION CRV            	    36.44	 $1356.66	      ---	 $1710.86	004	1	0	0.00	    $0.00	Y	
K	63266	EXCISE INTRSPINL LESION THRC            	    35.66	 $1327.62	      ---	 $1674.24	004	1	0	0.00	    $0.00	Y	
O	63266	EXCISE INTRSPINL LESION THRC            	     7.13	  $265.45	      ---	  $334.75	004	1	0	0.00	    $0.00	Y	
O	63267	EXCISE INTRSPINL LESION LMBR            	     6.05	  $225.24	      ---	  $284.05	004	1	0	0.00	    $0.00	Y	
K	63267	EXCISE INTRSPINL LESION LMBR            	    30.26	 $1126.58	      ---	 $1420.71	004	1	0	0.00	    $0.00	Y	
K	63268	EXCISE INTRSPINL LESION SCRL            	    31.75	 $1182.05	      ---	 $1490.66	004	1	0	0.00	    $0.00	Y	
O	63268	EXCISE INTRSPINL LESION SCRL            	     6.35	  $236.41	      ---	  $298.13	004	1	0	0.00	    $0.00	Y	
O	63270	EXCISE INTRSPINL LESION CRVL            	     7.85	  $292.26	      ---	  $368.56	004	1	0	0.00	    $0.00	Y	
K	63270	EXCISE INTRSPINL LESION CRVL            	    39.23	 $1460.53	      ---	 $1841.85	004	1	0	0.00	    $0.00	Y	
K	63271	EXCISE INTRSPINL LESION THRC            	    42.47	 $1581.16	      ---	 $1993.97	004	1	0	0.00	    $0.00	Y	
O	63271	EXCISE INTRSPINL LESION THRC            	     8.49	  $316.08	      ---	  $398.61	004	1	0	0.00	    $0.00	Y	
O	63272	EXCISE INTRSPINL LESION LMBR            	     7.38	  $274.76	      ---	  $346.49	004	1	0	0.00	    $0.00	Y	
K	63272	EXCISE INTRSPINL LESION LMBR            	    36.90	 $1373.79	      ---	 $1732.46	004	1	0	0.00	    $0.00	Y	
K	63273	EXCISE INTRSPINL LESION SCRL            	    35.67	 $1327.99	      ---	 $1674.71	004	1	0	0.00	    $0.00	Y	
O	63273	EXCISE INTRSPINL LESION SCRL            	     7.13	  $265.45	      ---	  $334.75	004	1	0	0.00	    $0.00	Y	
O	63275	BX/EXC XDRL SPINE LESN CRVL             	     7.83	  $291.51	      ---	  $367.62	004	1	0	0.00	    $0.00	Y	
K	63275	BX/EXC XDRL SPINE LESN CRVL             	    39.17	 $1458.30	      ---	 $1839.03	004	1	0	0.00	    $0.00	Y	
K	63276	BX/EXC XDRL SPINE LESN THRC             	    34.26	 $1275.50	      ---	 $1608.51	004	1	0	0.00	    $0.00	Y	
O	63276	BX/EXC XDRL SPINE LESN THRC             	     6.85	  $255.03	      ---	  $321.61	004	1	0	0.00	    $0.00	Y	
O	63277	BX/EXC XDRL SPINE LESN LMBR             	     6.11	  $227.48	      ---	  $286.86	004	1	0	0.00	    $0.00	Y	
K	63277	BX/EXC XDRL SPINE LESN LMBR             	    30.54	 $1137.00	      ---	 $1433.85	004	1	0	0.00	    $0.00	Y	
K	63278	BX/EXC XDRL SPINE LESN SCRL             	    30.12	 $1121.37	      ---	 $1414.13	004	1	0	0.00	    $0.00	Y	
O	63278	BX/EXC XDRL SPINE LESN SCRL             	     6.02	  $224.12	      ---	  $282.64	004	1	0	0.00	    $0.00	Y	
O	63280	BX/EXC IDRL SPINE LESN CRVL             	     8.27	  $307.89	      ---	  $388.28	004	1	0	0.00	    $0.00	Y	
K	63280	BX/EXC IDRL SPINE LESN CRVL             	    41.35	 $1539.46	      ---	 $1941.38	004	1	0	0.00	    $0.00	Y	
K	63281	BX/EXC IDRL SPINE LESN THRC             	    40.81	 $1519.36	      ---	 $1916.03	004	1	0	0.00	    $0.00	Y	
O	63281	BX/EXC IDRL SPINE LESN THRC             	     8.16	  $303.80	      ---	  $383.11	004	1	0	0.00	    $0.00	Y	
O	63282	BX/EXC IDRL SPINE LESN LMBR             	     7.73	  $287.79	      ---	  $362.92	004	1	0	0.00	    $0.00	Y	
K	63282	BX/EXC IDRL SPINE LESN LMBR             	    38.66	 $1439.31	      ---	 $1815.09	004	1	0	0.00	    $0.00	Y	
K	63283	BX/EXC IDRL SPINE LESN SCRL             	    18.80	  $699.92	      ---	  $882.66	004	1	0	0.00	    $0.00	Y	
O	63283	BX/EXC IDRL SPINE LESN SCRL             	     3.76	  $139.98	      ---	  $176.53	004	1	0	0.00	    $0.00	Y	
O	63285	BX/EXC IDRL IMED LESN CERVL             	    10.41	  $387.56	      ---	  $488.75	004	1	0	0.00	    $0.00	Y	
K	63285	BX/EXC IDRL IMED LESN CERVL             	    52.04	 $1937.45	      ---	 $2443.28	004	1	0	0.00	    $0.00	Y	
K	63286	BX/EXC IDRL IMED LESN THRC              	    54.90	 $2043.93	      ---	 $2577.56	004	1	0	0.00	    $0.00	Y	
O	63286	BX/EXC IDRL IMED LESN THRC              	    10.98	  $408.79	      ---	  $515.51	004	1	0	0.00	    $0.00	Y	
O	63287	BX/EXC IDRL IMED LESN THRLMB            	    10.64	  $396.13	      ---	  $499.55	004	1	0	0.00	    $0.00	Y	
K	63287	BX/EXC IDRL IMED LESN THRLMB            	    53.22	 $1981.38	      ---	 $2498.68	004	1	0	0.00	    $0.00	Y	
K	63290	BX/EXC XDRL/IDRL LSN ANY LVL            	    53.78	 $2002.23	      ---	 $2524.97	004	1	0	0.00	    $0.00	Y	
O	63290	BX/EXC XDRL/IDRL LSN ANY LVL            	    10.76	  $400.59	      ---	  $505.18	004	1	0	0.00	    $0.00	Y	
O	63295	REPAIR LAMINECTOMY DEFECT               	     1.02	   $37.97	      ---	   $47.89	004	1	0	0.00	    $0.00	Y	
K	63295	REPAIR LAMINECTOMY DEFECT               	     5.10	  $189.87	      ---	  $239.45	004	1	0	0.00	    $0.00	Y	
K	63300	REMOVE VERT XDRL BODY CRVCL             	    37.32	 $1389.42	      ---	 $1752.17	004	1	0	0.00	    $0.00	Y	
O	63300	REMOVE VERT XDRL BODY CRVCL             	     7.46	  $277.74	      ---	  $350.25	004	1	0	0.00	    $0.00	Y	
O	63301	REMOVE VERT XDRL BODY THRC              	     7.89	  $293.74	      ---	  $370.44	004	1	0	0.00	    $0.00	Y	
K	63301	REMOVE VERT XDRL BODY THRC              	    39.46	 $1469.10	      ---	 $1852.65	004	1	0	0.00	    $0.00	Y	
K	63302	REMOVE VERT XDRL BODY THRLMB            	    39.82	 $1482.50	      ---	 $1869.55	004	1	0	0.00	    $0.00	Y	
O	63302	REMOVE VERT XDRL BODY THRLMB            	     7.96	  $296.35	      ---	  $373.72	004	1	0	0.00	    $0.00	Y	
O	63303	REMOV VERT XDRL BDY LMBR/SAC            	     9.21	  $342.89	      ---	  $432.41	004	1	0	0.00	    $0.00	Y	
K	63303	REMOV VERT XDRL BDY LMBR/SAC            	    46.07	 $1715.19	      ---	 $2162.99	004	1	0	0.00	    $0.00	Y	
K	63304	REMOVE VERT IDRL BODY CRVCL             	    45.61	 $1698.06	      ---	 $2141.39	004	1	0	0.00	    $0.00	Y	
O	63304	REMOVE VERT IDRL BODY CRVCL             	     9.12	  $339.54	      ---	  $428.18	004	1	0	0.00	    $0.00	Y	
O	63305	REMOVE VERT IDRL BODY THRC              	     9.69	  $360.76	      ---	  $454.95	004	1	0	0.00	    $0.00	Y	
K	63305	REMOVE VERT IDRL BODY THRC              	    48.47	 $1804.54	      ---	 $2275.67	004	1	0	0.00	    $0.00	Y	
K	63306	REMOV VERT IDRL BDY THRCLMBR            	    47.62	 $1772.89	      ---	 $2235.76	004	1	0	0.00	    $0.00	Y	
O	63306	REMOV VERT IDRL BDY THRCLMBR            	     9.52	  $354.43	      ---	  $446.96	004	1	0	0.00	    $0.00	Y	
O	63307	REMOV VERT IDRL BDY LMBR/SAC            	     9.24	  $344.01	      ---	  $433.82	004	1	0	0.00	    $0.00	Y	
K	63307	REMOV VERT IDRL BDY LMBR/SAC            	    46.20	 $1720.03	      ---	 $2169.09	004	1	0	0.00	    $0.00	Y	
K	63308	REMOVE VERTEBRAL BODY ADD-ON            	     7.89	  $293.74	      ---	  $370.44	004	1	0	0.00	    $0.00	Y	
O	63308	REMOVE VERTEBRAL BODY ADD-ON            	     1.58	   $58.82	      ---	   $74.18	004	1	0	0.00	    $0.00	Y	
O	63600	REMOVE SPINAL CORD LESION               	     4.80	  $178.70	      ---	  $225.36	004	1	0	0.00	    $0.00	Y	
K	63600	REMOVE SPINAL CORD LESION               	    24.00	  $893.52	      ---	 $1126.80	004	1	0	0.00	    $0.00	Y	
K	63610	STIMULATION OF SPINAL CORD              	     6.23	  $231.94	      ---	  $292.50	004	1	0	0.00	    $0.00	Y	
O	63610	STIMULATION OF SPINAL CORD              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	63620	SRS SPINAL LESION                       	     2.85	  $106.11	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	63620	SRS SPINAL LESION                       	    14.27	  $531.27	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	63621	SRS SPINAL LESION ADDL                  	     4.43	  $164.93	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	63621	SRS SPINAL LESION ADDL                  	     0.89	   $33.13	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	63650	IMPLANT NEUROELECTRODES                 	     2.34	   $87.12	      ---	  $109.86	004	1	0	0.00	    $0.00	Y	
K	63650	IMPLANT NEUROELECTRODES                 	    11.72	  $436.34	      ---	  $550.25	004	1	0	0.00	    $0.00	Y	
K	63655	IMPLANT NEUROELECTRODES                 	    20.86	  $776.62	      ---	  $979.38	004	1	0	0.00	    $0.00	Y	
O	63655	IMPLANT NEUROELECTRODES                 	     4.17	  $155.25	      ---	  $195.78	004	1	0	0.00	    $0.00	Y	
O	63661	REMOVE SPINE ELTRD PERQ ARAY            	     2.58	   $96.05	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	63661	REMOVE SPINE ELTRD PERQ ARAY            	    12.89	  $479.89	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	63662	REMOVE SPINE ELTRD PLATE                	    15.62	  $581.53	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	63662	REMOVE SPINE ELTRD PLATE                	     3.12	  $116.16	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	63663	REVISE SPINE ELTRD PERQ ARAY            	     3.75	  $139.61	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	63663	REVISE SPINE ELTRD PERQ ARAY            	    18.76	  $698.43	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	63664	REVISE SPINE ELTRD PLATE                	    16.26	  $605.36	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	63664	REVISE SPINE ELTRD PLATE                	     3.25	  $121.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	63685	INS/RPLC SPI NPG/RCVR POCKET            	     2.03	   $75.58	      ---	   $95.31	004	1	0	0.00	    $0.00	Y	
K	63685	INS/RPLC SPI NPG/RCVR POCKET            	    10.16	  $378.26	      ---	  $477.01	004	1	0	0.00	    $0.00	Y	
K	63688	REV/RMV IMP SP NPG/R DTCH CN            	     8.13	  $302.68	      ---	  $381.70	004	1	0	0.00	    $0.00	Y	
O	63688	REV/RMV IMP SP NPG/R DTCH CN            	     1.63	   $60.68	      ---	   $76.53	004	1	0	0.00	    $0.00	Y	
O	63700	REPAIR OF SPINAL HERNIATION             	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	63700	REPAIR OF SPINAL HERNIATION             	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
K	63702	REPAIR OF SPINAL HERNIATION             	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
O	63702	REPAIR OF SPINAL HERNIATION             	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
O	63704	REPAIR OF SPINAL HERNIATION             	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
K	63704	REPAIR OF SPINAL HERNIATION             	    27.18	 $1011.91	      ---	 $1276.10	004	1	0	0.00	    $0.00	Y	
K	63706	REPAIR OF SPINAL HERNIATION             	    27.18	 $1011.91	      ---	 $1276.10	004	1	0	0.00	    $0.00	Y	
O	63706	REPAIR OF SPINAL HERNIATION             	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
O	63707	REPAIR SPINAL FLUID LEAKAGE             	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
K	63707	REPAIR SPINAL FLUID LEAKAGE             	    30.00	 $1116.90	      ---	 $1408.50	004	1	0	0.00	    $0.00	Y	
K	63709	REPAIR SPINAL FLUID LEAKAGE             	    30.00	 $1116.90	      ---	 $1408.50	004	1	0	0.00	    $0.00	Y	
O	63709	REPAIR SPINAL FLUID LEAKAGE             	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
O	63710	GRAFT REPAIR OF SPINE DEFECT            	     4.52	  $168.28	      ---	  $212.21	004	1	0	0.00	    $0.00	Y	
K	63710	GRAFT REPAIR OF SPINE DEFECT            	    22.60	  $841.40	      ---	 $1061.07	004	1	0	0.00	    $0.00	Y	
K	63740	INSTALL SPINAL SHUNT                    	    26.00	  $967.98	      ---	 $1220.70	004	1	0	0.00	    $0.00	Y	
O	63740	INSTALL SPINAL SHUNT                    	     5.20	  $193.60	      ---	  $244.14	004	1	0	0.00	    $0.00	Y	
O	63741	INSTALL SPINAL SHUNT                    	     4.16	  $154.88	      ---	  $195.31	004	1	0	0.00	    $0.00	Y	
K	63741	INSTALL SPINAL SHUNT                    	    20.80	  $774.38	      ---	  $976.56	004	1	0	0.00	    $0.00	Y	
K	63744	REVISION OF SPINAL SHUNT                	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	63744	REVISION OF SPINAL SHUNT                	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	63746	REMOVAL OF SPINAL SHUNT                 	     2.00	   $74.46	      ---	   $93.90	004	1	0	0.00	    $0.00	Y	
K	63746	REMOVAL OF SPINAL SHUNT                 	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
K	64400	NJX AA&/STRD TRIGEMINAL NRV             	     1.52	   $56.59	      ---	   $71.36	004	1	1	0.00	    $0.00	Y	
K	64405	NJX AA&/STRD GR OCPL NRV                	     1.69	   $62.92	      ---	   $79.35	004	1	1	0.00	    $0.00	Y	
K	64408	NJX AA&/STRD VAGUS NRV                  	     1.78	   $66.27	      ---	   $83.57	004	1	1	0.00	    $0.00	Y	
K	64415	NJX AA&/STRD BRCH PLXS IMG              	     1.94	   $72.23	      ---	   $91.08	004	1	0	0.00	    $0.00	Y	
K	64416	NJX AA&/STRD BRCH PL NFS IMG            	     2.87	  $106.85	      ---	  $134.75	004	1	0	0.00	    $0.00	Y	
K	64417	NJX AA&/STRD AX NERVE IMG               	     1.75	   $65.15	      ---	   $82.16	004	1	0	0.00	    $0.00	Y	
K	64418	NJX AA&/STRD SPRSCAP NRV                	     1.63	   $60.68	      ---	   $76.53	004	1	0	0.00	    $0.00	Y	
K	64420	NJX AA&/STRD NTRCOST NRV 1              	     1.60	   $59.57	      ---	   $75.12	004	1	1	0.00	    $0.00	Y	
K	64421	NJX AA&/STRD NTRCOST NRV EA             	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	64425	NJX AA&/STRD II IH NERVES               	     1.85	   $68.88	      ---	   $86.86	004	1	0	0.00	    $0.00	Y	
K	64430	NJX AA&/STRD PUDENDAL NERVE             	     1.88	   $69.99	      ---	   $88.27	004	1	0	0.00	    $0.00	Y	
K	64435	NJX AA&/STRD PARACRV NRV                	     1.96	   $72.97	      ---	   $92.02	004	1	0	0.00	    $0.00	Y	
K	64445	NJX AA&/STRD SCIATIC NRV IMG            	     2.11	   $78.56	      ---	   $99.06	004	1	1	0.00	    $0.00	Y	
K	64446	NJX AA&/STRD SC NRV NFS IMG             	     2.67	   $99.40	      ---	  $125.36	004	1	0	0.00	    $0.00	Y	
K	64447	NJX AA&/STRD FEMORAL NRV IMG            	     1.32	   $49.14	      ---	   $61.97	004	1	0	0.00	    $0.00	Y	
K	64448	NJX AA&/STRD FEM NRV NFS IMG            	     2.46	   $91.59	      ---	  $115.50	004	1	0	0.00	    $0.00	Y	
K	64449	NJX AA&/STRD LMBR PLEX NFS              	     2.46	   $91.59	      ---	  $115.50	004	1	0	0.00	    $0.00	Y	
K	64450	NJX AA&/STRD OTHER PN/BRANCH            	     1.32	   $49.14	      ---	   $61.97	004	1	1	0.00	    $0.00	Y	
P	64450	NJX AA&/STRD OTHER PN/BRANCH            	     1.32	   $49.14	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	64451	NJX AA&/STRD NRV NRVTG SI JT            	     5.18	  $192.85	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64454	NJX AA&/STRD GNCLR NRV BRNCH            	     5.23	  $194.71	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64455	NJX AA&/STRD PLTR COM DG NRV            	     0.76	   $28.29	      ---	       --	004	0	1	0.00	    $0.00	Y	
P	64455	NJX AA&/STRD PLTR COM DG NRV            	     0.76	   $28.29	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	64461	PVB THORACIC SINGLE INJ SITE            	     3.53	  $131.42	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64462	PVB THORACIC 2ND+ INJ SITE              	     1.99	   $74.09	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64463	PVB THORACIC CONT INFUSION              	     3.86	  $143.71	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64466	THRC FASCIAL PLN BLK UNI NJX            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64467	THRC FASCIAL PLN BLK UNI NFS            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64468	THRC FASCIAL PLN BLK BI NJX             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64469	THRC FASCIAL PLN BLK BI NFS             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64473	LWR XTR FSCL PLN BLK UNI NJX            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	64473	LWR XTR FSCL PLN BLK UNI NJX            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	64474	LWR XTR FSCL PLN BLK UNI NFS            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64474	LWR XTR FSCL PLN BLK UNI NFS            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64479	NJX AA&/STRD TFRM EPI C/T 1             	     4.15	  $154.50	      ---	  $194.84	004	1	0	0.00	    $0.00	Y	
K	64480	NJX AA&/STRD TFRM EPI C/T EA            	     3.77	  $140.36	      ---	  $177.00	004	1	0	0.00	    $0.00	Y	
K	64483	NJX AA&/STRD TFRM EPI L/S 1             	     3.85	  $143.34	      ---	  $180.76	004	1	0	0.00	    $0.00	Y	
K	64484	NJX AA&/STRD TFRM EPI L/S EA            	     3.58	  $133.28	      ---	  $168.08	004	1	0	0.00	    $0.00	Y	
K	64486	TAP BLOCK UNIL BY INJECTION             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	64487	TAP BLOCK UNI BY INFUSION               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	64488	TAP BLOCK BI INJECTION                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	64489	TAP BLOCK BI BY INFUSION                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	64490	INJ PARAVERT F JNT C/T 1 LEV            	     4.32	  $160.83	      ---	  $202.82	004	1	0	0.00	    $0.00	Y	
K	64491	INJ PARAVERT F JNT C/T 2 LEV            	     2.14	   $79.67	      ---	  $100.47	004	1	0	0.00	    $0.00	Y	
K	64492	INJ PARAVERT F JNT C/T 3 LEV            	     2.17	   $80.79	      ---	  $101.88	004	1	0	0.00	    $0.00	Y	
K	64493	INJ PARAVERT F JNT L/S 1 LEV            	     3.88	  $144.45	      ---	  $182.17	004	1	0	0.00	    $0.00	Y	
K	64494	INJ PARAVERT F JNT L/S 2 LEV            	     1.96	   $72.97	      ---	   $92.02	004	1	0	0.00	    $0.00	Y	
K	64495	INJ PARAVERT F JNT L/S 3 LEV            	     1.99	   $74.09	      ---	   $93.43	004	1	0	0.00	    $0.00	Y	
K	64505	N BLOCK SPENOPALATINE GANGL             	     1.63	   $60.68	      ---	   $76.53	004	1	0	0.00	    $0.00	Y	
K	64510	N BLOCK STELLATE GANGLION               	     1.63	   $60.68	      ---	   $76.53	004	1	0	0.00	    $0.00	Y	
K	64517	N BLOCK INJ HYPOGAS PLXS                	     4.25	  $158.23	      ---	  $199.54	004	1	0	0.00	    $0.00	Y	
K	64520	N BLOCK LUMBAR/THORACIC                 	     2.25	   $83.77	      ---	  $105.64	004	1	0	0.00	    $0.00	Y	
K	64530	N BLOCK INJ CELIAC PELUS                	     3.77	  $140.36	      ---	  $177.00	004	1	0	0.00	    $0.00	Y	
K	64553	IMPLANT NEUROELECTRODES                 	     3.82	  $142.22	      ---	  $179.35	004	1	0	0.00	    $0.00	Y	
O	64553	IMPLANT NEUROELECTRODES                 	     0.74	   $27.55	      ---	   $34.74	004	1	0	0.00	    $0.00	Y	
K	64561	IMPLANT NEUROELECTRODES                 	    18.14	  $675.35	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64566	NEUROELTRD STIM POST TIBIAL             	     3.16	  $117.65	      ---	       --	004	0	1	0.00	    $0.00	Y	
K	64568	OPN IMPLTJ CRNL NRV NEA&PG              	    14.77	  $549.89	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	64568	OPN IMPLTJ CRNL NRV NEA&PG              	     2.95	  $109.83	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	64569	REVISE/REPL VAGUS N ELTRD               	     2.72	  $101.27	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64569	REVISE/REPL VAGUS N ELTRD               	    13.58	  $505.58	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64570	REMOVE VAGUS N ELTRD                    	    11.82	  $440.06	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	64570	REMOVE VAGUS N ELTRD                    	     2.36	   $87.86	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64575	OPN IMPLTJ NEA PERPH NERVE              	     7.33	  $272.90	      ---	  $344.14	004	1	0	0.00	    $0.00	Y	
K	64581	OPN IMPLTJ NEA SACRAL NERVE             	    14.62	  $544.30	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64582	OPN MPLTJ HPGLSL NSTM ARY PG            	    19.88	  $740.13	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	64582	OPN MPLTJ HPGLSL NSTM ARY PG            	     3.97	  $147.80	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	64583	REV/RPLCT HPGLSL NSTM ARY PG            	     3.68	  $137.01	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64583	REV/RPLCT HPGLSL NSTM ARY PG            	    18.42	  $685.78	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64584	RMVL HPGLSL NSTIM ARY PG                	    15.55	  $578.93	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	64584	RMVL HPGLSL NSTIM ARY PG                	     3.11	  $115.79	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64585	REV/RMV PERPH NSTIM ELTRD RA            	     3.32	  $123.60	      ---	  $155.87	004	1	0	0.00	    $0.00	Y	
K	64590	INS/RPL PRPH SAC/GSTR NPG/R             	     3.63	  $135.14	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64595	REV/RMV PRPH SAC/GSTR NPG/R             	     2.91	  $108.34	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64596	INS/RPLCMT PRQ ELTRD RA PN 1            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64597	INS/RPLCM PRQ ELTRD RA PN EA            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64598	REVJ/RMVL NEA PN W/INT NSTIM            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64600	INJECTION TREATMENT OF NERVE            	     3.05	  $113.55	      ---	  $143.20	004	1	0	0.00	    $0.00	Y	
K	64605	INJECTION TREATMENT OF NERVE            	     4.27	  $158.97	      ---	  $200.48	004	1	0	0.00	    $0.00	Y	
K	64610	INJECTION TREATMENT OF NERVE            	     5.51	  $205.14	      ---	  $258.69	004	1	0	0.00	    $0.00	Y	
K	64611	CHEMODENERV SALIV GLANDS                	     2.31	   $86.00	      ---	       --	004	0	1	0.00	    $0.00	Y	
K	64612	DESTROY NERVE FACE MUSCLE               	     2.24	   $83.40	      ---	  $105.17	004	1	0	0.00	    $0.00	Y	
K	64615	CHEMODENERV MUSC MIGRAINE               	     2.79	  $103.87	      ---	  $130.99	004	1	0	0.00	    $0.00	Y	
K	64616	CHEMODENERV MUSC NECK DYSTON            	     2.43	   $90.47	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64617	CHEMODENER MUSCLE LARYNX EMG            	     2.64	   $98.29	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64620	INJECTION TREATMENT OF NERVE            	     2.67	   $99.40	      ---	  $125.36	004	1	0	0.00	    $0.00	Y	
K	64624	DSTRJ NULYT AGT GNCLR NRV               	    10.07	  $374.91	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64625	RF ABLTJ NRV NRVTG SI JT                	    12.26	  $456.44	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64628	TRML DSTRJ IOS BVN 1ST 2 L/S            	    10.50	  $390.92	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64629	TRML DSTRJ IOS BVN EA ADDL              	     4.84	  $180.19	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64630	INJECTION TREATMENT OF NERVE            	     2.64	   $98.29	      ---	  $123.95	004	1	0	0.00	    $0.00	Y	
K	64632	N BLOCK INJ COMMON DIGIT                	     1.37	   $51.01	      ---	       --	004	0	1	0.00	    $0.00	Y	
P	64632	N BLOCK INJ COMMON DIGIT                	     1.37	   $51.01	      ---	       --	015	0	1	0.00	    $0.00	Y	
K	64633	DESTROY CERV/THOR FACET JNT             	     5.36	  $199.55	      ---	  $251.65	004	1	0	0.00	    $0.00	Y	
K	64634	DESTROY C/TH FACET JNT ADDL             	     1.58	   $58.82	      ---	   $74.18	004	1	0	0.00	    $0.00	Y	
K	64635	DESTROY LUMB/SAC FACET JNT              	     5.25	  $195.46	      ---	  $246.49	004	1	0	0.00	    $0.00	Y	
K	64636	DESTROY L/S FACET JNT ADDL              	     1.38	   $51.38	      ---	   $64.79	004	1	0	0.00	    $0.00	Y	
K	64640	INJECTION TREATMENT OF NERVE            	     3.37	  $125.47	      ---	  $158.22	004	1	1	0.00	    $0.00	Y	
K	64642	CHEMODENERV 1 EXTREMITY 1-4             	     2.45	   $91.21	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64643	CHEMODENERV 1 EXTREM 1-4 EA             	     1.63	   $60.68	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64644	CHEMODENERV 1 EXTREM 5/> MUS            	     1.63	   $60.68	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64645	CHEMODENERV 1 EXTREM 5/> EA             	     1.86	   $69.25	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64646	CHEMODENERV TRUNK MUSC 1-5              	     2.65	   $98.66	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64647	CHEMODENERV TRUNK MUSC 6/>              	     3.06	  $113.92	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64650	CHEMODENERV ECCRINE GLANDS              	     1.37	   $51.01	      ---	   $64.32	004	1	0	0.00	    $0.00	Y	
K	64653	CHEMODENERV ECCRINE GLANDS              	     1.57	   $58.45	      ---	   $73.71	004	1	0	0.00	    $0.00	Y	
K	64680	INJECTION TREATMENT OF NERVE            	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
K	64681	INJECTION TREATMENT OF NERVE            	    10.63	  $395.75	      ---	  $499.08	004	1	0	0.00	    $0.00	Y	
K	64702	REVISE FINGER/TOE NERVE                 	     5.44	  $202.53	      ---	  $255.41	004	1	1	0.00	    $0.00	Y	
P	64702	REVISE FINGER/TOE NERVE                 	     5.44	  $202.53	      ---	       --	015	0	1	0.00	    $0.00	Y	
O	64702	REVISE FINGER/TOE NERVE                 	     1.09	   $40.58	      ---	   $51.18	004	1	0	0.00	    $0.00	Y	
O	64704	REVISE HAND/FOOT NERVE                  	     1.60	   $59.57	      ---	   $75.12	004	1	0	0.00	    $0.00	Y	
P	64704	REVISE HAND/FOOT NERVE                  	     8.00	  $297.84	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	64704	REVISE HAND/FOOT NERVE                  	     8.00	  $297.84	      ---	  $375.60	004	1	0	0.00	    $0.00	Y	
K	64708	REVISE ARM/LEG NERVE                    	    12.00	  $446.76	      ---	  $563.40	004	1	0	0.00	    $0.00	Y	
O	64708	REVISE ARM/LEG NERVE                    	     2.40	   $89.35	      ---	  $112.68	004	1	0	0.00	    $0.00	Y	
O	64712	REVISION OF SCIATIC NERVE               	     2.38	   $88.61	      ---	  $111.74	004	1	0	0.00	    $0.00	Y	
K	64712	REVISION OF SCIATIC NERVE               	    11.92	  $443.78	      ---	  $559.64	004	1	0	0.00	    $0.00	Y	
K	64713	REVISION OF ARM NERVE(S)                	    16.97	  $631.79	      ---	  $796.74	004	1	0	0.00	    $0.00	Y	
O	64713	REVISION OF ARM NERVE(S)                	     3.39	  $126.21	      ---	  $159.16	004	1	0	0.00	    $0.00	Y	
O	64714	REVISE LOW BACK NERVE(S)                	     2.71	  $100.89	      ---	  $127.23	004	1	0	0.00	    $0.00	Y	
K	64714	REVISE LOW BACK NERVE(S)                	    13.56	  $504.84	      ---	  $636.64	004	1	0	0.00	    $0.00	Y	
K	64716	REVISION OF CRANIAL NERVE               	    10.71	  $398.73	      ---	  $502.83	004	1	0	0.00	    $0.00	Y	
O	64716	REVISION OF CRANIAL NERVE               	     2.14	   $79.67	      ---	  $100.47	004	1	0	0.00	    $0.00	Y	
O	64718	REVISE ULNAR NERVE AT ELBOW             	     2.40	   $89.35	      ---	  $112.68	004	1	0	0.00	    $0.00	Y	
K	64718	REVISE ULNAR NERVE AT ELBOW             	    12.00	  $446.76	      ---	  $563.40	004	1	0	0.00	    $0.00	Y	
K	64719	REVISE ULNAR NERVE AT WRIST             	     7.96	  $296.35	      ---	  $373.72	004	1	0	0.00	    $0.00	Y	
O	64719	REVISE ULNAR NERVE AT WRIST             	     1.59	   $59.20	      ---	   $74.65	004	1	0	0.00	    $0.00	Y	
O	64721	CARPAL TUNNEL SURGERY                   	     1.70	   $63.29	      ---	   $79.82	004	1	0	0.00	    $0.00	Y	
K	64721	CARPAL TUNNEL SURGERY                   	     8.51	  $316.83	      ---	  $399.54	004	1	0	0.00	    $0.00	Y	
K	64722	RELIEVE PRESSURE ON NERVE(S)            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	64722	RELIEVE PRESSURE ON NERVE(S)            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	64726	RELEASE FOOT/TOE NERVE                  	     1.09	   $40.58	      ---	   $51.18	004	1	0	0.00	    $0.00	Y	
P	64726	RELEASE FOOT/TOE NERVE                  	     5.44	  $202.53	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	64726	RELEASE FOOT/TOE NERVE                  	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
K	64727	INTERNAL NERVE REVISION                 	     4.73	  $176.10	      ---	  $222.07	004	1	0	0.00	    $0.00	Y	
O	64727	INTERNAL NERVE REVISION                 	     0.95	   $35.37	      ---	   $44.60	004	1	0	0.00	    $0.00	Y	
O	64732	INCISION OF BROW NERVE                  	     1.42	   $52.87	      ---	   $66.67	004	1	0	0.00	    $0.00	Y	
K	64732	INCISION OF BROW NERVE                  	     7.08	  $263.59	      ---	  $332.41	004	1	0	0.00	    $0.00	Y	
K	64734	INCISION OF CHEEK NERVE                 	     7.43	  $276.62	      ---	  $348.84	004	1	0	0.00	    $0.00	Y	
O	64734	INCISION OF CHEEK NERVE                 	     1.49	   $55.47	      ---	   $69.96	004	1	0	0.00	    $0.00	Y	
O	64736	INCISION OF CHIN NERVE                  	     1.40	   $52.12	      ---	   $65.73	004	1	0	0.00	    $0.00	Y	
K	64736	INCISION OF CHIN NERVE                  	     7.00	  $260.61	      ---	  $328.65	004	1	0	0.00	    $0.00	Y	
K	64738	INCISION OF JAW NERVE                   	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
O	64738	INCISION OF JAW NERVE                   	     2.00	   $74.46	      ---	   $93.90	004	1	0	0.00	    $0.00	Y	
O	64740	INCISION OF TONGUE NERVE                	     2.00	   $74.46	      ---	   $93.90	004	1	0	0.00	    $0.00	Y	
K	64740	INCISION OF TONGUE NERVE                	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
K	64742	INCISION OF FACIAL NERVE                	    10.20	  $379.75	      ---	  $478.89	004	1	0	0.00	    $0.00	Y	
O	64742	INCISION OF FACIAL NERVE                	     2.04	   $75.95	      ---	   $95.78	004	1	0	0.00	    $0.00	Y	
O	64744	INCISE NERVE BACK OF HEAD               	     1.59	   $59.20	      ---	   $74.65	004	1	0	0.00	    $0.00	Y	
K	64744	INCISE NERVE BACK OF HEAD               	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
K	64746	INCISE DIAPHRAGM NERVE                  	     5.66	  $210.72	      ---	  $265.74	004	1	0	0.00	    $0.00	Y	
O	64746	INCISE DIAPHRAGM NERVE                  	     1.13	   $42.07	      ---	   $53.05	004	1	0	0.00	    $0.00	Y	
O	64755	INCISION OF STOMACH NERVES              	     3.17	  $118.02	      ---	  $148.83	004	1	0	0.00	    $0.00	Y	
K	64755	INCISION OF STOMACH NERVES              	    15.86	  $590.47	      ---	  $744.63	004	1	0	0.00	    $0.00	Y	
K	64760	INCISION OF VAGUS NERVE                 	    14.00	  $521.22	      ---	  $657.30	004	1	0	0.00	    $0.00	Y	
O	64760	INCISION OF VAGUS NERVE                 	     2.80	  $104.24	      ---	  $131.46	004	1	0	0.00	    $0.00	Y	
O	64763	INCISE HIP/THIGH NERVE                  	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
K	64763	INCISE HIP/THIGH NERVE                  	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
K	64766	INCISE HIP/THIGH NERVE                  	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	64766	INCISE HIP/THIGH NERVE                  	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	64771	SEVER CRANIAL NERVE                     	     1.59	   $59.20	      ---	   $74.65	004	1	0	0.00	    $0.00	Y	
K	64771	SEVER CRANIAL NERVE                     	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
K	64772	INCISION OF SPINAL NERVE                	    10.89	  $405.43	      ---	  $511.29	004	1	0	0.00	    $0.00	Y	
O	64772	INCISION OF SPINAL NERVE                	     2.18	   $81.16	      ---	  $102.35	004	1	0	0.00	    $0.00	Y	
O	64774	REMOVE SKIN NERVE LESION                	     0.82	   $30.53	      ---	   $38.50	004	1	0	0.00	    $0.00	Y	
K	64774	REMOVE SKIN NERVE LESION                	     4.10	  $152.64	      ---	  $192.50	004	1	1	0.00	    $0.00	Y	
K	64776	REMOVE DIGIT NERVE LESION               	     4.11	  $153.02	      ---	  $192.96	004	1	1	0.00	    $0.00	Y	
O	64776	REMOVE DIGIT NERVE LESION               	     0.82	   $30.53	      ---	   $38.50	004	1	0	0.00	    $0.00	Y	
O	64778	DIGIT NERVE SURGERY ADD-ON              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	64778	DIGIT NERVE SURGERY ADD-ON              	     2.16	   $80.42	      ---	  $101.41	004	1	1	0.00	    $0.00	Y	
K	64782	REMOVE LIMB NERVE LESION                	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
O	64782	REMOVE LIMB NERVE LESION                	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
P	64782	REMOVE LIMB NERVE LESION                	     6.80	  $253.16	      ---	       --	015	0	0	0.00	    $0.00	Y	
P	64783	LIMB NERVE SURGERY ADD-ON               	     0.00	    $0.00	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	64783	LIMB NERVE SURGERY ADD-ON               	     1.12	   $41.70	      ---	   $52.58	004	1	0	0.00	    $0.00	Y	
K	64783	LIMB NERVE SURGERY ADD-ON               	     5.61	  $208.86	      ---	  $263.39	004	1	0	0.00	    $0.00	Y	
K	64784	REMOVE NERVE LESION                     	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	64784	REMOVE NERVE LESION                     	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	64786	REMOVE SCIATIC NERVE LESION             	     4.84	  $180.19	      ---	  $227.24	004	1	0	0.00	    $0.00	Y	
K	64786	REMOVE SCIATIC NERVE LESION             	    24.18	  $900.22	      ---	 $1135.25	004	1	0	0.00	    $0.00	Y	
K	64787	IMPLANT NERVE END                       	     6.19	  $230.45	      ---	  $290.62	004	1	0	0.00	    $0.00	Y	
O	64787	IMPLANT NERVE END                       	     1.24	   $46.17	      ---	   $58.22	004	1	0	0.00	    $0.00	Y	
O	64788	REMOVE SKIN NERVE LESION                	     1.36	   $50.63	      ---	   $63.85	004	1	0	0.00	    $0.00	Y	
K	64788	REMOVE SKIN NERVE LESION                	     6.80	  $253.16	      ---	  $319.26	004	1	1	0.00	    $0.00	Y	
K	64790	REMOVAL OF NERVE LESION                 	    16.22	  $603.87	      ---	  $761.53	004	1	0	0.00	    $0.00	Y	
O	64790	REMOVAL OF NERVE LESION                 	     3.24	  $120.63	      ---	  $152.12	004	1	0	0.00	    $0.00	Y	
O	64792	REMOVAL OF NERVE LESION                 	     4.20	  $156.37	      ---	  $197.19	004	1	0	0.00	    $0.00	Y	
K	64792	REMOVAL OF NERVE LESION                 	    21.02	  $782.57	      ---	  $986.89	004	1	0	0.00	    $0.00	Y	
K	64795	BIOPSY OF NERVE                         	     4.28	  $159.34	      ---	  $200.95	004	1	0	0.00	    $0.00	Y	
O	64795	BIOPSY OF NERVE                         	     0.86	   $32.02	      ---	   $40.38	004	1	0	0.00	    $0.00	Y	
O	64802	SYMPATHECTOMY CERVICAL                  	     2.90	  $107.97	      ---	  $136.16	004	1	0	0.00	    $0.00	Y	
K	64802	SYMPATHECTOMY CERVICAL                  	    14.50	  $539.84	      ---	  $680.78	004	1	0	0.00	    $0.00	Y	
K	64804	SYMPATHECTOMY CERVICOTHORAC             	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
O	64804	SYMPATHECTOMY CERVICOTHORAC             	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
O	64809	SYMPATHECTOMY THORACOLUMBAR             	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
K	64809	SYMPATHECTOMY THORACOLUMBAR             	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
K	64818	SYMPATHECTOMY LUMBAR                    	    15.00	  $558.45	      ---	  $704.25	004	1	0	0.00	    $0.00	Y	
O	64818	SYMPATHECTOMY LUMBAR                    	     3.00	  $111.69	      ---	  $140.85	004	1	0	0.00	    $0.00	Y	
O	64820	SYMPATHECTOMY DIGITAL ARTERY            	     2.13	   $79.30	      ---	  $100.00	004	1	0	0.00	    $0.00	Y	
K	64820	SYMPATHECTOMY DIGITAL ARTERY            	    10.67	  $397.24	      ---	  $500.96	004	1	0	0.00	    $0.00	Y	
K	64821	SYMPATHECTOMY RADIAL ARTERY             	    13.85	  $515.64	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	64821	SYMPATHECTOMY RADIAL ARTERY             	     2.77	  $103.13	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	64822	SYMPATHECTOMY ULNAR ARTERY              	     2.77	  $103.13	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64822	SYMPATHECTOMY ULNAR ARTERY              	    13.85	  $515.64	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64823	SYMPATHECTOMY SUPFC PALMAR              	    15.97	  $594.56	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	64823	SYMPATHECTOMY SUPFC PALMAR              	     3.19	  $118.76	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	64831	REPAIR OF DIGIT NERVE                   	     1.52	   $56.59	      ---	   $71.36	004	1	0	0.00	    $0.00	Y	
P	64831	REPAIR OF DIGIT NERVE                   	     7.59	  $282.58	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	64831	REPAIR OF DIGIT NERVE                   	     7.59	  $282.58	      ---	  $356.35	004	1	0	0.00	    $0.00	Y	
K	64832	REPAIR NERVE ADD-ON                     	     4.11	  $153.02	      ---	  $192.96	004	1	0	0.00	    $0.00	Y	
P	64832	REPAIR NERVE ADD-ON                     	     4.11	  $153.02	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	64832	REPAIR NERVE ADD-ON                     	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	64834	REPAIR OF HAND OR FOOT NERVE            	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
P	64834	REPAIR OF HAND OR FOOT NERVE            	     9.06	  $337.30	      ---	       --	015	0	0	0.00	    $0.00	Y	
K	64834	REPAIR OF HAND OR FOOT NERVE            	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
K	64835	REPAIR OF HAND OR FOOT NERVE            	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	64835	REPAIR OF HAND OR FOOT NERVE            	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	64836	REPAIR OF HAND OR FOOT NERVE            	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	64836	REPAIR OF HAND OR FOOT NERVE            	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	64837	REPAIR NERVE ADD-ON                     	     9.41	  $350.33	      ---	  $441.80	004	1	0	0.00	    $0.00	Y	
O	64837	REPAIR NERVE ADD-ON                     	     1.88	   $69.99	      ---	   $88.27	004	1	0	0.00	    $0.00	Y	
P	64837	REPAIR NERVE ADD-ON                     	     0.00	    $0.00	      ---	       --	015	0	0	0.00	    $0.00	Y	
O	64840	REPAIR OF LEG NERVE                     	     3.80	  $141.47	      ---	  $178.41	004	1	0	0.00	    $0.00	Y	
K	64840	REPAIR OF LEG NERVE                     	    19.02	  $708.11	      ---	  $892.99	004	1	0	0.00	    $0.00	Y	
K	64856	REPAIR/TRANSPOSE NERVE                  	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	64856	REPAIR/TRANSPOSE NERVE                  	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
O	64857	REPAIR ARM/LEG NERVE                    	     4.20	  $156.37	      ---	  $197.19	004	1	0	0.00	    $0.00	Y	
K	64857	REPAIR ARM/LEG NERVE                    	    20.99	  $781.46	      ---	  $985.48	004	1	0	0.00	    $0.00	Y	
K	64858	REPAIR SCIATIC NERVE                    	    25.75	  $958.67	      ---	 $1208.96	004	1	0	0.00	    $0.00	Y	
O	64858	REPAIR SCIATIC NERVE                    	     5.15	  $191.73	      ---	  $241.79	004	1	0	0.00	    $0.00	Y	
O	64859	NERVE SURGERY                           	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	64859	NERVE SURGERY                           	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	64861	REPAIR OF ARM NERVES                    	    29.46	 $1096.80	      ---	 $1383.15	004	1	0	0.00	    $0.00	Y	
O	64861	REPAIR OF ARM NERVES                    	     5.89	  $219.28	      ---	  $276.54	004	1	0	0.00	    $0.00	Y	
O	64862	REPAIR OF LOW BACK NERVES               	     5.92	  $220.40	      ---	  $277.94	004	1	0	0.00	    $0.00	Y	
K	64862	REPAIR OF LOW BACK NERVES               	    29.60	 $1102.01	      ---	 $1389.72	004	1	0	0.00	    $0.00	Y	
K	64864	REPAIR OF FACIAL NERVE                  	    18.21	  $677.96	      ---	  $854.96	004	1	0	0.00	    $0.00	Y	
O	64864	REPAIR OF FACIAL NERVE                  	     3.64	  $135.52	      ---	  $170.90	004	1	0	0.00	    $0.00	Y	
O	64865	REPAIR OF FACIAL NERVE                  	     4.47	  $166.42	      ---	  $209.87	004	1	0	0.00	    $0.00	Y	
K	64865	REPAIR OF FACIAL NERVE                  	    22.36	  $832.46	      ---	 $1049.80	004	1	0	0.00	    $0.00	Y	
K	64866	FUSION OF FACIAL/OTHER NERVE            	    26.00	  $967.98	      ---	 $1220.70	004	1	0	0.00	    $0.00	Y	
O	64866	FUSION OF FACIAL/OTHER NERVE            	     5.20	  $193.60	      ---	  $244.14	004	1	0	0.00	    $0.00	Y	
O	64868	FUSION OF FACIAL/OTHER NERVE            	     5.20	  $193.60	      ---	  $244.14	004	1	0	0.00	    $0.00	Y	
K	64868	FUSION OF FACIAL/OTHER NERVE            	    26.00	  $967.98	      ---	 $1220.70	004	1	0	0.00	    $0.00	Y	
K	64872	SUBSEQUENT REPAIR OF NERVE              	     3.05	  $113.55	      ---	  $143.20	004	1	0	0.00	    $0.00	Y	
O	64872	SUBSEQUENT REPAIR OF NERVE              	     0.61	   $22.71	      ---	   $28.64	004	1	0	0.00	    $0.00	Y	
O	64874	REPAIR & REVISE NERVE ADD-ON            	     0.89	   $33.13	      ---	   $41.79	004	1	0	0.00	    $0.00	Y	
K	64874	REPAIR & REVISE NERVE ADD-ON            	     4.47	  $166.42	      ---	  $209.87	004	1	0	0.00	    $0.00	Y	
K	64876	REPAIR NERVE/SHORTEN BONE               	     4.68	  $174.24	      ---	  $219.73	004	1	0	0.00	    $0.00	Y	
O	64876	REPAIR NERVE/SHORTEN BONE               	     0.94	   $35.00	      ---	   $44.13	004	1	0	0.00	    $0.00	Y	
O	64885	NERVE GRAFT HEAD/NECK <4 CM             	     3.74	  $139.24	      ---	  $175.59	004	1	0	0.00	    $0.00	Y	
K	64885	NERVE GRAFT HEAD/NECK <4 CM             	    18.71	  $696.57	      ---	  $878.43	004	1	0	0.00	    $0.00	Y	
K	64886	NERVE GRAFT HEAD/NECK >4 CM             	    22.31	  $830.60	      ---	 $1047.45	004	1	0	0.00	    $0.00	Y	
O	64886	NERVE GRAFT HEAD/NECK >4 CM             	     4.46	  $166.05	      ---	  $209.40	004	1	0	0.00	    $0.00	Y	
O	64890	NRV GRF 1STRND HND/FOOT <4CM            	     3.48	  $129.56	      ---	  $163.39	004	1	0	0.00	    $0.00	Y	
K	64890	NRV GRF 1STRND HND/FOOT <4CM            	    17.40	  $647.80	      ---	  $816.93	004	1	0	0.00	    $0.00	Y	
K	64891	NRV GRF 1STRND HND/FOOT >4CM            	    16.57	  $616.90	      ---	  $777.96	004	1	0	0.00	    $0.00	Y	
O	64891	NRV GRF 1STRND HND/FOOT >4CM            	     0.22	    $8.19	      ---	   $10.33	004	1	0	0.00	    $0.00	Y	
O	64892	NRV GRF 1STRND ARM/LEG <4CM             	     3.21	  $119.51	      ---	  $150.71	004	1	0	0.00	    $0.00	Y	
K	64892	NRV GRF 1STRND ARM/LEG <4CM             	    16.09	  $599.03	      ---	  $755.43	004	1	0	0.00	    $0.00	Y	
K	64893	NRV GRF 1STRND ARM/LEG >4 CM            	    18.65	  $694.34	      ---	  $875.62	004	1	0	0.00	    $0.00	Y	
O	64893	NRV GRF 1STRND ARM/LEG >4 CM            	     3.73	  $138.87	      ---	  $175.12	004	1	0	0.00	    $0.00	Y	
O	64895	NRV GRF MLTST HND/FOOT <4 CM            	     4.12	  $153.39	      ---	  $193.43	004	1	0	0.00	    $0.00	Y	
K	64895	NRV GRF MLTST HND/FOOT <4 CM            	    20.65	  $768.80	      ---	  $969.52	004	1	0	0.00	    $0.00	Y	
K	64896	NRV GRF MLTST HND/FOOT >4 CM            	    23.51	  $875.28	      ---	 $1103.79	004	1	0	0.00	    $0.00	Y	
O	64896	NRV GRF MLTST HND/FOOT >4 CM            	     4.70	  $174.98	      ---	  $220.67	004	1	0	0.00	    $0.00	Y	
O	64897	NRV GRF MLTST ARM/LEG <4 CM             	     3.93	  $146.31	      ---	  $184.51	004	1	0	0.00	    $0.00	Y	
K	64897	NRV GRF MLTST ARM/LEG <4 CM             	    19.66	  $731.94	      ---	  $923.04	004	1	0	0.00	    $0.00	Y	
K	64898	NRV GRF MLTST ARM/LEG >4 CM             	    21.27	  $791.88	      ---	  $998.63	004	1	0	0.00	    $0.00	Y	
O	64898	NRV GRF MLTST ARM/LEG >4 CM             	     4.25	  $158.23	      ---	  $199.54	004	1	0	0.00	    $0.00	Y	
O	64901	NERVE GRAFT ADD-ON                      	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	64901	NERVE GRAFT ADD-ON                      	    12.88	  $479.52	      ---	  $604.72	004	1	0	0.00	    $0.00	Y	
K	64902	NERVE GRAFT ADD-ON                      	    14.98	  $557.71	      ---	  $703.31	004	1	0	0.00	    $0.00	Y	
O	64902	NERVE GRAFT ADD-ON                      	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	64905	NERVE PEDICLE TRANSFER                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	64905	NERVE PEDICLE TRANSFER                  	    14.13	  $526.06	      ---	  $663.40	004	1	0	0.00	    $0.00	Y	
K	64907	NERVE PEDICLE TRANSFER                  	    18.53	  $689.87	      ---	  $869.98	004	1	0	0.00	    $0.00	Y	
O	64907	NERVE PEDICLE TRANSFER                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	64910	NERVE REPAIR W/ALLOGRAFT                	     3.09	  $115.04	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64910	NERVE REPAIR W/ALLOGRAFT                	    15.44	  $574.83	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64911	NEURORRAPHY W/VEIN AUTOGRAFT            	    18.78	  $699.18	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	64911	NEURORRAPHY W/VEIN AUTOGRAFT            	     3.76	  $139.98	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	64912	NRV RPR W/NRV ALGRFT 1ST                	     3.63	  $135.14	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64912	NRV RPR W/NRV ALGRFT 1ST                	    18.15	  $675.72	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	64913	NRV RPR W/NRV ALGRFT EA ADDL            	     3.58	  $133.28	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	64913	NRV RPR W/NRV ALGRFT EA ADDL            	     0.71	   $26.43	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	64999	UNLISTED PX NERVOUS SYSTEM              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	64999	UNLISTED PX NERVOUS SYSTEM              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	65091	REVISE EYE                              	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	65091	REVISE EYE                              	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	65093	REVISE EYE WITH IMPLANT                 	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	65093	REVISE EYE WITH IMPLANT                 	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	65101	REMOVAL OF EYE                          	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	65101	REMOVAL OF EYE                          	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	65103	REMOVE EYE/INSERT IMPLANT               	     2.38	   $88.61	      ---	  $111.74	004	1	0	0.00	    $0.00	Y	
K	65103	REMOVE EYE/INSERT IMPLANT               	    12.23	  $455.32	      ---	  $574.20	004	1	0	0.00	    $0.00	Y	
K	65105	REMOVE EYE/ATTACH IMPLANT               	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	65105	REMOVE EYE/ATTACH IMPLANT               	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
O	65110	REMOVAL OF EYE                          	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	65110	REMOVAL OF EYE                          	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
K	65112	REMOVE EYE/REVISE SOCKET                	    30.71	 $1143.33	      ---	 $1441.83	004	1	0	0.00	    $0.00	Y	
O	65112	REMOVE EYE/REVISE SOCKET                	     6.14	  $228.59	      ---	  $288.27	004	1	0	0.00	    $0.00	Y	
O	65114	REMOVE EYE/REVISE SOCKET                	     5.10	  $189.87	      ---	  $239.45	004	1	0	0.00	    $0.00	Y	
K	65114	REMOVE EYE/REVISE SOCKET                	    25.37	  $944.53	      ---	 $1191.12	004	1	0	0.00	    $0.00	Y	
K	65125	REVISE OCULAR IMPLANT                   	     7.02	  $261.35	      ---	  $329.59	004	1	0	0.00	    $0.00	Y	
K	65130	INSERT OCULAR IMPLANT                   	    10.53	  $392.03	      ---	  $494.38	004	1	0	0.00	    $0.00	Y	
O	65130	INSERT OCULAR IMPLANT                   	     2.04	   $75.95	      ---	   $95.78	004	1	0	0.00	    $0.00	Y	
O	65135	INSERT OCULAR IMPLANT                   	     2.49	   $92.70	      ---	  $116.91	004	1	0	0.00	    $0.00	Y	
K	65135	INSERT OCULAR IMPLANT                   	    12.57	  $467.98	      ---	  $590.16	004	1	0	0.00	    $0.00	Y	
K	65140	ATTACH OCULAR IMPLANT                   	    15.75	  $586.37	      ---	  $739.46	004	1	0	0.00	    $0.00	Y	
O	65140	ATTACH OCULAR IMPLANT                   	     3.15	  $117.27	      ---	  $147.89	004	1	0	0.00	    $0.00	Y	
O	65150	REVISE OCULAR IMPLANT                   	     2.85	  $106.11	      ---	  $133.81	004	1	0	0.00	    $0.00	Y	
K	65150	REVISE OCULAR IMPLANT                   	    14.23	  $529.78	      ---	  $668.10	004	1	0	0.00	    $0.00	Y	
K	65155	REINSERT OCULAR IMPLANT                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	65155	REINSERT OCULAR IMPLANT                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	65175	REMOVAL OF OCULAR IMPLANT               	     2.69	  $100.15	      ---	  $126.30	004	1	0	0.00	    $0.00	Y	
K	65175	REMOVAL OF OCULAR IMPLANT               	    13.47	  $501.49	      ---	  $632.42	004	1	0	0.00	    $0.00	Y	
K	65205	REMOVE FOREIGN BODY FROM EYE            	     2.99	  $111.32	      ---	  $140.38	004	1	1	0.00	    $0.00	Y	
1	65205	REMOVE FOREIGN BODY FROM EYE            	     6.74	    $6.74	      ---	    $6.74	009	1	1	0.00	    $0.00	Y	
1	65210	REMOVE FOREIGN BODY FROM EYE            	   117.27	  $117.27	      ---	  $117.27	009	1	0	0.00	    $0.00	Y	
K	65210	REMOVE FOREIGN BODY FROM EYE            	     3.15	  $117.27	      ---	  $147.89	004	1	1	0.00	    $0.00	Y	
K	65220	REMOVE FOREIGN BODY FROM EYE            	     3.87	  $144.08	      ---	  $181.70	004	1	1	0.00	    $0.00	Y	
1	65220	REMOVE FOREIGN BODY FROM EYE            	    13.48	   $13.48	      ---	   $13.48	009	1	1	0.00	    $0.00	Y	
1	65222	REMOVE FOREIGN BODY FROM EYE            	    20.21	   $20.21	      ---	   $20.21	009	1	1	0.00	    $0.00	Y	
K	65222	REMOVE FOREIGN BODY FROM EYE            	     3.16	  $117.65	      ---	  $148.36	004	1	1	0.00	    $0.00	Y	
K	65235	REMOVE FOREIGN BODY FROM EYE            	    12.27	  $456.81	      ---	  $576.08	004	1	0	0.00	    $0.00	Y	
O	65235	REMOVE FOREIGN BODY FROM EYE            	     2.45	   $91.21	      ---	  $115.03	004	1	0	0.00	    $0.00	Y	
O	65260	REMOVE FOREIGN BODY FROM EYE            	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	65260	REMOVE FOREIGN BODY FROM EYE            	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	65265	REMOVE FOREIGN BODY FROM EYE            	    18.12	  $674.61	      ---	  $850.73	004	1	0	0.00	    $0.00	Y	
O	65265	REMOVE FOREIGN BODY FROM EYE            	     3.62	  $134.77	      ---	  $169.96	004	1	0	0.00	    $0.00	Y	
O	65270	REPAIR OF EYE WOUND                     	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	65270	REPAIR OF EYE WOUND                     	     2.49	   $92.70	      ---	  $116.91	004	1	0	0.00	    $0.00	Y	
K	65272	REPAIR OF EYE WOUND                     	     4.15	  $154.50	      ---	  $194.84	004	1	0	0.00	    $0.00	Y	
O	65272	REPAIR OF EYE WOUND                     	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	65273	REPAIR OF EYE WOUND                     	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	65273	REPAIR OF EYE WOUND                     	     4.14	  $154.13	      ---	  $194.37	004	1	0	0.00	    $0.00	Y	
K	65275	REPAIR OF EYE WOUND                     	     8.91	  $331.72	      ---	  $418.32	004	1	0	0.00	    $0.00	Y	
O	65275	REPAIR OF EYE WOUND                     	     1.78	   $66.27	      ---	   $83.57	004	1	0	0.00	    $0.00	Y	
O	65280	REPAIR OF EYE WOUND                     	     2.58	   $96.05	      ---	  $121.13	004	1	0	0.00	    $0.00	Y	
K	65280	REPAIR OF EYE WOUND                     	    12.89	  $479.89	      ---	  $605.19	004	1	0	0.00	    $0.00	Y	
K	65285	REPAIR OF EYE WOUND                     	    22.75	  $846.98	      ---	 $1068.11	004	1	0	0.00	    $0.00	Y	
O	65285	REPAIR OF EYE WOUND                     	     4.55	  $169.40	      ---	  $213.62	004	1	0	0.00	    $0.00	Y	
O	65286	REPAIR OF EYE WOUND                     	     2.33	   $86.75	      ---	  $109.39	004	1	0	0.00	    $0.00	Y	
K	65286	REPAIR OF EYE WOUND                     	    11.63	  $432.98	      ---	  $546.03	004	1	0	0.00	    $0.00	Y	
K	65290	REPAIR OF EYE SOCKET WOUND              	     5.25	  $195.46	      ---	  $246.49	004	1	0	0.00	    $0.00	Y	
O	65290	REPAIR OF EYE SOCKET WOUND              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	65400	REMOVAL OF EYE LESION                   	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
K	65410	BIOPSY OF CORNEA                        	     1.45	   $53.98	      ---	   $68.08	004	1	0	0.00	    $0.00	Y	
K	65420	REMOVAL OF EYE LESION                   	     6.80	  $253.16	      ---	  $319.26	004	1	1	0.00	    $0.00	Y	
K	65426	REMOVAL OF EYE LESION                   	    10.73	  $399.48	      ---	  $503.77	004	1	0	0.00	    $0.00	Y	
O	65426	REMOVAL OF EYE LESION                   	     2.15	   $80.04	      ---	  $100.94	004	1	0	0.00	    $0.00	Y	
1	65430	CORNEAL SMEAR                           	     3.70	  $137.75	      ---	  $173.72	004	1	1	0.00	    $0.00	Y	
K	65430	CORNEAL SMEAR                           	     3.70	  $137.75	      ---	  $173.72	004	1	1	0.00	    $0.00	Y	
K	65435	CURETTE/TREAT CORNEA                    	     1.13	   $42.07	      ---	   $53.05	004	1	0	0.00	    $0.00	Y	
1	65435	CURETTE/TREAT CORNEA                    	     1.13	   $42.07	      ---	   $53.05	004	1	0	0.00	    $0.00	Y	
1	65436	CURETTE/TREAT CORNEA                    	     4.39	  $163.44	      ---	  $206.11	004	1	0	0.00	    $0.00	Y	
K	65436	CURETTE/TREAT CORNEA                    	     4.39	  $163.44	      ---	  $206.11	004	1	0	0.00	    $0.00	Y	
K	65450	TREATMENT OF CORNEAL LESION             	     4.71	  $175.35	      ---	  $221.13	004	1	0	0.00	    $0.00	Y	
K	65600	REVISION OF CORNEA                      	     8.00	  $297.84	      ---	  $375.60	004	1	0	0.00	    $0.00	Y	
O	65600	REVISION OF CORNEA                      	     1.60	   $59.57	      ---	   $75.12	004	1	0	0.00	    $0.00	Y	
O	65710	CORNEAL TRANSPLANT                      	     4.80	  $178.70	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	65710	CORNEAL TRANSPLANT                      	    24.00	  $893.52	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	65730	CORNEAL TRANSPLANT                      	    30.00	 $1116.90	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	65730	CORNEAL TRANSPLANT                      	     6.00	  $223.38	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	65750	CORNEAL TRANSPLANT                      	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
K	65750	CORNEAL TRANSPLANT                      	    30.00	 $1116.90	      ---	 $1408.50	004	1	0	0.00	    $0.00	Y	
K	65755	CORNEAL TRANSPLANT                      	    30.00	 $1116.90	      ---	 $1408.50	004	1	0	0.00	    $0.00	Y	
O	65755	CORNEAL TRANSPLANT                      	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
O	65756	CORNEAL TRNSPL ENDOTHELIAL              	     4.01	  $149.29	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	65756	CORNEAL TRNSPL ENDOTHELIAL              	    20.07	  $747.21	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	65757	PREP CORNEAL ENDO ALLOGRAFT             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	65757	PREP CORNEAL ENDO ALLOGRAFT             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	65770	KERATOPROSTHESIS                        	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
K	65770	KERATOPROSTHESIS                        	    29.90	 $1113.18	      ---	 $1403.81	004	1	0	0.00	    $0.00	Y	
K	65778	COVER EYE W/MEMBRANE                    	     1.70	   $63.29	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	65778	COVER EYE W/MEMBRANE                    	     0.34	   $12.66	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	65779	COVER EYE W/MEMBRANE SUTURE             	     1.34	   $49.89	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	65779	COVER EYE W/MEMBRANE SUTURE             	     6.70	  $249.44	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	65780	OCULAR RECONST TRANSPLANT               	     8.42	  $313.48	      ---	  $395.32	004	1	0	0.00	    $0.00	Y	
O	65780	OCULAR RECONST TRANSPLANT               	     1.68	   $62.55	      ---	   $78.88	004	1	0	0.00	    $0.00	Y	
O	65781	OCULAR RECONST TRANSPLANT               	     2.87	  $106.85	      ---	  $134.75	004	1	0	0.00	    $0.00	Y	
K	65781	OCULAR RECONST TRANSPLANT               	    14.35	  $534.25	      ---	  $673.73	004	1	0	0.00	    $0.00	Y	
K	65782	OCULAR RECONST TRANSPLANT               	    12.22	  $454.95	      ---	  $573.73	004	1	0	0.00	    $0.00	Y	
O	65782	OCULAR RECONST TRANSPLANT               	     2.44	   $90.84	      ---	  $114.56	004	1	0	0.00	    $0.00	Y	
K	65785	IMPLTJ NTRSTRML CRNL RNG SEG            	    52.28	 $1946.38	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	65800	DRAINAGE OF EYE                         	     2.11	   $78.56	      ---	   $99.06	004	1	0	0.00	    $0.00	Y	
K	65810	DRAINAGE OF EYE                         	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
K	65815	DRAINAGE OF EYE                         	     6.12	  $227.85	      ---	  $287.33	004	1	0	0.00	    $0.00	Y	
O	65815	DRAINAGE OF EYE                         	     1.22	   $45.42	      ---	   $57.28	004	1	0	0.00	    $0.00	Y	
O	65820	GONIOTOMY                               	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	65820	GONIOTOMY                               	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	65850	TRABECULOTOMY AB EXTERNO                	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	65850	TRABECULOTOMY AB EXTERNO                	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
O	65855	TRABECULOPLASTY LASER SURG              	     1.15	   $42.81	      ---	   $53.99	004	1	0	0.00	    $0.00	Y	
K	65855	TRABECULOPLASTY LASER SURG              	     5.79	  $215.56	      ---	  $271.84	004	1	0	0.00	    $0.00	Y	
K	65860	SEVERING ADS ANT SGM LASER              	     8.47	  $315.34	      ---	  $397.67	004	1	0	0.00	    $0.00	Y	
O	65860	SEVERING ADS ANT SGM LASER              	     1.69	   $62.92	      ---	   $79.35	004	1	0	0.00	    $0.00	Y	
O	65865	INCISE INNER EYE ADHESIONS              	     2.20	   $81.91	      ---	  $103.29	004	1	0	0.00	    $0.00	Y	
K	65865	INCISE INNER EYE ADHESIONS              	    11.10	  $413.25	      ---	  $521.15	004	1	0	0.00	    $0.00	Y	
K	65870	INCISE INNER EYE ADHESIONS              	    10.53	  $392.03	      ---	  $494.38	004	1	0	0.00	    $0.00	Y	
O	65870	INCISE INNER EYE ADHESIONS              	     2.04	   $75.95	      ---	   $95.78	004	1	0	0.00	    $0.00	Y	
O	65875	INCISE INNER EYE ADHESIONS              	     2.04	   $75.95	      ---	   $95.78	004	1	0	0.00	    $0.00	Y	
K	65875	INCISE INNER EYE ADHESIONS              	    10.53	  $392.03	      ---	  $494.38	004	1	0	0.00	    $0.00	Y	
K	65880	INCISE INNER EYE ADHESIONS              	    10.53	  $392.03	      ---	  $494.38	004	1	0	0.00	    $0.00	Y	
O	65880	INCISE INNER EYE ADHESIONS              	     2.04	   $75.95	      ---	   $95.78	004	1	0	0.00	    $0.00	Y	
O	65900	REMOVE EYE LESION                       	     4.43	  $164.93	      ---	  $207.99	004	1	0	0.00	    $0.00	Y	
K	65900	REMOVE EYE LESION                       	    22.14	  $824.27	      ---	 $1039.47	004	1	0	0.00	    $0.00	Y	
K	65920	REMOVE IMPLANT OF EYE                   	    13.85	  $515.64	      ---	  $650.26	004	1	0	0.00	    $0.00	Y	
O	65920	REMOVE IMPLANT OF EYE                   	     2.77	  $103.13	      ---	  $130.05	004	1	0	0.00	    $0.00	Y	
O	65930	REMOVE BLOOD CLOT FROM EYE              	     2.98	  $110.95	      ---	  $139.91	004	1	0	0.00	    $0.00	Y	
K	65930	REMOVE BLOOD CLOT FROM EYE              	    14.91	  $555.10	      ---	  $700.02	004	1	0	0.00	    $0.00	Y	
K	66020	INJECTION TREATMENT OF EYE              	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	66030	INJECTION TREATMENT OF EYE              	     1.54	   $57.33	      ---	   $72.30	004	1	0	0.00	    $0.00	Y	
K	66130	REMOVE EYE LESION                       	    12.64	  $470.59	      ---	  $593.45	004	1	0	0.00	    $0.00	Y	
O	66130	REMOVE EYE LESION                       	     2.53	   $94.19	      ---	  $118.78	004	1	0	0.00	    $0.00	Y	
O	66150	GLAUCOMA SURGERY                        	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	66150	GLAUCOMA SURGERY                        	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	66155	GLAUCOMA SURGERY                        	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	66155	GLAUCOMA SURGERY                        	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
O	66160	GLAUCOMA SURGERY                        	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	66160	GLAUCOMA SURGERY                        	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	66170	GLAUCOMA SURGERY                        	    18.12	  $674.61	      ---	  $850.73	004	1	0	0.00	    $0.00	Y	
O	66170	GLAUCOMA SURGERY                        	     3.62	  $134.77	      ---	  $169.96	004	1	0	0.00	    $0.00	Y	
O	66172	INCISION OF EYE                         	     4.70	  $174.98	      ---	  $220.67	004	1	0	0.00	    $0.00	Y	
K	66172	INCISION OF EYE                         	    23.48	  $874.16	      ---	 $1102.39	004	1	0	0.00	    $0.00	Y	
K	66179	AQUEOUS SHUNT EYE W/O GRAFT             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	66179	AQUEOUS SHUNT EYE W/O GRAFT             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	66180	AQUEOUS SHUNT EYE W/GRAFT               	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
K	66180	AQUEOUS SHUNT EYE W/GRAFT               	    30.00	 $1116.90	      ---	 $1408.50	004	1	0	0.00	    $0.00	Y	
K	66184	REVISION OF AQUEOUS SHUNT               	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	66184	REVISION OF AQUEOUS SHUNT               	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	66185	REVISE AQUEOUS SHUNT EYE                	     1.53	   $56.96	      ---	   $71.83	004	1	0	0.00	    $0.00	Y	
K	66185	REVISE AQUEOUS SHUNT EYE                	     7.67	  $285.55	      ---	  $360.11	004	1	0	0.00	    $0.00	Y	
K	66225	REPAIR/GRAFT EYE LESION                 	    24.00	  $893.52	      ---	 $1126.80	004	1	0	0.00	    $0.00	Y	
O	66225	REPAIR/GRAFT EYE LESION                 	     4.80	  $178.70	      ---	  $225.36	004	1	0	0.00	    $0.00	Y	
O	66250	FOLLOW-UP SURGERY OF EYE                	     2.39	   $88.98	      ---	  $112.21	004	1	0	0.00	    $0.00	Y	
K	66250	FOLLOW-UP SURGERY OF EYE                	    11.97	  $445.64	      ---	  $561.99	004	1	0	0.00	    $0.00	Y	
K	66500	INCISION OF IRIS                        	     5.66	  $210.72	      ---	  $265.74	004	1	0	0.00	    $0.00	Y	
O	66500	INCISION OF IRIS                        	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	66505	INCISION OF IRIS                        	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	66505	INCISION OF IRIS                        	     5.66	  $210.72	      ---	  $265.74	004	1	0	0.00	    $0.00	Y	
K	66600	REMOVE IRIS AND LESION                  	    15.58	  $580.04	      ---	  $731.48	004	1	0	0.00	    $0.00	Y	
O	66600	REMOVE IRIS AND LESION                  	     3.12	  $116.16	      ---	  $146.48	004	1	0	0.00	    $0.00	Y	
O	66605	REMOVAL OF IRIS                         	     4.31	  $160.46	      ---	  $202.35	004	1	0	0.00	    $0.00	Y	
K	66605	REMOVAL OF IRIS                         	    21.55	  $802.31	      ---	 $1011.77	004	1	0	0.00	    $0.00	Y	
K	66625	REMOVAL OF IRIS                         	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	66625	REMOVAL OF IRIS                         	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	66630	REMOVAL OF IRIS                         	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	66630	REMOVAL OF IRIS                         	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	66635	REMOVAL OF IRIS                         	    11.12	  $414.00	      ---	  $522.08	004	1	0	0.00	    $0.00	Y	
O	66635	REMOVAL OF IRIS                         	     2.22	   $82.65	      ---	  $104.23	004	1	0	0.00	    $0.00	Y	
O	66680	REPAIR IRIS & CILIARY BODY              	     2.01	   $74.83	      ---	   $94.37	004	1	0	0.00	    $0.00	Y	
K	66680	REPAIR IRIS & CILIARY BODY              	    10.03	  $373.42	      ---	  $470.91	004	1	0	0.00	    $0.00	Y	
K	66682	REPAIR IRIS & CILIARY BODY              	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	66682	REPAIR IRIS & CILIARY BODY              	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	66683	IMPLANTATION IRIS PROSTHESIS            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	66683	IMPLANTATION IRIS PROSTHESIS            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	66700	DESTRUCTION CILIARY BODY                	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	66700	DESTRUCTION CILIARY BODY                	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
O	66710	CILIARY TRANSSLERAL THERAPY             	     1.34	   $49.89	      ---	   $62.91	004	1	0	0.00	    $0.00	Y	
K	66710	CILIARY TRANSSLERAL THERAPY             	     6.68	  $248.70	      ---	  $313.63	004	1	0	0.00	    $0.00	Y	
K	66711	ECP CILIARY BODY DESTRUCTION            	     5.74	  $213.70	      ---	  $269.49	004	1	0	0.00	    $0.00	Y	
O	66711	ECP CILIARY BODY DESTRUCTION            	     1.15	   $42.81	      ---	   $53.99	004	1	0	0.00	    $0.00	Y	
K	66720	DESTRUCTION CILIARY BODY                	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
K	66740	DESTRUCTION CILIARY BODY                	    12.00	  $446.76	      ---	  $563.40	004	1	0	0.00	    $0.00	Y	
O	66740	DESTRUCTION CILIARY BODY                	     2.40	   $89.35	      ---	  $112.68	004	1	0	0.00	    $0.00	Y	
K	66761	REVISION OF IRIS                        	     5.66	  $210.72	      ---	  $265.74	004	1	0	0.00	    $0.00	Y	
K	66762	REVISION OF IRIS                        	     5.66	  $210.72	      ---	  $265.74	004	1	0	0.00	    $0.00	Y	
K	66770	REMOVAL OF INNER EYE LESION             	     8.49	  $316.08	      ---	  $398.61	004	1	0	0.00	    $0.00	Y	
O	66770	REMOVAL OF INNER EYE LESION             	     1.70	   $63.29	      ---	   $79.82	004	1	0	0.00	    $0.00	Y	
O	66820	INCISION SECONDARY CATARACT             	     1.13	   $42.07	      ---	   $53.05	004	1	0	0.00	    $0.00	Y	
K	66820	INCISION SECONDARY CATARACT             	     5.66	  $210.72	      ---	  $265.74	004	1	0	0.00	    $0.00	Y	
K	66821	AFTER CATARACT LASER SURGERY            	     5.00	  $186.15	      ---	  $234.75	004	1	0	0.00	    $0.00	Y	
O	66821	AFTER CATARACT LASER SURGERY            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	66825	REPOSITION INTRAOCULAR LENS             	     2.73	  $101.64	      ---	  $128.17	004	1	0	0.00	    $0.00	Y	
K	66825	REPOSITION INTRAOCULAR LENS             	    13.67	  $508.93	      ---	  $641.81	004	1	0	0.00	    $0.00	Y	
K	66830	REMOVAL OF LENS LESION                  	    13.00	  $483.99	      ---	  $610.35	004	1	0	0.00	    $0.00	Y	
O	66830	REMOVAL OF LENS LESION                  	     2.60	   $96.80	      ---	  $122.07	004	1	0	0.00	    $0.00	Y	
O	66840	REMOVAL OF LENS MATERIAL                	     2.44	   $90.84	      ---	  $114.56	004	1	0	0.00	    $0.00	Y	
K	66840	REMOVAL OF LENS MATERIAL                	    12.19	  $453.83	      ---	  $572.32	004	1	0	0.00	    $0.00	Y	
K	66850	REMOVAL OF LENS MATERIAL                	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	66850	REMOVAL OF LENS MATERIAL                	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
O	66852	REMOVAL OF LENS MATERIAL                	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	66852	REMOVAL OF LENS MATERIAL                	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	66920	EXTRACTION OF LENS                      	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
O	66920	EXTRACTION OF LENS                      	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
O	66930	EXTRACTION OF LENS                      	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
K	66930	EXTRACTION OF LENS                      	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
K	66940	EXTRACTION OF LENS                      	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
O	66940	EXTRACTION OF LENS                      	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
O	66982	XCAPSL CTRC RMVL CPLX WO ECP            	     5.40	  $201.04	      ---	  $253.53	004	1	0	0.00	    $0.00	Y	
K	66982	XCAPSL CTRC RMVL CPLX WO ECP            	    27.10	 $1008.93	      ---	 $1272.35	004	1	0	0.00	    $0.00	Y	
K	66983	CATARACT SURG W/IOL 1 STAGE             	    27.00	 $1005.21	      ---	 $1267.65	004	1	0	0.00	    $0.00	Y	
O	66983	CATARACT SURG W/IOL 1 STAGE             	     5.40	  $201.04	      ---	  $253.53	004	1	0	0.00	    $0.00	Y	
O	66984	XCAPSL CTRC RMVL W/O ECP                	     5.40	  $201.04	      ---	  $253.53	004	1	0	0.00	    $0.00	Y	
K	66984	XCAPSL CTRC RMVL W/O ECP                	    27.00	 $1005.21	      ---	 $1267.65	004	1	0	0.00	    $0.00	Y	
K	66985	INSERT LENS PROSTHESIS                  	    12.69	  $472.45	      ---	  $595.80	004	1	0	0.00	    $0.00	Y	
O	66985	INSERT LENS PROSTHESIS                  	     2.54	   $94.56	      ---	  $119.25	004	1	0	0.00	    $0.00	Y	
O	66986	EXCHANGE LENS PROSTHESIS                	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	66986	EXCHANGE LENS PROSTHESIS                	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	66987	XCAPSL CTRC RMVL CPLX W/ECP             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	66987	XCAPSL CTRC RMVL CPLX W/ECP             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	66988	XCAPSL CTRC RMVL W/ECP                  	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	66988	XCAPSL CTRC RMVL W/ECP                  	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	66989	XCPSL CTRC RMVL CPLX INSJ 1+            	    19.93	  $741.99	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	66990	OPHTHALMIC ENDOSCOPE ADD-ON             	     1.25	   $46.54	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	66991	XCAPSL CTRC RMVL INSJ 1+                	    15.96	  $594.19	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	66999	UNLISTED PX ANT SEGMENT EYE             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	66999	UNLISTED PX ANT SEGMENT EYE             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	67005	PARTIAL REMOVAL OF EYE FLUID            	     3.00	  $111.69	      ---	  $140.85	004	1	0	0.00	    $0.00	Y	
K	67005	PARTIAL REMOVAL OF EYE FLUID            	    15.00	  $558.45	      ---	  $704.25	004	1	0	0.00	    $0.00	Y	
K	67010	PARTIAL REMOVAL OF EYE FLUID            	    30.00	 $1116.90	      ---	 $1408.50	004	1	0	0.00	    $0.00	Y	
O	67010	PARTIAL REMOVAL OF EYE FLUID            	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
O	67015	RELEASE OF EYE FLUID                    	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
K	67015	RELEASE OF EYE FLUID                    	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
K	67025	REPLACE EYE FLUID                       	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	67025	REPLACE EYE FLUID                       	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
O	67027	IMPLANT EYE DRUG SYSTEM                 	     3.16	  $117.65	      ---	  $148.36	004	1	0	0.00	    $0.00	Y	
K	67027	IMPLANT EYE DRUG SYSTEM                 	    15.80	  $588.23	      ---	  $741.81	004	1	0	0.00	    $0.00	Y	
K	67028	INJECTION EYE DRUG                      	     9.78	  $364.11	      ---	  $459.17	004	1	0	0.00	    $0.00	Y	
O	67028	INJECTION EYE DRUG                      	     1.96	   $72.97	      ---	   $92.02	004	1	0	0.00	    $0.00	Y	
K	67030	INCISE INNER EYE STRANDS                	    10.38	  $386.45	      ---	  $487.34	004	1	0	0.00	    $0.00	Y	
K	67031	LASER SURGERY EYE STRANDS               	     6.52	  $242.74	      ---	  $306.11	004	1	0	0.00	    $0.00	Y	
O	67031	LASER SURGERY EYE STRANDS               	     1.30	   $48.40	      ---	   $61.04	004	1	0	0.00	    $0.00	Y	
O	67036	REMOVAL OF INNER EYE FLUID              	     6.40	  $238.27	      ---	  $300.48	004	1	0	0.00	    $0.00	Y	
K	67036	REMOVAL OF INNER EYE FLUID              	    31.00	 $1154.13	      ---	 $1455.45	004	1	0	0.00	    $0.00	Y	
K	67039	LASER TREATMENT OF RETINA               	    34.00	 $1265.82	      ---	 $1596.30	004	1	0	0.00	    $0.00	Y	
O	67039	LASER TREATMENT OF RETINA               	     6.80	  $253.16	      ---	  $319.26	004	1	0	0.00	    $0.00	Y	
O	67040	LASER TREATMENT OF RETINA               	     4.65	  $173.12	      ---	  $218.32	004	1	0	0.00	    $0.00	Y	
K	67040	LASER TREATMENT OF RETINA               	    24.69	  $919.21	      ---	 $1159.20	004	1	0	0.00	    $0.00	Y	
K	67041	VIT FOR MACULAR PUCKER                  	    22.11	  $823.16	      ---	 $1038.06	004	1	0	0.00	    $0.00	Y	
O	67041	VIT FOR MACULAR PUCKER                  	     4.42	  $164.56	      ---	  $207.52	004	1	0	0.00	    $0.00	Y	
O	67042	VIT FOR MACULAR HOLE                    	     5.06	  $188.38	      ---	  $237.57	004	1	0	0.00	    $0.00	Y	
K	67042	VIT FOR MACULAR HOLE                    	    25.28	  $941.17	      ---	 $1186.90	004	1	0	0.00	    $0.00	Y	
K	67043	VIT FOR MEMBRANE DISSECT                	    26.56	  $988.83	      ---	 $1246.99	004	1	0	0.00	    $0.00	Y	
O	67043	VIT FOR MEMBRANE DISSECT                	     5.31	  $197.69	      ---	  $249.30	004	1	0	0.00	    $0.00	Y	
K	67101	REPAIR DETACHED RETINA CRTX             	     7.83	  $291.51	      ---	  $367.62	004	1	0	0.00	    $0.00	Y	
K	67105	REPAIR DETACHED RETINA PC               	     7.06	  $262.84	      ---	  $331.47	004	1	0	0.00	    $0.00	Y	
K	67107	REPAIR DETACHED RETINA                  	    26.67	  $992.92	      ---	 $1252.16	004	1	0	0.00	    $0.00	Y	
O	67107	REPAIR DETACHED RETINA                  	     5.33	  $198.44	      ---	  $250.24	004	1	0	0.00	    $0.00	Y	
O	67108	REPAIR DETACHED RETINA                  	     5.65	  $210.35	      ---	  $265.27	004	1	0	0.00	    $0.00	Y	
K	67108	REPAIR DETACHED RETINA                  	    28.26	 $1052.12	      ---	 $1326.81	004	1	0	0.00	    $0.00	Y	
K	67110	REPAIR DETACHED RETINA                  	    25.00	  $930.75	      ---	 $1173.75	004	1	0	0.00	    $0.00	Y	
O	67110	REPAIR DETACHED RETINA                  	     5.00	  $186.15	      ---	  $234.75	004	1	0	0.00	    $0.00	Y	
O	67113	REPAIR RETINAL DETACH CPLX              	     6.31	  $234.92	      ---	  $296.25	004	1	0	0.00	    $0.00	Y	
K	67113	REPAIR RETINAL DETACH CPLX              	    31.55	 $1174.61	      ---	 $1481.27	004	1	0	0.00	    $0.00	Y	
K	67115	RELEASE ENCIRCLING MATERIAL             	     9.75	  $362.99	      ---	  $457.76	004	1	0	0.00	    $0.00	Y	
O	67115	RELEASE ENCIRCLING MATERIAL             	     1.95	   $72.60	      ---	   $91.55	004	1	0	0.00	    $0.00	Y	
O	67120	REMOVE EYE IMPLANT MATERIAL             	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	67120	REMOVE EYE IMPLANT MATERIAL             	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	67121	REMOVE EYE IMPLANT MATERIAL             	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	67121	REMOVE EYE IMPLANT MATERIAL             	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	67141	PROPH RTA DTCHMNT CRTX DTHRM            	     2.19	   $81.53	      ---	  $102.82	004	1	0	0.00	    $0.00	Y	
K	67141	PROPH RTA DTCHMNT CRTX DTHRM            	    10.94	  $407.30	      ---	  $513.63	004	1	0	0.00	    $0.00	Y	
K	67145	PROPH RTA DTCHMNT PC                    	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
O	67145	PROPH RTA DTCHMNT PC                    	     2.00	   $74.46	      ---	   $93.90	004	1	0	0.00	    $0.00	Y	
O	67208	TREATMENT OF RETINAL LESION             	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	67208	TREATMENT OF RETINAL LESION             	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	67210	TREATMENT OF RETINAL LESION             	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	67210	TREATMENT OF RETINAL LESION             	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	67218	TREATMENT OF RETINAL LESION             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	67218	TREATMENT OF RETINAL LESION             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	67220	TREATMENT OF CHOROID LESION             	    16.95	  $631.05	      ---	  $795.80	004	1	0	0.00	    $0.00	Y	
O	67220	TREATMENT OF CHOROID LESION             	     3.39	  $126.21	      ---	  $159.16	004	1	0	0.00	    $0.00	Y	
O	67221	OCULAR PHOTODYNAMIC THER                	     1.56	   $58.08	      ---	   $73.24	004	1	0	0.00	    $0.00	Y	
K	67221	OCULAR PHOTODYNAMIC THER                	     7.82	  $291.14	      ---	  $367.15	004	1	0	0.00	    $0.00	Y	
K	67225	EYE PHOTODYNAMIC THER ADD-ON            	    17.93	  $667.53	      ---	  $841.81	004	1	0	0.00	    $0.00	Y	
O	67225	EYE PHOTODYNAMIC THER ADD-ON            	     3.59	  $133.66	      ---	  $168.55	004	1	0	0.00	    $0.00	Y	
O	67227	DSTRJ EXTENSIVE RETINOPATHY             	     1.37	   $51.01	      ---	   $64.32	004	1	0	0.00	    $0.00	Y	
K	67227	DSTRJ EXTENSIVE RETINOPATHY             	     6.88	  $256.14	      ---	  $323.02	004	1	0	0.00	    $0.00	Y	
K	67228	TREATMENT X10SV RETINOPATHY             	     8.06	  $300.07	      ---	  $378.42	004	1	0	0.00	    $0.00	Y	
O	67228	TREATMENT X10SV RETINOPATHY             	     1.61	   $59.94	      ---	   $75.59	004	1	0	0.00	    $0.00	Y	
O	67229	TR RETINAL LES PRETERM INF              	     5.49	  $204.39	      ---	  $257.76	004	1	0	0.00	    $0.00	Y	
K	67229	TR RETINAL LES PRETERM INF              	    27.47	 $1022.71	      ---	 $1289.72	004	1	0	0.00	    $0.00	Y	
K	67250	REINFORCE EYE WALL                      	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
O	67250	REINFORCE EYE WALL                      	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
O	67255	REINFORCE/GRAFT EYE WALL                	     4.80	  $178.70	      ---	  $225.36	004	1	0	0.00	    $0.00	Y	
K	67255	REINFORCE/GRAFT EYE WALL                	    24.00	  $893.52	      ---	 $1126.80	004	1	0	0.00	    $0.00	Y	
K	67299	UNLISTED PX POSTERIOR SEGMNT            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	67299	UNLISTED PX POSTERIOR SEGMNT            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	67311	REVISE EYE MUSCLE                       	     2.80	  $104.24	      ---	  $131.46	004	1	0	0.00	    $0.00	Y	
K	67311	REVISE EYE MUSCLE                       	    14.00	  $521.22	      ---	  $657.30	004	1	0	0.00	    $0.00	Y	
K	67312	REVISE TWO EYE MUSCLES                  	    14.00	  $521.22	      ---	  $657.30	004	1	0	0.00	    $0.00	Y	
O	67312	REVISE TWO EYE MUSCLES                  	     2.80	  $104.24	      ---	  $131.46	004	1	0	0.00	    $0.00	Y	
O	67314	REVISE EYE MUSCLE                       	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	67314	REVISE EYE MUSCLE                       	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	67316	REVISE TWO EYE MUSCLES                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	67316	REVISE TWO EYE MUSCLES                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	67318	REVISE EYE MUSCLE(S)                    	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	67318	REVISE EYE MUSCLE(S)                    	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	67320	REVISE EYE MUSCLE(S) ADD-ON             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	67320	REVISE EYE MUSCLE(S) ADD-ON             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	67331	EYE SURGERY FOLLOW-UP ADD-ON            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	67331	EYE SURGERY FOLLOW-UP ADD-ON            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	67332	REREVISE EYE MUSCLES ADD-ON             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	67332	REREVISE EYE MUSCLES ADD-ON             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	67334	REVISE EYE MUSCLE W/SUTURE              	     1.87	   $69.62	      ---	   $87.80	004	1	0	0.00	    $0.00	Y	
K	67334	REVISE EYE MUSCLE W/SUTURE              	     9.36	  $348.47	      ---	  $439.45	004	1	0	0.00	    $0.00	Y	
K	67335	EYE SUTURE DURING SURGERY               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	67335	EYE SUTURE DURING SURGERY               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	67340	REVISE EYE MUSCLE ADD-ON                	     2.34	   $87.12	      ---	  $109.86	004	1	0	0.00	    $0.00	Y	
K	67340	REVISE EYE MUSCLE ADD-ON                	    11.71	  $435.96	      ---	  $549.78	004	1	0	0.00	    $0.00	Y	
K	67343	RELEASE EYE TISSUE                      	    14.06	  $523.45	      ---	  $660.12	004	1	0	0.00	    $0.00	Y	
O	67343	RELEASE EYE TISSUE                      	     2.81	  $104.62	      ---	  $131.93	004	1	0	0.00	    $0.00	Y	
K	67345	DESTROY NERVE OF EYE MUSCLE             	     4.08	  $151.90	      ---	  $191.56	004	1	0	0.00	    $0.00	Y	
K	67346	BIOPSY EYE MUSCLE                       	     4.11	  $153.02	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	67346	BIOPSY EYE MUSCLE                       	     0.82	   $30.53	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	67399	UNLISTED PX EXTRAOCULAR MUSC            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	67399	UNLISTED PX EXTRAOCULAR MUSC            	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	67400	EXPLORE/BIOPSY EYE SOCKET               	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	67400	EXPLORE/BIOPSY EYE SOCKET               	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
O	67405	EXPLORE/DRAIN EYE SOCKET                	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	67405	EXPLORE/DRAIN EYE SOCKET                	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	67412	EXPLORE/TREAT EYE SOCKET                	    14.25	  $530.53	      ---	  $669.04	004	1	0	0.00	    $0.00	Y	
O	67412	EXPLORE/TREAT EYE SOCKET                	     2.85	  $106.11	      ---	  $133.81	004	1	0	0.00	    $0.00	Y	
O	67413	EXPLORE/TREAT EYE SOCKET                	     2.41	   $89.72	      ---	  $113.15	004	1	0	0.00	    $0.00	Y	
K	67413	EXPLORE/TREAT EYE SOCKET                	    12.08	  $449.74	      ---	  $567.16	004	1	0	0.00	    $0.00	Y	
K	67414	EXPLR/DECOMPRESS EYE SOCKET             	    12.38	  $460.91	      ---	  $581.24	004	1	0	0.00	    $0.00	Y	
O	67414	EXPLR/DECOMPRESS EYE SOCKET             	     2.48	   $92.33	      ---	  $116.44	004	1	0	0.00	    $0.00	Y	
K	67415	ASPIRATION ORBITAL CONTENTS             	     2.25	   $83.77	      ---	  $105.64	004	1	0	0.00	    $0.00	Y	
K	67420	EXPLORE/TREAT EYE SOCKET                	    24.92	  $927.77	      ---	 $1169.99	004	1	0	0.00	    $0.00	Y	
O	67420	EXPLORE/TREAT EYE SOCKET                	     4.98	  $185.41	      ---	  $233.81	004	1	0	0.00	    $0.00	Y	
O	67430	EXPLORE/TREAT EYE SOCKET                	     4.98	  $185.41	      ---	  $233.81	004	1	0	0.00	    $0.00	Y	
K	67430	EXPLORE/TREAT EYE SOCKET                	    24.92	  $927.77	      ---	 $1169.99	004	1	0	0.00	    $0.00	Y	
K	67440	EXPLORE/DRAIN EYE SOCKET                	    22.65	  $843.26	      ---	 $1063.42	004	1	0	0.00	    $0.00	Y	
O	67440	EXPLORE/DRAIN EYE SOCKET                	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
O	67445	EXPLR/DECOMPRESS EYE SOCKET             	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
K	67445	EXPLR/DECOMPRESS EYE SOCKET             	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
K	67450	EXPLORE/BIOPSY EYE SOCKET               	    24.46	  $910.65	      ---	 $1148.40	004	1	0	0.00	    $0.00	Y	
O	67450	EXPLORE/BIOPSY EYE SOCKET               	     4.89	  $182.05	      ---	  $229.59	004	1	0	0.00	    $0.00	Y	
K	67500	INJECT/TREAT EYE SOCKET                 	     4.01	  $149.29	      ---	  $188.27	004	1	1	0.00	    $0.00	Y	
K	67505	INJECT/TREAT EYE SOCKET                 	     3.24	  $120.63	      ---	  $152.12	004	1	0	0.00	    $0.00	Y	
K	67515	INJECT/TREAT EYE SOCKET                 	     3.07	  $114.30	      ---	  $144.14	004	1	0	0.00	    $0.00	Y	
K	67516	SPRCHOROIDAL SPC NJX RX AGT             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	67550	INSERT EYE SOCKET IMPLANT               	    14.72	  $548.03	      ---	  $691.10	004	1	0	0.00	    $0.00	Y	
O	67550	INSERT EYE SOCKET IMPLANT               	     2.94	  $109.46	      ---	  $138.03	004	1	0	0.00	    $0.00	Y	
O	67560	REVISE EYE SOCKET IMPLANT               	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
K	67560	REVISE EYE SOCKET IMPLANT               	    19.99	  $744.23	      ---	  $938.53	004	1	0	0.00	    $0.00	Y	
K	67570	DECOMPRESS OPTIC NERVE                  	    13.49	  $502.23	      ---	  $633.36	004	1	0	0.00	    $0.00	Y	
O	67570	DECOMPRESS OPTIC NERVE                  	     2.70	  $100.52	      ---	  $126.77	004	1	0	0.00	    $0.00	Y	
O	67599	UNLISTED PROCEDURE ORBIT                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	67599	UNLISTED PROCEDURE ORBIT                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	67700	BLEPHAROTOMY DRG ABSC EYELID            	     3.35	  $124.72	      ---	  $157.28	004	1	1	0.00	    $0.00	Y	
K	67710	SEVERING TARSORRHAPHY                   	     3.29	  $122.49	      ---	  $154.47	004	1	0	0.00	    $0.00	Y	
K	67715	CANTHOTOMY                              	     0.85	   $31.65	      ---	   $39.91	004	1	0	0.00	    $0.00	Y	
K	67800	REMOVE EYELID LESION                    	     3.46	  $128.82	      ---	  $162.45	004	1	1	0.00	    $0.00	Y	
K	67801	REMOVE EYELID LESIONS                   	     3.83	  $142.59	      ---	  $179.82	004	1	1	0.00	    $0.00	Y	
K	67805	REMOVE EYELID LESIONS                   	     4.08	  $151.90	      ---	  $191.56	004	1	1	0.00	    $0.00	Y	
K	67808	REMOVE EYELID LESION(S)                 	     3.53	  $131.42	      ---	  $165.73	004	1	0	0.00	    $0.00	Y	
O	67808	REMOVE EYELID LESION(S)                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	67810	INCAL BX EYELID SKN LID MRGN            	     2.91	  $108.34	      ---	  $136.62	004	1	1	0.00	    $0.00	Y	
K	67820	REVISE EYELASHES                        	     1.14	   $42.44	      ---	   $53.52	004	1	1	0.00	    $0.00	Y	
1	67820	REVISE EYELASHES                        	    13.48	   $13.48	      ---	   $13.48	009	1	1	0.00	    $0.00	Y	
K	67825	REVISE EYELASHES                        	     4.20	  $156.37	      ---	  $197.19	004	1	1	0.00	    $0.00	Y	
K	67830	REVISE EYELASHES                        	     8.23	  $306.40	      ---	  $386.40	004	1	1	0.00	    $0.00	Y	
O	67830	REVISE EYELASHES                        	     1.64	   $61.06	      ---	   $77.00	004	1	0	0.00	    $0.00	Y	
O	67835	REVISE EYELASHES                        	     1.98	   $73.72	      ---	   $92.96	004	1	0	0.00	    $0.00	Y	
K	67835	REVISE EYELASHES                        	     9.91	  $368.95	      ---	  $465.27	004	1	0	0.00	    $0.00	Y	
K	67840	REMOVE EYELID LESION                    	     3.91	  $145.57	      ---	  $183.57	004	1	0	0.00	    $0.00	Y	
K	67850	DSTRJ LESION LID MARGIN <1CM            	     4.15	  $154.50	      ---	  $194.84	004	1	0	0.00	    $0.00	Y	
K	67875	CLOSURE OF EYELID BY SUTURE             	     5.66	  $210.72	      ---	  $265.74	004	1	0	0.00	    $0.00	Y	
O	67875	CLOSURE OF EYELID BY SUTURE             	     1.13	   $42.07	      ---	   $53.05	004	1	0	0.00	    $0.00	Y	
O	67880	REVISION OF EYELID                      	     2.39	   $88.98	      ---	  $112.21	004	1	0	0.00	    $0.00	Y	
K	67880	REVISION OF EYELID                      	    11.94	  $444.53	      ---	  $560.58	004	1	0	0.00	    $0.00	Y	
K	67882	REVISION OF EYELID                      	    15.39	  $572.97	      ---	  $722.56	004	1	0	0.00	    $0.00	Y	
O	67882	REVISION OF EYELID                      	     3.08	  $114.67	      ---	  $144.61	004	1	0	0.00	    $0.00	Y	
O	67900	REPAIR BROW DEFECT                      	     1.77	   $65.90	      ---	   $83.10	004	1	0	0.00	    $0.00	Y	
K	67900	REPAIR BROW DEFECT                      	     8.86	  $329.86	      ---	  $415.98	004	1	0	0.00	    $0.00	Y	
K	67901	REPAIR EYELID DEFECT                    	    16.00	  $595.68	      ---	  $751.20	004	1	0	0.00	    $0.00	Y	
O	67901	REPAIR EYELID DEFECT                    	     3.20	  $119.14	      ---	  $150.24	004	1	0	0.00	    $0.00	Y	
O	67902	REPAIR EYELID DEFECT                    	     2.40	   $89.35	      ---	  $112.68	004	1	0	0.00	    $0.00	Y	
K	67902	REPAIR EYELID DEFECT                    	    12.00	  $446.76	      ---	  $563.40	004	1	0	0.00	    $0.00	Y	
K	67903	REPAIR EYELID DEFECT                    	    16.00	  $595.68	      ---	  $751.20	004	1	0	0.00	    $0.00	Y	
O	67903	REPAIR EYELID DEFECT                    	     3.20	  $119.14	      ---	  $150.24	004	1	0	0.00	    $0.00	Y	
O	67904	REPAIR EYELID DEFECT                    	     3.23	  $120.25	      ---	  $151.65	004	1	0	0.00	    $0.00	Y	
K	67904	REPAIR EYELID DEFECT                    	    16.16	  $601.64	      ---	  $758.71	004	1	0	0.00	    $0.00	Y	
K	67906	REPAIR EYELID DEFECT                    	    16.00	  $595.68	      ---	  $751.20	004	1	0	0.00	    $0.00	Y	
O	67906	REPAIR EYELID DEFECT                    	     3.20	  $119.14	      ---	  $150.24	004	1	0	0.00	    $0.00	Y	
O	67908	REPAIR EYELID DEFECT                    	     2.31	   $86.00	      ---	  $108.45	004	1	0	0.00	    $0.00	Y	
K	67908	REPAIR EYELID DEFECT                    	    11.64	  $433.36	      ---	  $546.50	004	1	0	0.00	    $0.00	Y	
K	67909	REVISE EYELID DEFECT                    	    12.60	  $469.10	      ---	  $591.57	004	1	0	0.00	    $0.00	Y	
O	67909	REVISE EYELID DEFECT                    	     2.52	   $93.82	      ---	  $118.31	004	1	0	0.00	    $0.00	Y	
O	67911	REVISE EYELID DEFECT                    	     2.20	   $81.91	      ---	  $103.29	004	1	0	0.00	    $0.00	Y	
K	67911	REVISE EYELID DEFECT                    	    11.10	  $413.25	      ---	  $521.15	004	1	0	0.00	    $0.00	Y	
K	67912	CORRECTION EYELID W/IMPLANT             	    22.66	  $843.63	      ---	 $1063.89	004	1	0	0.00	    $0.00	Y	
O	67912	CORRECTION EYELID W/IMPLANT             	     4.53	  $168.65	      ---	  $212.68	004	1	0	0.00	    $0.00	Y	
K	67914	REPAIR EYELID DEFECT                    	     6.50	  $242.00	      ---	  $305.18	004	1	0	0.00	    $0.00	Y	
K	67915	REPAIR EYELID DEFECT                    	     5.72	  $212.96	      ---	  $268.55	004	1	0	0.00	    $0.00	Y	
K	67916	REPAIR EYELID DEFECT                    	     9.06	  $337.30	      ---	  $425.37	004	1	0	0.00	    $0.00	Y	
O	67916	REPAIR EYELID DEFECT                    	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
O	67917	REPAIR EYELID DEFECT                    	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	67917	REPAIR EYELID DEFECT                    	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	67921	REPAIR EYELID DEFECT                    	     6.31	  $234.92	      ---	  $296.25	004	1	0	0.00	    $0.00	Y	
K	67922	REPAIR EYELID DEFECT                    	     5.63	  $209.60	      ---	  $264.33	004	1	0	0.00	    $0.00	Y	
K	67923	REPAIR EYELID DEFECT                    	     9.07	  $337.68	      ---	  $425.84	004	1	0	0.00	    $0.00	Y	
O	67923	REPAIR EYELID DEFECT                    	     1.81	   $67.39	      ---	   $84.98	004	1	0	0.00	    $0.00	Y	
O	67924	REPAIR EYELID DEFECT                    	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
K	67924	REPAIR EYELID DEFECT                    	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
K	67930	REPAIR EYELID WOUND                     	     6.55	  $243.86	      ---	  $307.52	004	1	0	0.00	    $0.00	Y	
K	67935	REPAIR EYELID WOUND                     	     9.36	  $348.47	      ---	  $439.45	004	1	0	0.00	    $0.00	Y	
O	67935	REPAIR EYELID WOUND                     	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	67938	REMOVE EYELID FOREIGN BODY              	     1.47	   $54.73	      ---	   $69.02	004	1	0	0.00	    $0.00	Y	
1	67938	REMOVE EYELID FOREIGN BODY              	   273.27	  $273.27	      ---	  $273.27	009	1	0	0.00	    $0.00	Y	
K	67938	REMOVE EYELID FOREIGN BODY              	     7.34	  $273.27	      ---	  $344.61	004	1	1	0.00	    $0.00	Y	
K	67950	REVISION OF EYELID                      	    11.51	  $428.52	      ---	  $540.39	004	1	0	0.00	    $0.00	Y	
O	67950	REVISION OF EYELID                      	     2.30	   $85.63	      ---	  $107.99	004	1	0	0.00	    $0.00	Y	
O	67961	REVISION OF EYELID                      	     2.25	   $83.77	      ---	  $105.64	004	1	0	0.00	    $0.00	Y	
K	67961	REVISION OF EYELID                      	    11.27	  $419.58	      ---	  $529.13	004	1	0	0.00	    $0.00	Y	
K	67966	REVISION OF EYELID                      	    12.41	  $462.02	      ---	  $582.65	004	1	0	0.00	    $0.00	Y	
O	67966	REVISION OF EYELID                      	     2.48	   $92.33	      ---	  $116.44	004	1	0	0.00	    $0.00	Y	
O	67971	RECONSTRUCTION OF EYELID                	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	67971	RECONSTRUCTION OF EYELID                	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	67973	RECONSTRUCTION OF EYELID                	    16.99	  $632.54	      ---	  $797.68	004	1	0	0.00	    $0.00	Y	
O	67973	RECONSTRUCTION OF EYELID                	     3.40	  $126.58	      ---	  $159.63	004	1	0	0.00	    $0.00	Y	
O	67974	RECONSTRUCTION OF EYELID                	     3.89	  $144.82	      ---	  $182.64	004	1	0	0.00	    $0.00	Y	
K	67974	RECONSTRUCTION OF EYELID                	    19.44	  $723.75	      ---	  $912.71	004	1	0	0.00	    $0.00	Y	
K	67975	RECONSTRUCTION OF EYELID                	     7.69	  $286.30	      ---	  $361.05	004	1	0	0.00	    $0.00	Y	
O	67975	RECONSTRUCTION OF EYELID                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	67999	UNLISTED PROCEDURE EYELIDS              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	67999	UNLISTED PROCEDURE EYELIDS              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	68020	INCISE/DRAIN EYELID LINING              	     3.41	  $126.95	      ---	  $160.10	004	1	1	0.00	    $0.00	Y	
K	68040	TREATMENT OF EYELID LESIONS             	     5.74	  $213.70	      ---	  $269.49	004	1	1	0.00	    $0.00	Y	
K	68100	BIOPSY CONJUNCTIVA                      	     3.49	  $129.93	      ---	  $163.86	004	1	1	0.00	    $0.00	Y	
K	68110	EXC LES CONJUNCTIVA <1 CM               	     4.03	  $150.04	      ---	  $189.21	004	1	0	0.00	    $0.00	Y	
K	68115	EXC LES CONJUNCTIVA >1 CM               	     4.18	  $155.62	      ---	  $196.25	004	1	0	0.00	    $0.00	Y	
O	68115	EXC LES CONJUNCTIVA >1 CM               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	68130	EXC LES CONJUNCTIVA ADJ SCL             	     1.27	   $47.28	      ---	   $59.63	004	1	0	0.00	    $0.00	Y	
K	68130	EXC LES CONJUNCTIVA ADJ SCL             	     6.36	  $236.78	      ---	  $298.60	004	1	0	0.00	    $0.00	Y	
K	68135	DESTRUCTION LES CONJUNCTIVA             	     3.80	  $141.47	      ---	  $178.41	004	1	0	0.00	    $0.00	Y	
K	68200	TREAT EYELID BY INJECTION               	     2.97	  $110.57	      ---	  $139.44	004	1	1	0.00	    $0.00	Y	
K	68320	REVISE/GRAFT EYELID LINING              	    12.00	  $446.76	      ---	  $563.40	004	1	0	0.00	    $0.00	Y	
O	68320	REVISE/GRAFT EYELID LINING              	     2.40	   $89.35	      ---	  $112.68	004	1	0	0.00	    $0.00	Y	
O	68325	REVISE/GRAFT EYELID LINING              	     2.80	  $104.24	      ---	  $131.46	004	1	0	0.00	    $0.00	Y	
K	68325	REVISE/GRAFT EYELID LINING              	    14.00	  $521.22	      ---	  $657.30	004	1	0	0.00	    $0.00	Y	
K	68326	REVISE/GRAFT EYELID LINING              	    13.03	  $485.11	      ---	  $611.76	004	1	0	0.00	    $0.00	Y	
O	68326	REVISE/GRAFT EYELID LINING              	     2.61	   $97.17	      ---	  $122.54	004	1	0	0.00	    $0.00	Y	
O	68328	REVISE/GRAFT EYELID LINING              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	68328	REVISE/GRAFT EYELID LINING              	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	68330	REVISE EYELID LINING                    	    10.47	  $389.80	      ---	  $491.57	004	1	0	0.00	    $0.00	Y	
O	68330	REVISE EYELID LINING                    	     2.09	   $77.81	      ---	   $98.13	004	1	0	0.00	    $0.00	Y	
O	68335	REVISE/GRAFT EYELID LINING              	     2.36	   $87.86	      ---	  $110.80	004	1	0	0.00	    $0.00	Y	
K	68335	REVISE/GRAFT EYELID LINING              	    11.81	  $439.69	      ---	  $554.48	004	1	0	0.00	    $0.00	Y	
K	68340	SEPARATE EYELID ADHESIONS               	    14.44	  $537.60	      ---	  $677.96	004	1	0	0.00	    $0.00	Y	
O	68340	SEPARATE EYELID ADHESIONS               	     2.89	  $107.59	      ---	  $135.69	004	1	0	0.00	    $0.00	Y	
O	68360	REVISE EYELID LINING                    	     1.13	   $42.07	      ---	   $53.05	004	1	0	0.00	    $0.00	Y	
K	68360	REVISE EYELID LINING                    	     5.66	  $210.72	      ---	  $265.74	004	1	0	0.00	    $0.00	Y	
K	68362	REVISE EYELID LINING                    	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	68362	REVISE EYELID LINING                    	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	68371	HARVEST EYE TISSUE ALOGRAFT             	     0.81	   $30.16	      ---	   $38.03	004	1	0	0.00	    $0.00	Y	
K	68371	HARVEST EYE TISSUE ALOGRAFT             	     4.05	  $150.78	      ---	  $190.15	004	1	0	0.00	    $0.00	Y	
K	68399	UNLISTED PX CONJUNCTIVA                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	68399	UNLISTED PX CONJUNCTIVA                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	68400	I&D LACRIMAL GLAND                      	     0.98	   $36.49	      ---	   $46.01	004	1	0	0.00	    $0.00	Y	
K	68400	I&D LACRIMAL GLAND                      	     4.90	  $182.43	      ---	  $230.06	004	1	0	0.00	    $0.00	Y	
K	68420	I&D LACRIMAL SAC                        	     5.37	  $199.93	      ---	  $252.12	004	1	0	0.00	    $0.00	Y	
O	68420	I&D LACRIMAL SAC                        	     1.07	   $39.84	      ---	   $50.24	004	1	0	0.00	    $0.00	Y	
K	68440	SNIP INC LACRIMAL PUNCTUM               	     3.20	  $119.14	      ---	  $150.24	004	1	1	0.00	    $0.00	Y	
K	68500	REMOVAL OF TEAR GLAND                   	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	68500	REMOVAL OF TEAR GLAND                   	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
O	68505	PARTIAL REMOVAL TEAR GLAND              	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	68505	PARTIAL REMOVAL TEAR GLAND              	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	68510	BIOPSY OF TEAR GLAND                    	    12.79	  $476.17	      ---	  $600.49	004	1	0	0.00	    $0.00	Y	
O	68510	BIOPSY OF TEAR GLAND                    	     2.56	   $95.31	      ---	  $120.19	004	1	0	0.00	    $0.00	Y	
O	68520	REMOVAL OF TEAR SAC                     	     2.44	   $90.84	      ---	  $114.56	004	1	0	0.00	    $0.00	Y	
K	68520	REMOVAL OF TEAR SAC                     	    12.20	  $454.21	      ---	  $572.79	004	1	0	0.00	    $0.00	Y	
K	68525	BIOPSY OF TEAR SAC                      	     6.89	  $256.51	      ---	  $323.49	004	1	0	0.00	    $0.00	Y	
O	68525	BIOPSY OF TEAR SAC                      	     1.38	   $51.38	      ---	   $64.79	004	1	0	0.00	    $0.00	Y	
O	68530	CLEARANCE OF TEAR DUCT                  	     2.65	   $98.66	      ---	  $124.42	004	1	0	0.00	    $0.00	Y	
K	68530	CLEARANCE OF TEAR DUCT                  	    13.27	  $494.04	      ---	  $623.03	004	1	0	0.00	    $0.00	Y	
K	68540	REMOVE TEAR GLAND LESION                	    16.52	  $615.04	      ---	  $775.61	004	1	0	0.00	    $0.00	Y	
O	68540	REMOVE TEAR GLAND LESION                	     3.30	  $122.86	      ---	  $154.94	004	1	0	0.00	    $0.00	Y	
O	68550	REMOVE TEAR GLAND LESION                	     4.46	  $166.05	      ---	  $209.40	004	1	0	0.00	    $0.00	Y	
K	68550	REMOVE TEAR GLAND LESION                	    22.29	  $829.86	      ---	 $1046.52	004	1	0	0.00	    $0.00	Y	
K	68700	REPAIR TEAR DUCTS                       	    22.29	  $829.86	      ---	 $1046.52	004	1	0	0.00	    $0.00	Y	
O	68700	REPAIR TEAR DUCTS                       	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	68705	REVISE TEAR DUCT OPENING                	     4.02	  $149.66	      ---	  $188.74	004	1	0	0.00	    $0.00	Y	
K	68720	CREATE TEAR SAC DRAIN                   	    14.06	  $523.45	      ---	  $660.12	004	1	0	0.00	    $0.00	Y	
O	68720	CREATE TEAR SAC DRAIN                   	     2.81	  $104.62	      ---	  $131.93	004	1	0	0.00	    $0.00	Y	
O	68745	CREATE TEAR DUCT DRAIN                  	     3.00	  $111.69	      ---	  $140.85	004	1	0	0.00	    $0.00	Y	
K	68745	CREATE TEAR DUCT DRAIN                  	    15.00	  $558.45	      ---	  $704.25	004	1	0	0.00	    $0.00	Y	
K	68750	CREATE TEAR DUCT DRAIN                  	    15.00	  $558.45	      ---	  $704.25	004	1	0	0.00	    $0.00	Y	
O	68750	CREATE TEAR DUCT DRAIN                  	     3.00	  $111.69	      ---	  $140.85	004	1	0	0.00	    $0.00	Y	
K	68760	CLOSE TEAR DUCT OPENING                 	     3.69	  $137.38	      ---	  $173.25	004	1	1	0.00	    $0.00	Y	
K	68761	CLOSE TEAR DUCT OPENING                 	     3.37	  $125.47	      ---	  $158.22	004	1	0	0.00	    $0.00	Y	
1	68761	CLOSE TEAR DUCT OPENING                 	   125.47	  $125.47	      ---	  $125.47	009	1	0	0.00	    $0.00	Y	
O	68770	CLOSE TEAR SYSTEM FISTULA               	     1.92	   $71.48	      ---	   $90.14	004	1	0	0.00	    $0.00	Y	
K	68770	CLOSE TEAR SYSTEM FISTULA               	     9.63	  $358.52	      ---	  $452.13	004	1	0	0.00	    $0.00	Y	
K	68801	DILATE TEAR DUCT OPENING                	     3.67	  $136.63	      ---	  $172.31	004	1	1	0.00	    $0.00	Y	
1	68801	DILATE TEAR DUCT OPENING                	   136.63	  $136.63	      ---	  $136.63	009	1	0	0.00	    $0.00	Y	
K	68810	PROBE NASOLACRIMAL DUCT                 	     4.99	  $185.78	      ---	  $234.28	004	1	1	0.00	    $0.00	Y	
K	68811	PROBE NASOLACRIMAL DUCT                 	     3.01	  $112.06	      ---	  $141.32	004	1	0	0.00	    $0.00	Y	
O	68811	PROBE NASOLACRIMAL DUCT                 	     0.60	   $22.34	      ---	   $28.17	004	1	0	0.00	    $0.00	Y	
O	68815	PROBE NASOLACRIMAL DUCT                 	     1.19	   $44.30	      ---	   $55.87	004	1	0	0.00	    $0.00	Y	
K	68815	PROBE NASOLACRIMAL DUCT                 	     5.94	  $221.15	      ---	  $278.88	004	1	0	0.00	    $0.00	Y	
K	68816	PROBE NL DUCT W/BALLOON                 	    12.32	  $458.67	      ---	  $578.42	004	1	0	0.00	    $0.00	Y	
O	68816	PROBE NL DUCT W/BALLOON                 	     2.46	   $91.59	      ---	  $115.50	004	1	0	0.00	    $0.00	Y	
K	68840	EXPLORE/IRRIGATE TEAR DUCTS             	     4.17	  $155.25	      ---	  $195.78	004	1	1	0.00	    $0.00	Y	
K	68841	INSJ RX ELUT IMPLT LAC CANAL            	     0.89	   $33.13	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	68841	INSJ RX ELUT IMPLT LAC CANAL            	     0.17	    $6.33	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	68850	INJECTION FOR TEAR SAC X-RAY            	     6.53	  $243.11	      ---	  $306.58	004	1	0	0.00	    $0.00	Y	
K	68899	UNLISTED PX LACRIMAL SYSTEM             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	68899	UNLISTED PX LACRIMAL SYSTEM             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	69000	DRG XTRNL EAR ABSC/HEM SMPL             	     1.52	   $56.59	      ---	   $71.36	004	1	1	0.00	    $0.00	Y	
K	69005	DRG XTRNL EAR ABSC/HEM COMP             	    91.84	   $91.84	      ---	       --	042	0	0	0.00	    $0.00	Y	
O	69005	DRG XTRNL EAR ABSC/HEM COMP             	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	69020	DRG XTRNL AUD CANAL ABSCESS             	     1.58	   $58.82	      ---	   $74.18	004	1	1	0.00	    $0.00	Y	
K	69100	BIOPSY OF EXTERNAL EAR                  	     1.08	   $40.21	      ---	   $50.71	004	1	1	0.00	    $0.00	Y	
K	69105	BIOPSY OF EXTERNAL EAR CANAL            	     0.99	   $36.86	      ---	   $46.48	004	1	1	0.00	    $0.00	Y	
K	69110	REMOVE EXTERNAL EAR PARTIAL             	     3.40	  $126.58	      ---	  $159.63	004	1	1	0.00	    $0.00	Y	
K	69120	REMOVAL OF EXTERNAL EAR                 	     8.00	  $297.84	      ---	  $375.60	004	1	0	0.00	    $0.00	Y	
O	69120	REMOVAL OF EXTERNAL EAR                 	     1.60	   $59.57	      ---	   $75.12	004	1	0	0.00	    $0.00	Y	
O	69140	REMOVE EAR CANAL LESION(S)              	     2.63	   $97.91	      ---	  $123.48	004	1	0	0.00	    $0.00	Y	
K	69140	REMOVE EAR CANAL LESION(S)              	    13.17	  $490.32	      ---	  $618.33	004	1	0	0.00	    $0.00	Y	
K	69145	REMOVE EAR CANAL LESION(S)              	     4.85	  $180.57	      ---	  $227.71	004	1	1	0.00	    $0.00	Y	
O	69145	REMOVE EAR CANAL LESION(S)              	     0.97	   $36.11	      ---	   $45.54	004	1	0	0.00	    $0.00	Y	
O	69150	EXTENSIVE EAR CANAL SURGERY             	     4.14	  $154.13	      ---	  $194.37	004	1	0	0.00	    $0.00	Y	
K	69150	EXTENSIVE EAR CANAL SURGERY             	    20.70	  $770.66	      ---	  $971.87	004	1	0	0.00	    $0.00	Y	
K	69155	EXTENSIVE EAR/NECK SURGERY              	    33.73	 $1255.77	      ---	 $1583.62	004	1	0	0.00	    $0.00	Y	
O	69155	EXTENSIVE EAR/NECK SURGERY              	     6.75	  $251.30	      ---	  $316.91	004	1	0	0.00	    $0.00	Y	
X	69200	CLEAR OUTER EAR CANAL                   	    74.15	   $74.15	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	69200	CLEAR OUTER EAR CANAL                   	     0.93	   $34.62	      ---	   $43.66	004	1	1	0.00	    $0.00	Y	
K	69205	CLEAR OUTER EAR CANAL                   	     2.16	   $80.42	      ---	  $101.41	004	1	0	0.00	    $0.00	Y	
X	69205	CLEAR OUTER EAR CANAL                   	    87.39	   $87.39	      ---	       --	009	1	0	0.00	    $0.00	Y	
X	69209	REMOVE IMPACTED EAR WAX UNI             	    14.57	   $14.57	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	69209	REMOVE IMPACTED EAR WAX UNI             	     0.31	   $11.54	      ---	   $14.55	004	1	1	0.00	    $0.00	Y	
K	69210	REMOVE IMPACTED EAR WAX UNI             	     0.82	   $30.53	      ---	   $38.50	004	1	1	0.00	    $0.00	Y	
X	69210	REMOVE IMPACTED EAR WAX UNI             	    43.20	   $43.20	      ---	       --	009	1	1	0.00	    $0.00	Y	
K	69220	CLEAN OUT MASTOID CAVITY                	     1.13	   $42.07	      ---	   $53.05	004	1	0	0.00	    $0.00	Y	
K	69222	CLEAN OUT MASTOID CAVITY                	     3.00	  $111.69	      ---	  $140.85	004	1	0	0.00	    $0.00	Y	
K	69300	REVISE EXTERNAL EAR                     	    10.00	  $372.30	      ---	  $469.50	004	1	0	0.00	    $0.00	Y	
O	69300	REVISE EXTERNAL EAR                     	     2.00	   $74.46	      ---	   $93.90	004	1	0	0.00	    $0.00	Y	
O	69310	REBUILD OUTER EAR CANAL                 	     3.40	  $126.58	      ---	  $159.63	004	1	0	0.00	    $0.00	Y	
K	69310	REBUILD OUTER EAR CANAL                 	    16.99	  $632.54	      ---	  $797.68	004	1	0	0.00	    $0.00	Y	
K	69320	REBUILD OUTER EAR CANAL                 	    18.12	  $674.61	      ---	  $850.73	004	1	0	0.00	    $0.00	Y	
O	69320	REBUILD OUTER EAR CANAL                 	     3.62	  $134.77	      ---	  $169.96	004	1	0	0.00	    $0.00	Y	
O	69399	UNLISTED PX EXTERNAL EAR                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	69399	UNLISTED PX EXTERNAL EAR                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	69420	INCISION OF EARDRUM                     	     1.50	   $55.85	      ---	   $70.43	004	1	1	0.00	    $0.00	Y	
K	69424	REMOVE VENTILATING TUBE                 	     1.70	   $63.29	      ---	   $79.82	004	1	0	0.00	    $0.00	Y	
K	69433	CREATE EARDRUM OPENING                  	     1.61	   $59.94	      ---	   $75.59	004	1	0	0.00	    $0.00	Y	
K	69436	CREATE EARDRUM OPENING                  	     3.24	  $120.63	      ---	  $152.12	004	1	0	0.00	    $0.00	Y	
K	69440	EXPLORATION OF MIDDLE EAR               	    11.33	  $421.82	      ---	  $531.94	004	1	0	0.00	    $0.00	Y	
O	69440	EXPLORATION OF MIDDLE EAR               	     2.27	   $84.51	      ---	  $106.58	004	1	0	0.00	    $0.00	Y	
O	69450	EARDRUM REVISION                        	     1.02	   $37.97	      ---	   $47.89	004	1	0	0.00	    $0.00	Y	
K	69450	EARDRUM REVISION                        	     5.10	  $189.87	      ---	  $239.45	004	1	0	0.00	    $0.00	Y	
K	69501	MASTOIDECTOMY                           	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	69501	MASTOIDECTOMY                           	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
O	69502	MASTOIDECTOMY                           	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	69502	MASTOIDECTOMY                           	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	69505	REMOVE MASTOID STRUCTURES               	    20.14	  $749.81	      ---	  $945.57	004	1	0	0.00	    $0.00	Y	
O	69505	REMOVE MASTOID STRUCTURES               	     4.03	  $150.04	      ---	  $189.21	004	1	0	0.00	    $0.00	Y	
O	69511	EXTENSIVE MASTOID SURGERY               	     4.17	  $155.25	      ---	  $195.78	004	1	0	0.00	    $0.00	Y	
K	69511	EXTENSIVE MASTOID SURGERY               	    20.85	  $776.25	      ---	  $978.91	004	1	0	0.00	    $0.00	Y	
K	69530	EXTENSIVE MASTOID SURGERY               	    30.00	 $1116.90	      ---	 $1408.50	004	1	0	0.00	    $0.00	Y	
O	69530	EXTENSIVE MASTOID SURGERY               	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
O	69535	REMOVE PART OF TEMPORAL BONE            	    11.36	  $422.93	      ---	  $533.35	004	1	0	0.00	    $0.00	Y	
K	69535	REMOVE PART OF TEMPORAL BONE            	    56.82	 $2115.41	      ---	 $2667.70	004	1	0	0.00	    $0.00	Y	
K	69540	EXCISION AURAL POLYP                    	     1.40	   $52.12	      ---	   $65.73	004	1	0	0.00	    $0.00	Y	
O	69540	EXCISION AURAL POLYP                    	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	69550	EXC AURL GLOMUS TUM TRNSCANL            	     4.10	  $152.64	      ---	  $192.50	004	1	0	0.00	    $0.00	Y	
K	69550	EXC AURL GLOMUS TUM TRNSCANL            	    20.51	  $763.59	      ---	  $962.94	004	1	0	0.00	    $0.00	Y	
K	69552	EXC AURL GLOMUS TUM TRNSMSTD            	    31.76	 $1182.42	      ---	 $1491.13	004	1	0	0.00	    $0.00	Y	
O	69552	EXC AURL GLOMUS TUM TRNSMSTD            	     6.35	  $236.41	      ---	  $298.13	004	1	0	0.00	    $0.00	Y	
O	69554	EXC AURL GLOMUS TUM EXTENDED            	    10.23	  $380.86	      ---	  $480.30	004	1	0	0.00	    $0.00	Y	
K	69554	EXC AURL GLOMUS TUM EXTENDED            	    51.15	 $1904.31	      ---	 $2401.49	004	1	0	0.00	    $0.00	Y	
K	69601	REVJ MSTDC RSLTG COMPL MSTDC            	    16.99	  $632.54	      ---	  $797.68	004	1	0	0.00	    $0.00	Y	
O	69601	REVJ MSTDC RSLTG COMPL MSTDC            	     3.40	  $126.58	      ---	  $159.63	004	1	0	0.00	    $0.00	Y	
O	69602	REV MSTDC RSLT MOD RAD MSTDC            	     4.18	  $155.62	      ---	  $196.25	004	1	0	0.00	    $0.00	Y	
K	69602	REV MSTDC RSLT MOD RAD MSTDC            	    20.92	  $778.85	      ---	  $982.19	004	1	0	0.00	    $0.00	Y	
K	69603	REVJ MSTDC RSLTG RAD MSTDC              	    21.56	  $802.68	      ---	 $1012.24	004	1	0	0.00	    $0.00	Y	
O	69603	REVJ MSTDC RSLTG RAD MSTDC              	     4.31	  $160.46	      ---	  $202.35	004	1	0	0.00	    $0.00	Y	
O	69604	REVJ MSTDC RSLTG TYMPANPLSTY            	     4.80	  $178.70	      ---	  $225.36	004	1	0	0.00	    $0.00	Y	
K	69604	REVJ MSTDC RSLTG TYMPANPLSTY            	    24.00	  $893.52	      ---	 $1126.80	004	1	0	0.00	    $0.00	Y	
K	69610	TYMPANIC MEMBRANE REPAIR                	     3.83	  $142.59	      ---	  $179.82	004	1	1	0.00	    $0.00	Y	
K	69620	MYRINGOPLASTY                           	    13.00	  $483.99	      ---	  $610.35	004	1	0	0.00	    $0.00	Y	
O	69620	MYRINGOPLASTY                           	     2.60	   $96.80	      ---	  $122.07	004	1	0	0.00	    $0.00	Y	
O	69631	REPAIR EARDRUM STRUCTURES               	     4.40	  $163.81	      ---	  $206.58	004	1	0	0.00	    $0.00	Y	
K	69631	REPAIR EARDRUM STRUCTURES               	    22.00	  $819.06	      ---	 $1032.90	004	1	0	0.00	    $0.00	Y	
K	69632	REBUILD EARDRUM STRUCTURES              	    22.00	  $819.06	      ---	 $1032.90	004	1	0	0.00	    $0.00	Y	
O	69632	REBUILD EARDRUM STRUCTURES              	     4.40	  $163.81	      ---	  $206.58	004	1	0	0.00	    $0.00	Y	
O	69633	REBUILD EARDRUM STRUCTURES              	     4.40	  $163.81	      ---	  $206.58	004	1	0	0.00	    $0.00	Y	
K	69633	REBUILD EARDRUM STRUCTURES              	    22.00	  $819.06	      ---	 $1032.90	004	1	0	0.00	    $0.00	Y	
K	69635	REPAIR EARDRUM STRUCTURES               	    24.00	  $893.52	      ---	 $1126.80	004	1	0	0.00	    $0.00	Y	
O	69635	REPAIR EARDRUM STRUCTURES               	     4.80	  $178.70	      ---	  $225.36	004	1	0	0.00	    $0.00	Y	
O	69636	REBUILD EARDRUM STRUCTURES              	     4.80	  $178.70	      ---	  $225.36	004	1	0	0.00	    $0.00	Y	
K	69636	REBUILD EARDRUM STRUCTURES              	    24.00	  $893.52	      ---	 $1126.80	004	1	0	0.00	    $0.00	Y	
K	69637	REBUILD EARDRUM STRUCTURES              	    30.00	 $1116.90	      ---	 $1408.50	004	1	0	0.00	    $0.00	Y	
O	69637	REBUILD EARDRUM STRUCTURES              	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
O	69641	REVISE MIDDLE EAR & MASTOID             	     4.80	  $178.70	      ---	  $225.36	004	1	0	0.00	    $0.00	Y	
K	69641	REVISE MIDDLE EAR & MASTOID             	    24.00	  $893.52	      ---	 $1126.80	004	1	0	0.00	    $0.00	Y	
K	69642	REVISE MIDDLE EAR & MASTOID             	    25.95	  $966.12	      ---	 $1218.35	004	1	0	0.00	    $0.00	Y	
O	69642	REVISE MIDDLE EAR & MASTOID             	     5.19	  $193.22	      ---	  $243.67	004	1	0	0.00	    $0.00	Y	
O	69643	REVISE MIDDLE EAR & MASTOID             	     4.80	  $178.70	      ---	  $225.36	004	1	0	0.00	    $0.00	Y	
K	69643	REVISE MIDDLE EAR & MASTOID             	    24.00	  $893.52	      ---	 $1126.80	004	1	0	0.00	    $0.00	Y	
K	69644	REVISE MIDDLE EAR & MASTOID             	    26.08	  $970.96	      ---	 $1224.46	004	1	0	0.00	    $0.00	Y	
O	69644	REVISE MIDDLE EAR & MASTOID             	     5.22	  $194.34	      ---	  $245.08	004	1	0	0.00	    $0.00	Y	
O	69645	REVISE MIDDLE EAR & MASTOID             	     5.06	  $188.38	      ---	  $237.57	004	1	0	0.00	    $0.00	Y	
K	69645	REVISE MIDDLE EAR & MASTOID             	    25.28	  $941.17	      ---	 $1186.90	004	1	0	0.00	    $0.00	Y	
K	69646	REVISE MIDDLE EAR & MASTOID             	    27.18	 $1011.91	      ---	 $1276.10	004	1	0	0.00	    $0.00	Y	
O	69646	REVISE MIDDLE EAR & MASTOID             	     5.44	  $202.53	      ---	  $255.41	004	1	0	0.00	    $0.00	Y	
O	69650	STAPES MOBILIZATION                     	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
K	69650	STAPES MOBILIZATION                     	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
K	69660	REVISE MIDDLE EAR BONE                  	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
O	69660	REVISE MIDDLE EAR BONE                  	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
O	69661	REVISE MIDDLE EAR BONE                  	     4.80	  $178.70	      ---	  $225.36	004	1	0	0.00	    $0.00	Y	
K	69661	REVISE MIDDLE EAR BONE                  	    24.00	  $893.52	      ---	 $1126.80	004	1	0	0.00	    $0.00	Y	
K	69662	REVISE MIDDLE EAR BONE                  	    13.59	  $505.96	      ---	  $638.05	004	1	0	0.00	    $0.00	Y	
O	69662	REVISE MIDDLE EAR BONE                  	     2.72	  $101.27	      ---	  $127.70	004	1	0	0.00	    $0.00	Y	
O	69666	REPAIR MIDDLE EAR STRUCTURES            	     4.30	  $160.09	      ---	  $201.89	004	1	0	0.00	    $0.00	Y	
K	69666	REPAIR MIDDLE EAR STRUCTURES            	    21.60	  $804.17	      ---	 $1014.12	004	1	0	0.00	    $0.00	Y	
K	69667	REPAIR MIDDLE EAR STRUCTURES            	    21.60	  $804.17	      ---	 $1014.12	004	1	0	0.00	    $0.00	Y	
O	69667	REPAIR MIDDLE EAR STRUCTURES            	     4.30	  $160.09	      ---	  $201.89	004	1	0	0.00	    $0.00	Y	
O	69670	REMOVE MASTOID AIR CELLS                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	69670	REMOVE MASTOID AIR CELLS                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	69676	REMOVE MIDDLE EAR NERVE                 	    15.31	  $569.99	      ---	  $718.80	004	1	0	0.00	    $0.00	Y	
O	69676	REMOVE MIDDLE EAR NERVE                 	     3.06	  $113.92	      ---	  $143.67	004	1	0	0.00	    $0.00	Y	
O	69700	CLOSE MASTOID FISTULA                   	     1.59	   $59.20	      ---	   $74.65	004	1	0	0.00	    $0.00	Y	
K	69700	CLOSE MASTOID FISTULA                   	     7.93	  $295.23	      ---	  $372.31	004	1	0	0.00	    $0.00	Y	
K	69705	NPS SURG DILAT EUST TUBE UNI            	    76.72	 $2856.29	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	69706	NPS SURG DILAT EUST TUBE BI             	    78.88	 $2936.70	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	69714	IMPL OI IMPLT SKULL PERQ ESP            	    10.73	  $399.48	      ---	  $503.77	004	1	0	0.00	    $0.00	N	
O	69714	IMPL OI IMPLT SKULL PERQ ESP            	     2.14	   $79.67	      ---	  $100.47	004	1	0	0.00	    $0.00	Y	
O	69716	IMPL OI IMPLT SK TC ESP<100             	     2.67	   $99.40	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	69716	IMPL OI IMPLT SK TC ESP<100             	    13.37	  $497.77	      ---	       --	004	0	0	0.00	    $0.00	N	
K	69717	RPLCMT OI IMPLT SKL PRQ ESP             	    12.12	  $451.23	      ---	  $569.03	004	1	0	0.00	    $0.00	N	
O	69717	RPLCMT OI IMPLT SKL PRQ ESP             	     2.42	   $90.10	      ---	  $113.62	004	1	0	0.00	    $0.00	Y	
O	69719	RPLCM OI IMPLT SK TC ESP<100            	     2.77	  $103.13	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	69719	RPLCM OI IMPLT SK TC ESP<100            	    13.87	  $516.38	      ---	       --	004	0	0	0.00	    $0.00	N	
K	69720	RELEASE FACIAL NERVE                    	    24.00	  $893.52	      ---	 $1126.80	004	1	0	0.00	    $0.00	Y	
O	69720	RELEASE FACIAL NERVE                    	     4.80	  $178.70	      ---	  $225.36	004	1	0	0.00	    $0.00	Y	
O	69725	RELEASE FACIAL NERVE                    	     5.89	  $219.28	      ---	  $276.54	004	1	0	0.00	    $0.00	Y	
K	69725	RELEASE FACIAL NERVE                    	    29.45	 $1096.42	      ---	 $1382.68	004	1	0	0.00	    $0.00	Y	
K	69726	RMV NTR OI IMPLT SKL PRQ ESP            	    10.36	  $385.70	      ---	       --	004	0	0	0.00	    $0.00	N	
O	69726	RMV NTR OI IMPLT SKL PRQ ESP            	     2.07	   $77.07	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	69727	RMV NTR OI IMP SK TC ESP<100            	     2.30	   $85.63	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	69727	RMV NTR OI IMP SK TC ESP<100            	    11.52	  $428.89	      ---	       --	004	0	0	0.00	    $0.00	N	
K	69728	RMV NTR OI IMP SK TC>=100               	    12.96	  $482.50	      ---	       --	004	0	0	0.00	    $0.00	N	
O	69728	RMV NTR OI IMP SK TC>=100               	     2.59	   $96.43	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	69729	IMPL OI IMPLT SK TC ESP>=100            	     2.89	  $107.59	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	69729	IMPL OI IMPLT SK TC ESP>=100            	    14.46	  $538.35	      ---	       --	004	0	0	0.00	    $0.00	N	
K	69730	RPLC OI IMPLT SK TC ESP>=100            	    14.95	  $556.59	      ---	       --	004	0	0	0.00	    $0.00	N	
O	69730	RPLC OI IMPLT SK TC ESP>=100            	     2.99	  $111.32	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	69740	REPAIR FACIAL NERVE                     	     6.00	  $223.38	      ---	  $281.70	004	1	0	0.00	    $0.00	Y	
K	69740	REPAIR FACIAL NERVE                     	    30.00	 $1116.90	      ---	 $1408.50	004	1	0	0.00	    $0.00	Y	
K	69745	REPAIR FACIAL NERVE                     	    32.00	 $1191.36	      ---	 $1502.40	004	1	0	0.00	    $0.00	Y	
O	69745	REPAIR FACIAL NERVE                     	     6.40	  $238.27	      ---	  $300.48	004	1	0	0.00	    $0.00	Y	
O	69799	UNLISTED PX MIDDLE EAR                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	69799	UNLISTED PX MIDDLE EAR                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	69801	INCISE INNER EAR                        	     4.64	  $172.75	      ---	  $217.85	004	1	0	0.00	    $0.00	Y	
O	69801	INCISE INNER EAR                        	     0.92	   $34.25	      ---	   $43.19	004	1	0	0.00	    $0.00	Y	
O	69805	EXPLORE INNER EAR                       	     4.17	  $155.25	      ---	  $195.78	004	1	0	0.00	    $0.00	Y	
K	69805	EXPLORE INNER EAR                       	    20.87	  $776.99	      ---	  $979.85	004	1	0	0.00	    $0.00	Y	
K	69806	EXPLORE INNER EAR                       	    20.00	  $744.60	      ---	  $939.00	004	1	0	0.00	    $0.00	Y	
O	69806	EXPLORE INNER EAR                       	     4.00	  $148.92	      ---	  $187.80	004	1	0	0.00	    $0.00	Y	
O	69905	REMOVE INNER EAR                        	     4.14	  $154.13	      ---	  $194.37	004	1	0	0.00	    $0.00	Y	
K	69905	REMOVE INNER EAR                        	    20.68	  $769.92	      ---	  $970.93	004	1	0	0.00	    $0.00	Y	
K	69910	REMOVE INNER EAR & MASTOID              	    20.91	  $778.48	      ---	  $981.72	004	1	0	0.00	    $0.00	Y	
O	69910	REMOVE INNER EAR & MASTOID              	     4.18	  $155.62	      ---	  $196.25	004	1	0	0.00	    $0.00	Y	
O	69915	INCISE INNER EAR NERVE                  	     7.08	  $263.59	      ---	  $332.41	004	1	0	0.00	    $0.00	Y	
K	69915	INCISE INNER EAR NERVE                  	    35.40	 $1317.94	      ---	 $1662.03	004	1	0	0.00	    $0.00	Y	
K	69930	IMPLANT COCHLEAR DEVICE                 	    30.28	 $1127.32	      ---	 $1421.65	004	1	0	0.00	    $0.00	Y	
O	69930	IMPLANT COCHLEAR DEVICE                 	     6.06	  $225.61	      ---	  $284.52	004	1	0	0.00	    $0.00	Y	
O	69949	UNLISTED PX INNER EAR                   	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	69949	UNLISTED PX INNER EAR                   	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	69950	INCISE INNER EAR NERVE                  	    40.71	 $1515.63	      ---	 $1911.33	004	1	0	0.00	    $0.00	Y	
O	69950	INCISE INNER EAR NERVE                  	     8.14	  $303.05	      ---	  $382.17	004	1	0	0.00	    $0.00	Y	
O	69955	RELEASE FACIAL NERVE                    	     8.55	  $318.32	      ---	  $401.42	004	1	0	0.00	    $0.00	Y	
K	69955	RELEASE FACIAL NERVE                    	    42.76	 $1591.95	      ---	 $2007.58	004	1	0	0.00	    $0.00	Y	
K	69960	RELEASE INNER EAR CANAL                 	    42.65	 $1587.86	      ---	 $2002.42	004	1	0	0.00	    $0.00	Y	
O	69960	RELEASE INNER EAR CANAL                 	     8.53	  $317.57	      ---	  $400.48	004	1	0	0.00	    $0.00	Y	
O	69970	REMOVE INNER EAR LESION                 	     9.50	  $353.69	      ---	  $446.03	004	1	0	0.00	    $0.00	Y	
K	69970	REMOVE INNER EAR LESION                 	    47.48	 $1767.68	      ---	 $2229.19	004	1	0	0.00	    $0.00	Y	
K	69979	UNLISTED PX TEMPORAL BONE               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	69979	UNLISTED PX TEMPORAL BONE               	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	69990	MICROSURGERY ADD-ON                     	     0.99	   $36.86	      ---	   $46.48	004	1	0	0.00	    $0.00	Y	
K	69990	MICROSURGERY ADD-ON                     	     4.93	  $183.54	      ---	  $231.46	004	1	0	0.00	    $0.00	Y	
L	70010	CONTRAST X-RAY OF BRAIN                 	    13.10	   $50.04	      ---	       --	005	0	0	0.39	    $0.00	Y	
L	70015	CONTRAST X-RAY OF BRAIN                 	    23.30	   $89.01	      ---	       --	005	0	0	0.38	    $0.00	Y	
L	70030	X-RAY EYE FOR FOREIGN BODY              	     6.46	   $24.68	      ---	       --	005	0	0	0.29	    $0.00	Y	
L	70100	X-RAY EXAM OF JAW <4VIEWS               	     6.57	   $25.10	      ---	       --	005	0	0	0.26	    $0.00	Y	
L	70110	X-RAY EXAM OF JAW 4/> VIEWS             	     8.91	   $34.04	      ---	       --	005	0	0	0.32	    $0.00	Y	
L	70120	X-RAY EXAM OF MASTOIDS                  	     6.80	   $25.98	      ---	       --	005	0	0	0.26	    $0.00	Y	
L	70130	X-RAY EXAM OF MASTOIDS                  	    12.00	   $45.84	      ---	       --	005	0	0	0.30	    $0.00	Y	
L	70134	X-RAY EXAM OF MIDDLE EAR                	    12.00	   $45.84	      ---	       --	005	0	0	0.33	    $0.00	Y	
L	70140	X-RAY EXAM OF FACIAL BONES              	     6.80	   $25.98	      ---	       --	005	0	0	0.34	    $0.00	Y	
L	70150	X-RAY EXAM OF FACIAL BONES              	     9.76	   $37.28	      ---	       --	005	0	0	0.31	    $0.00	Y	
L	70160	X-RAY EXAM OF NASAL BONES               	     6.49	   $24.79	      ---	       --	005	0	0	0.26	    $0.00	Y	
L	70170	X-RAY EXAM OF TEAR DUCT                 	    11.33	   $43.28	      ---	       --	005	0	0	0.31	    $0.00	Y	
L	70190	X-RAY EXAM OF EYE SOCKETS               	     6.80	   $25.98	      ---	       --	005	0	0	0.30	    $0.00	Y	
L	70200	X-RAY EXAM OF EYE SOCKETS               	     9.92	   $37.89	      ---	       --	005	0	0	0.32	    $0.00	Y	
L	70210	X-RAY EXAM OF SINUSES                   	     5.66	   $21.62	      ---	       --	005	0	0	0.28	    $0.00	Y	
L	70220	X-RAY EXAM OF SINUSES                   	     8.73	   $33.35	      ---	       --	005	0	0	0.32	    $0.00	Y	
L	70240	X-RAY EXAM PITUITARY SADDLE             	     5.66	   $21.62	      ---	       --	005	0	0	0.31	    $0.00	Y	
L	70250	X-RAY EXAM OF SKULL                     	     6.80	   $25.98	      ---	       --	005	0	0	0.34	    $0.00	Y	
L	70260	X-RAY EXAM OF SKULL                     	    10.53	   $40.22	      ---	       --	005	0	0	0.37	    $0.00	Y	
L	70300	X-RAY EXAM OF TEETH                     	     2.26	    $8.63	      ---	       --	005	0	0	0.39	    $0.00	Y	
L	70310	X-RAY EXAM OF TEETH                     	     4.53	   $17.30	      ---	       --	005	0	0	0.21	    $0.00	Y	
L	70320	FULL MOUTH X-RAY OF TEETH               	     9.06	   $34.61	      ---	       --	005	0	0	0.22	    $0.00	Y	
L	70328	X-RAY EXAM OF JAW JOINT                 	     6.40	   $24.45	      ---	       --	005	0	0	0.29	    $0.00	Y	
L	70330	X-RAY EXAM OF JAW JOINTS                	     9.97	   $38.09	      ---	       --	005	0	0	0.25	    $0.00	Y	
L	70332	X-RAY EXAM OF JAW JOINT                 	    17.80	   $68.00	      ---	       --	005	0	0	0.37	    $0.00	Y	
L	70350	X-RAY HEAD FOR ORTHODONTIA              	     3.81	   $14.55	      ---	       --	005	0	0	0.50	    $0.00	Y	
L	70355	PANORAMIC X-RAY OF JAWS                 	     4.20	   $16.04	      ---	       --	005	0	0	0.52	    $0.00	N	
L	70360	X-RAY EXAM OF NECK                      	     4.53	   $17.30	      ---	       --	005	0	0	0.29	    $0.00	Y	
L	70370	THROAT X-RAY & FLUOROSCOPY              	     9.97	   $38.09	      ---	       --	005	0	0	0.20	    $0.00	Y	
L	70380	X-RAY EXAM OF SALIVARY GLAND            	     7.25	   $27.70	      ---	       --	005	0	0	0.24	    $0.00	Y	
L	70390	X-RAY EXAM OF SALIVARY DUCT             	    10.82	   $41.33	      ---	       --	005	0	0	0.19	    $0.00	Y	
L	70450	CT HEAD/BRAIN W/O DYE                   	    26.51	  $101.27	      ---	       --	005	0	0	0.35	    $0.00	Y	
L	70460	CT HEAD/BRAIN W/DYE                     	    37.39	  $142.83	      ---	       --	005	0	0	0.33	    $0.00	Y	
L	70470	CT HEAD/BRAIN W/O & W/DYE               	    43.99	  $168.04	      ---	       --	005	0	0	0.32	    $0.00	Y	
L	70480	CT ORBIT/EAR/FOSSA W/O DYE              	    39.88	  $152.34	      ---	       --	005	0	0	0.26	    $0.00	Y	
L	70481	CT ORBIT/EAR/FOSSA W/DYE                	    45.92	  $175.41	      ---	       --	005	0	0	0.24	    $0.00	Y	
L	70482	CT ORBIT/EAR/FOSSA W/O&W/DYE            	    54.00	  $206.28	      ---	       --	005	0	0	0.23	    $0.00	Y	
L	70486	CT MAXILLOFACIAL W/O DYE                	    32.29	  $123.35	      ---	       --	005	0	0	0.29	    $0.00	Y	
L	70487	CT MAXILLOFACIAL W/DYE                  	    38.39	  $146.65	      ---	       --	005	0	0	0.32	    $0.00	Y	
L	70488	CT MAXILLOFACIAL W/O & W/DYE            	    47.00	  $179.54	      ---	       --	005	0	0	0.30	    $0.00	Y	
L	70490	CT SOFT TISSUE NECK W/O DYE             	    37.70	  $144.01	      ---	       --	005	0	0	0.32	    $0.00	Y	
L	70491	CT SOFT TISSUE NECK W/DYE               	    46.74	  $178.55	      ---	       --	005	0	0	0.28	    $0.00	Y	
L	70492	CT SFT TSUE NCK W/O & W/DYE             	    56.24	  $214.84	      ---	       --	005	0	0	0.25	    $0.00	Y	
L	70496	CT ANGIOGRAPHY HEAD                     	    69.64	  $266.02	      ---	       --	005	0	0	0.28	    $0.00	Y	
L	70498	CT ANGIOGRAPHY NECK                     	    69.42	  $265.18	      ---	       --	005	0	0	0.28	    $0.00	Y	
L	70540	MRI ORBIT/FACE/NECK W/O DYE             	    58.37	  $222.97	      ---	       --	005	0	0	0.21	    $0.00	Y	
L	70542	MRI ORBIT/FACE/NECK W/DYE               	    69.33	  $264.84	      ---	       --	005	0	0	0.23	    $0.00	Y	
L	70543	MRI ORBT/FAC/NCK W/O &W/DYE             	    87.35	  $333.68	      ---	       --	005	0	0	0.24	    $0.00	Y	
L	70544	MR ANGIOGRAPHY HEAD W/O DYE             	    55.22	  $210.94	      ---	       --	005	0	0	0.14	    $0.00	Y	
L	70545	MR ANGIOGRAPHY HEAD W/DYE               	    58.32	  $222.78	      ---	       --	005	0	0	0.14	    $0.00	Y	
L	70546	MR ANGIOGRAPH HEAD W/O&W/DYE            	    84.86	  $324.17	      ---	       --	005	0	0	0.14	    $0.00	Y	
L	70547	MR ANGIOGRAPHY NECK W/O DYE             	    55.39	  $211.59	      ---	       --	005	0	0	0.14	    $0.00	Y	
L	70548	MR ANGIOGRAPHY NECK W/DYE               	    62.98	  $240.58	      ---	       --	005	0	0	0.14	    $0.00	Y	
L	70549	MR ANGIOGRAPH NECK W/O&W/DYE            	    88.76	  $339.06	      ---	       --	005	0	0	0.14	    $0.00	Y	
L	70551	MRI BRAIN STEM W/O DYE                  	    49.78	  $190.16	      ---	       --	005	0	0	0.31	    $0.00	Y	
L	70552	MRI BRAIN STEM W/DYE                    	    69.17	  $264.23	      ---	       --	005	0	0	0.27	    $0.00	Y	
L	70553	MRI BRAIN STEM W/O & W/DYE              	    81.43	  $311.06	      ---	       --	005	0	0	0.29	    $0.00	Y	
L	70554	FMRI BRAIN BY TECH                      	    97.90	  $373.98	      ---	       --	005	0	0	0.22	    $0.00	Y	
L	70555	FMRI BRAIN BY PHYS/PSYCH                	    25.92	   $99.01	      ---	       --	005	0	0	1.00	    $0.00	Y	
L	70557	MRI BRAIN W/O DYE                       	    44.96	  $171.75	      ---	       --	005	0	0	0.30	    $0.00	Y	
L	70558	MRI BRAIN W/DYE                         	    46.40	  $177.25	      ---	       --	005	0	0	0.30	    $0.00	Y	
L	70559	MRI BRAIN W/O & W/DYE                   	    43.66	  $166.78	      ---	       --	005	0	0	0.20	    $0.00	Y	
L	71045	X-RAY EXAM CHEST 1 VIEW                 	     4.62	   $17.65	      ---	       --	005	0	0	0.45	    $0.00	Y	
L	71046	X-RAY EXAM CHEST 2 VIEWS                	     7.19	   $27.47	      ---	       --	005	0	0	0.34	    $0.00	Y	
L	71047	X-RAY EXAM CHEST 3 VIEWS                	     9.23	   $35.26	      ---	       --	005	0	0	0.35	    $0.00	Y	
L	71048	X-RAY EXAM CHEST 4+ VIEWS               	     9.89	   $37.78	      ---	       --	005	0	0	0.37	    $0.00	Y	
L	71100	X-RAY EXAM RIBS UNI 2 VIEWS             	     7.11	   $27.16	      ---	       --	005	0	0	0.33	    $0.00	Y	
L	71101	X-RAY EXAM UNILAT RIBS/CHEST            	     8.46	   $32.32	      ---	       --	005	0	0	0.36	    $0.00	Y	
L	71110	X-RAY EXAM RIBS BIL 3 VIEWS             	     8.72	   $33.31	      ---	       --	005	0	0	0.35	    $0.00	Y	
L	71111	X-RAY EXAM RIBS/CHEST4/> VWS            	    11.10	   $42.40	      ---	       --	005	0	0	0.33	    $0.00	Y	
L	71120	X-RAY EXAM BREASTBONE 2/>VWS            	     6.80	   $25.98	      ---	       --	005	0	0	0.33	    $0.00	Y	
L	71130	X-RAY STRENOCLAVIC JT 3/>VWS            	     6.80	   $25.98	      ---	       --	005	0	0	0.30	    $0.00	Y	
L	71250	CT THORAX DX C-                         	    33.33	  $127.32	      ---	       --	005	0	0	0.27	    $0.00	Y	
L	71260	CT THORAX DX C+                         	    42.13	  $160.94	      ---	       --	005	0	0	0.26	    $0.00	Y	
L	71270	CT THORAX DX C-/C+                      	    50.16	  $191.61	      ---	       --	005	0	0	0.24	    $0.00	Y	
L	71271	CT THORAX LUNG CANCER SCR C-            	    34.50	  $131.79	      ---	       --	005	0	0	0.34	    $0.00	N	
L	71275	CT ANGIOGRAPHY CHEST                    	    70.92	  $270.91	      ---	       --	005	0	0	0.29	    $0.00	Y	
L	71550	MRI CHEST W/O DYE                       	    88.64	  $338.60	      ---	       --	005	0	0	0.17	    $0.00	Y	
L	71551	MRI CHEST W/DYE                         	    97.94	  $374.13	      ---	       --	005	0	0	0.18	    $0.00	Y	
L	71552	MRI CHEST W/O & W/DYE                   	   123.67	  $472.42	      ---	       --	005	0	0	0.18	    $0.00	Y	
L	71555	MRI ANGIO CHEST W OR W/O DYE            	    86.32	  $329.74	      ---	       --	005	0	0	0.21	    $0.00	Y	
L	72020	X-RAY EXAM OF SPINE 1 VIEW              	     4.53	   $17.30	      ---	       --	005	0	0	0.34	    $0.00	Y	
L	72040	X-RAY EXAM NECK SPINE 2-3 VW            	     6.80	   $25.98	      ---	       --	005	0	0	0.33	    $0.00	Y	
L	72050	X-RAY EXAM NECK SPINE 4/5VWS            	    10.47	   $40.00	      ---	       --	005	0	0	0.33	    $0.00	Y	
L	72052	X-RAY EXAM NECK SPINE 6/>VWS            	    13.17	   $50.31	      ---	       --	005	0	0	0.31	    $0.00	Y	
L	72070	X-RAY EXAM THORAC SPINE 2VWS            	     7.34	   $28.04	      ---	       --	005	0	0	0.32	    $0.00	Y	
L	72072	X-RAY EXAM THORAC SPINE 3VWS            	     8.07	   $30.83	      ---	       --	005	0	0	0.30	    $0.00	Y	
L	72074	X-RAY EXAM THORAC SPINE4/>VW            	     9.19	   $35.11	      ---	       --	005	0	0	0.27	    $0.00	Y	
L	72080	X-RAY EXAM THORACOLMB 2/> VW            	     7.17	   $27.39	      ---	       --	005	0	0	0.34	    $0.00	Y	
L	72081	X-RAY EXAM ENTIRE SPI 1 VW              	     9.09	   $34.72	      ---	       --	005	0	0	0.33	    $0.00	Y	
L	72082	X-RAY EXAM ENTIRE SPI 2/3 VW            	    14.74	   $56.31	      ---	       --	005	0	0	0.25	    $0.00	Y	
L	72083	X-RAY EXAM ENTIRE SPI 4/5 VW            	    16.00	   $61.12	      ---	       --	005	0	0	0.25	    $0.00	Y	
L	72084	X-RAY EXAM ENTIRE SPI 6/> VW            	    19.14	   $73.11	      ---	       --	005	0	0	0.24	    $0.00	Y	
L	72100	X-RAY EXAM L-S SPINE 2/3 VWS            	     7.93	   $30.29	      ---	       --	005	0	0	0.31	    $0.00	Y	
L	72110	X-RAY EXAM L-2 SPINE 4/>VWS             	    11.48	   $43.85	      ---	       --	005	0	0	0.31	    $0.00	Y	
L	72114	X-RAY EXAM L-S SPINE BENDING            	    13.85	   $52.91	      ---	       --	005	0	0	0.25	    $0.00	Y	
L	72120	X-RAY BEND ONLY L-S SPINE               	     9.06	   $34.61	      ---	       --	005	0	0	0.27	    $0.00	Y	
L	72125	CT NECK SPINE W/O DYE                   	    32.72	  $124.99	      ---	       --	005	0	0	0.28	    $0.00	Y	
L	72126	CT NECK SPINE W/DYE                     	    42.69	  $163.08	      ---	       --	005	0	0	0.25	    $0.00	Y	
L	72127	CT NECK SPINE W/O & W/DYE               	    50.36	  $192.38	      ---	       --	005	0	0	0.22	    $0.00	Y	
L	72128	CT CHEST SPINE W/O DYE                  	    32.64	  $124.68	      ---	       --	005	0	0	0.26	    $0.00	Y	
L	72129	CT CHEST SPINE W/DYE                    	    43.02	  $164.34	      ---	       --	005	0	0	0.25	    $0.00	Y	
L	72130	CT CHEST SPINE W/O & W/DYE              	    50.56	  $193.14	      ---	       --	005	0	0	0.22	    $0.00	Y	
L	72131	CT LUMBAR SPINE W/O DYE                 	    32.55	  $124.34	      ---	       --	005	0	0	0.26	    $0.00	Y	
L	72132	CT LUMBAR SPINE W/DYE                   	    42.69	  $163.08	      ---	       --	005	0	0	0.25	    $0.00	Y	
L	72133	CT LUMBAR SPINE W/O & W/DYE             	    50.28	  $192.07	      ---	       --	005	0	0	0.22	    $0.00	Y	
L	72141	MRI NECK SPINE W/O DYE                  	    48.60	  $185.65	      ---	       --	005	0	0	0.32	    $0.00	Y	
L	72142	MRI NECK SPINE W/DYE                    	    70.85	  $270.65	      ---	       --	005	0	0	0.26	    $0.00	Y	
L	72146	MRI CHEST SPINE W/O DYE                 	    48.52	  $185.35	      ---	       --	005	0	0	0.31	    $0.00	Y	
L	72147	MRI CHEST SPINE W/DYE                   	    70.09	  $267.74	      ---	       --	005	0	0	0.26	    $0.00	Y	
L	72148	MRI LUMBAR SPINE W/O DYE                	    48.69	  $186.00	      ---	       --	005	0	0	0.32	    $0.00	Y	
L	72149	MRI LUMBAR SPINE W/DYE                  	    69.51	  $265.53	      ---	       --	005	0	0	0.26	    $0.00	Y	
L	72156	MRI NECK SPINE W/O & W/DYE              	    82.00	  $313.24	      ---	       --	005	0	0	0.29	    $0.00	Y	
L	72157	MRI CHEST SPINE W/O & W/DYE             	    82.09	  $313.58	      ---	       --	005	0	0	0.29	    $0.00	Y	
L	72158	MRI LUMBAR SPINE W/O & W/DYE            	    81.75	  $312.29	      ---	       --	005	0	0	0.29	    $0.00	Y	
L	72159	MR ANGIO SPINE W/O&W/DYE                	    89.26	  $340.97	      ---	       --	005	0	0	0.21	    $0.00	Y	
L	72170	X-RAY EXAM OF PELVIS                    	     5.66	   $21.62	      ---	       --	005	0	0	0.26	    $0.00	Y	
L	72190	X-RAY EXAM OF PELVIS                    	     8.26	   $31.55	      ---	       --	005	0	0	0.27	    $0.00	Y	
L	72191	CT ANGIOGRAPH PELV W/O&W/DYE            	    71.96	  $274.89	      ---	       --	005	0	0	0.28	    $0.00	Y	
L	72192	CT PELVIS W/O DYE                       	    33.40	  $127.59	      ---	       --	005	0	0	0.36	    $0.00	Y	
L	72193	CT PELVIS W/DYE                         	    53.52	  $204.45	      ---	       --	005	0	0	0.24	    $0.00	Y	
L	72194	CT PELVIS W/O & W/DYE                   	    61.87	  $236.34	      ---	       --	005	0	0	0.22	    $0.00	Y	
L	72195	MRI PELVIS W/O DYE                      	    59.25	  $226.34	      ---	       --	005	0	0	0.18	    $0.00	Y	
L	72196	MRI PELVIS W/DYE                        	    69.38	  $265.03	      ---	       --	005	0	0	0.20	    $0.00	Y	
L	72197	MRI PELVIS W/O & W/DYE                  	    87.15	  $332.91	      ---	       --	005	0	0	0.21	    $0.00	Y	
L	72198	MR ANGIO PELVIS W/O & W/DYE             	    86.75	  $331.39	      ---	       --	005	0	0	0.21	    $0.00	Y	
L	72200	X-RAY EXAM SI JOINTS                    	     5.66	   $21.62	      ---	       --	005	0	0	0.30	    $0.00	Y	
L	72202	X-RAY EXAM SI JOINTS 3/> VWS            	     7.74	   $29.57	      ---	       --	005	0	0	0.27	    $0.00	Y	
L	72220	X-RAY EXAM SACRUM TAILBONE              	     6.55	   $25.02	      ---	       --	005	0	0	0.30	    $0.00	Y	
L	72240	MYELOGRAPHY NECK SPINE                  	    22.92	   $87.55	      ---	       --	005	0	0	0.44	    $0.00	Y	
L	72255	MYELOGRAPHY THORACIC SPINE              	    22.78	   $87.02	      ---	       --	005	0	0	0.46	    $0.00	Y	
L	72265	MYELOGRAPHY L-S SPINE                   	    21.46	   $81.98	      ---	       --	005	0	0	0.43	    $0.00	Y	
L	72270	MYELOGPHY 2/> SPINE REGIONS             	    29.56	  $112.92	      ---	       --	005	0	0	0.51	    $0.00	Y	
L	72285	DISCOGRAPHY CERV/THOR SPINE             	    26.30	  $100.47	      ---	       --	005	0	0	0.52	    $0.00	Y	
L	72295	X-RAY OF LOWER SPINE DISK               	    22.90	   $87.48	      ---	       --	005	0	0	0.42	    $0.00	Y	
L	73000	X-RAY EXAM OF COLLAR BONE               	     5.44	   $20.78	      ---	       --	005	0	0	0.29	    $0.00	Y	
L	73010	X-RAY EXAM OF SHOULDER BLADE            	     5.60	   $21.39	      ---	       --	005	0	0	0.29	    $0.00	Y	
L	73020	X-RAY EXAM OF SHOULDER                  	     4.53	   $17.30	      ---	       --	005	0	0	0.34	    $0.00	Y	
L	73030	X-RAY EXAM OF SHOULDER                  	     6.77	   $25.86	      ---	       --	005	0	0	0.31	    $0.00	Y	
L	73040	CONTRAST X-RAY OF SHOULDER              	    13.27	   $50.69	      ---	       --	005	0	0	0.26	    $0.00	Y	
L	73050	X-RAY EXAM OF SHOULDERS                 	     6.78	   $25.90	      ---	       --	005	0	0	0.28	    $0.00	Y	
L	73060	X-RAY EXAM OF HUMERUS                   	     5.44	   $20.78	      ---	       --	005	0	0	0.28	    $0.00	Y	
L	73070	X-RAY EXAM OF ELBOW                     	     5.44	   $20.78	      ---	       --	005	0	0	0.28	    $0.00	Y	
L	73080	X-RAY EXAM OF ELBOW                     	     6.80	   $25.98	      ---	       --	005	0	0	0.27	    $0.00	Y	
L	73085	CONTRAST X-RAY OF ELBOW                 	    18.80	   $71.82	      ---	       --	005	0	0	0.29	    $0.00	Y	
L	73090	X-RAY EXAM OF FOREARM                   	     5.44	   $20.78	      ---	       --	005	0	0	0.31	    $0.00	Y	
L	73092	X-RAY EXAM OF ARM INFANT                	     5.44	   $20.78	      ---	       --	005	0	0	0.28	    $0.00	Y	
L	73100	X-RAY EXAM OF WRIST                     	     4.53	   $17.30	      ---	       --	005	0	0	0.28	    $0.00	Y	
L	73110	X-RAY EXAM OF WRIST                     	     6.58	   $25.14	      ---	       --	005	0	0	0.24	    $0.00	Y	
L	73115	CONTRAST X-RAY OF WRIST                 	    10.77	   $41.14	      ---	       --	005	0	0	0.25	    $0.00	Y	
L	73120	X-RAY EXAM OF HAND                      	     4.53	   $17.30	      ---	       --	005	0	0	0.31	    $0.00	Y	
L	73130	X-RAY EXAM OF HAND                      	     6.58	   $25.14	      ---	       --	005	0	0	0.27	    $0.00	Y	
L	73140	X-RAY EXAM OF FINGER(S)                 	     4.08	   $15.59	      ---	       --	005	0	0	0.21	    $0.00	Y	
L	73200	CT UPPER EXTREMITY W/O DYE              	    41.51	  $158.57	      ---	       --	005	0	0	0.26	    $0.00	Y	
L	73201	CT UPPER EXTREMITY W/DYE                	    51.51	  $196.77	      ---	       --	005	0	0	0.25	    $0.00	Y	
L	73202	CT UPPR EXTREMITY W/O&W/DYE             	    64.75	  $247.35	      ---	       --	005	0	0	0.21	    $0.00	Y	
L	73206	CT ANGIO UPR EXTRM W/O&W/DYE            	    76.19	  $291.05	      ---	       --	005	0	0	0.26	    $0.00	Y	
L	73218	MRI UPPER EXTREMITY W/O DYE             	    79.38	  $303.23	      ---	       --	005	0	0	0.18	    $0.00	Y	
L	73219	MRI UPPER EXTREMITY W/DYE               	    86.37	  $329.93	      ---	       --	005	0	0	0.19	    $0.00	Y	
L	73220	MRI UPPR EXTREMITY W/O&W/DYE            	   102.22	  $390.48	      ---	       --	005	0	0	0.20	    $0.00	Y	
L	73221	MRI JOINT UPR EXTREM W/O DYE            	    51.64	  $197.26	      ---	       --	005	0	0	0.27	    $0.00	Y	
L	73222	MRI JOINT UPR EXTREM W/DYE              	    81.77	  $312.36	      ---	       --	005	0	0	0.20	    $0.00	Y	
L	73223	MRI JOINT UPR EXTR W/O&W/DYE            	   101.08	  $386.13	      ---	       --	005	0	0	0.22	    $0.00	Y	
L	73225	MR ANGIO UPR EXTR W/O&W/DYE             	    88.56	  $338.30	      ---	       --	005	0	0	0.20	    $0.00	Y	
L	73501	X-RAY EXAM HIP UNI 1 VIEW               	     6.94	   $26.51	      ---	       --	005	0	0	0.31	    $0.00	Y	
L	73502	X-RAY EXAM HIP UNI 2-3 VIEWS            	     9.76	   $37.28	      ---	       --	005	0	0	0.26	    $0.00	Y	
L	73503	X-RAY EXAM HIP UNI 4/> VIEWS            	    12.19	   $46.57	      ---	       --	005	0	0	0.26	    $0.00	Y	
L	73521	X-RAY EXAM HIPS BI 2 VIEWS              	     9.11	   $34.80	      ---	       --	005	0	0	0.28	    $0.00	Y	
L	73522	X-RAY EXAM HIPS BI 3-4 VIEWS            	    11.48	   $43.85	      ---	       --	005	0	0	0.29	    $0.00	Y	
L	73523	X-RAY EXAM HIPS BI 5/> VIEWS            	    13.36	   $51.04	      ---	       --	005	0	0	0.27	    $0.00	Y	
L	73525	CONTRAST X-RAY OF HIP                   	    19.71	   $75.29	      ---	       --	005	0	0	0.27	    $0.00	Y	
L	73551	X-RAY EXAM OF FEMUR 1                   	     6.53	   $24.94	      ---	       --	005	0	0	0.29	    $0.00	Y	
L	73552	X-RAY EXAM OF FEMUR 2/>                 	     7.63	   $29.15	      ---	       --	005	0	0	0.28	    $0.00	Y	
L	73560	X-RAY EXAM OF KNEE 1 OR 2               	     4.98	   $19.02	      ---	       --	005	0	0	0.26	    $0.00	Y	
L	73562	X-RAY EXAM OF KNEE 3                    	     6.12	   $23.38	      ---	       --	005	0	0	0.25	    $0.00	Y	
L	73564	X-RAY EXAM KNEE 4 OR MORE               	     7.25	   $27.70	      ---	       --	005	0	0	0.27	    $0.00	Y	
L	73565	X-RAY EXAM OF KNEES                     	     4.98	   $19.02	      ---	       --	005	0	0	0.23	    $0.00	Y	
L	73580	CONTRAST X-RAY OF KNEE JOINT            	    18.12	   $69.22	      ---	       --	005	0	0	0.23	    $0.00	Y	
L	73590	X-RAY EXAM OF LOWER LEG                 	     5.44	   $20.78	      ---	       --	005	0	0	0.28	    $0.00	Y	
P	73590	X-RAY EXAM OF LOWER LEG                 	     5.44	   $20.78	      ---	       --	010	0	0	0.35	    $0.00	Y	
L	73592	X-RAY EXAM OF LEG INFANT                	     5.44	   $20.78	      ---	       --	005	0	0	0.28	    $0.00	Y	
L	73600	X-RAY EXAM OF ANKLE                     	     4.98	   $19.02	      ---	       --	005	0	0	0.27	    $0.00	Y	
P	73600	X-RAY EXAM OF ANKLE                     	     4.98	   $19.02	      ---	       --	010	0	0	0.35	    $0.00	Y	
P	73610	X-RAY EXAM OF ANKLE                     	     6.58	   $25.14	      ---	       --	010	0	0	0.33	    $0.00	Y	
L	73610	X-RAY EXAM OF ANKLE                     	     6.58	   $25.14	      ---	       --	005	0	0	0.27	    $0.00	Y	
L	73615	CONTRAST X-RAY OF ANKLE                 	    19.71	   $75.29	      ---	       --	005	0	0	0.26	    $0.00	Y	
P	73615	CONTRAST X-RAY OF ANKLE                 	    19.71	   $75.29	      ---	       --	010	0	0	0.33	    $0.00	Y	
P	73620	X-RAY EXAM OF FOOT                      	     4.53	   $17.30	      ---	       --	010	0	0	0.35	    $0.00	Y	
L	73620	X-RAY EXAM OF FOOT                      	     4.53	   $17.30	      ---	       --	005	0	0	0.28	    $0.00	Y	
L	73630	X-RAY EXAM OF FOOT                      	     6.34	   $24.22	      ---	       --	005	0	0	0.28	    $0.00	Y	
P	73630	X-RAY EXAM OF FOOT                      	     6.34	   $24.22	      ---	       --	010	0	0	0.35	    $0.00	Y	
P	73650	X-RAY EXAM OF HEEL                      	     4.98	   $19.02	      ---	       --	010	0	0	0.35	    $0.00	Y	
L	73650	X-RAY EXAM OF HEEL                      	     4.98	   $19.02	      ---	       --	005	0	0	0.29	    $0.00	Y	
L	73660	X-RAY EXAM OF TOE(S)                    	     4.08	   $15.59	      ---	       --	005	0	0	0.23	    $0.00	Y	
P	73660	X-RAY EXAM OF TOE(S)                    	     4.08	   $15.59	      ---	       --	010	0	0	0.33	    $0.00	Y	
L	73700	CT LOWER EXTREMITY W/O DYE              	    32.55	  $124.34	      ---	       --	005	0	0	0.26	    $0.00	Y	
L	73701	CT LOWER EXTREMITY W/DYE                	    42.22	  $161.28	      ---	       --	005	0	0	0.24	    $0.00	Y	
L	73702	CT LWR EXTREMITY W/O&W/DYE              	    49.60	  $189.47	      ---	       --	005	0	0	0.21	    $0.00	Y	
L	73706	CT ANGIO LWR EXTR W/O&W/DYE             	    82.73	  $316.03	      ---	       --	005	0	0	0.25	    $0.00	Y	
L	73718	MRI LOWER EXTREMITY W/O DYE             	    57.61	  $220.07	      ---	       --	005	0	0	0.17	    $0.00	Y	
P	73718	MRI LOWER EXTREMITY W/O DYE             	   111.85	  $427.27	      ---	       --	010	0	0	1.00	    $0.00	N	
P	73719	MRI LOWER EXTREMITY W/DYE               	   125.21	  $478.30	      ---	       --	010	0	0	1.00	    $0.00	N	
L	73719	MRI LOWER EXTREMITY W/DYE               	    67.79	  $258.96	      ---	       --	005	0	0	0.19	    $0.00	Y	
L	73720	MRI LWR EXTREMITY W/O&W/DYE             	    87.19	  $333.07	      ---	       --	005	0	0	0.20	    $0.00	Y	
P	73720	MRI LWR EXTREMITY W/O&W/DYE             	   102.22	  $390.48	      ---	       --	010	0	0	1.00	    $0.00	N	
P	73721	MRI JNT OF LWR EXTRE W/O DYE            	   102.22	  $390.48	      ---	       --	010	0	0	1.00	    $0.00	N	
L	73721	MRI JNT OF LWR EXTRE W/O DYE            	    51.55	  $196.92	      ---	       --	005	0	0	0.27	    $0.00	Y	
L	73722	MRI JOINT OF LWR EXTR W/DYE             	    81.94	  $313.01	      ---	       --	005	0	0	0.20	    $0.00	Y	
P	73722	MRI JOINT OF LWR EXTR W/DYE             	   119.53	  $456.60	      ---	       --	010	0	0	1.00	    $0.00	N	
P	73723	MRI JOINT LWR EXTR W/O&W/DYE            	   150.05	  $573.19	      ---	       --	010	0	0	1.00	    $0.00	N	
L	73723	MRI JOINT LWR EXTR W/O&W/DYE            	   100.75	  $384.87	      ---	       --	005	0	0	0.22	    $0.00	Y	
L	73725	MR ANG LWR EXT W OR W/O DYE             	    86.40	  $330.05	      ---	       --	005	0	0	0.21	    $0.00	Y	
L	74018	RADEX ABDOMEN 1 VIEW                    	     6.44	   $24.60	      ---	       --	005	0	0	0.32	    $0.00	Y	
L	74019	RADEX ABDOMEN 2 VIEWS                   	     7.87	   $30.06	      ---	       --	005	0	0	0.33	    $0.00	Y	
L	74021	RADEX ABDOMEN 3+ VIEWS                  	     9.79	   $37.40	      ---	       --	005	0	0	0.33	    $0.00	Y	
L	74022	RADEX COMPL AQT ABD SERIES              	    10.32	   $39.42	      ---	       --	005	0	0	0.35	    $0.00	Y	
L	74150	CT ABDOMEN W/O CONTRAST                 	    34.34	  $131.18	      ---	       --	005	0	0	0.38	    $0.00	Y	
L	74160	CT ABDOMEN W/CONTRAST                   	    54.65	  $208.76	      ---	       --	005	0	0	0.26	    $0.00	Y	
L	74170	CT ABD WO CNTRST FLWD CNTRST            	    62.21	  $237.64	      ---	       --	005	0	0	0.25	    $0.00	Y	
L	74174	CTA ABD&PLVS W/CONTRAST                 	    92.09	  $351.78	      ---	       --	005	0	0	0.27	    $0.00	Y	
L	74175	CTA ABDOMEN W/CONTRAST                  	    72.56	  $277.18	      ---	       --	005	0	0	0.28	    $0.00	Y	
L	74176	CT ABD & PELVIS W/O CONTRAST            	    45.63	  $174.31	      ---	       --	005	0	0	0.42	    $0.00	Y	
L	74177	CT ABD & PELVIS W/CONTRAST              	    73.77	  $281.80	      ---	       --	005	0	0	0.28	    $0.00	Y	
L	74178	CT ABD&PLV WO CNTR FLWD CNTR            	    83.57	  $319.24	      ---	       --	005	0	0	0.27	    $0.00	Y	
L	74181	MRI ABDOMEN W/O CONTRAST                	    49.99	  $190.96	      ---	       --	005	0	0	0.21	    $0.00	Y	
L	74182	MRI ABDOMEN W/CONTRAST                  	    78.33	  $299.22	      ---	       --	005	0	0	0.18	    $0.00	Y	
L	74183	MRI ABD W/O CNTR FLWD CNTR              	    87.31	  $333.52	      ---	       --	005	0	0	0.21	    $0.00	Y	
L	74185	MRA ABD W OR W/O CNTRST                 	    86.92	  $332.03	      ---	       --	005	0	0	0.21	    $0.00	Y	
L	74190	PERITONEOGRAM RS&I                      	     9.04	   $34.53	      ---	       --	005	0	0	0.27	    $0.00	Y	
L	74210	X-RAY XM PHRNX&/CRV ESOPH C+            	     9.97	   $38.09	      ---	       --	005	0	0	0.22	    $0.00	Y	
L	74220	X-RAY XM ESOPHAGUS 1CNTRST              	     9.97	   $38.09	      ---	       --	005	0	0	0.25	    $0.00	Y	
L	74221	X-RAY XM ESOPHAGUS 2CNTRST              	    26.01	   $99.36	      ---	       --	005	0	0	0.31	    $0.00	Y	
L	74230	X-RAY XM SWLNG FUNCJ C+                 	    13.59	   $51.91	      ---	       --	005	0	0	0.20	    $0.00	Y	
L	74235	REMOVE ESOPHAGUS OBSTRUCTION            	    31.55	  $120.52	      ---	       --	005	0	0	0.40	    $0.00	Y	
L	74240	X-RAY XM UPR GI TRC 1CNTRST             	    26.71	  $102.03	      ---	       --	005	0	0	0.29	    $0.00	Y	
L	74246	X-RAY XM UPR GI TRC 2CNTRST             	    30.17	  $115.25	      ---	       --	005	0	0	0.26	    $0.00	Y	
L	74248	X-RAY SM INT F-THRU STD                 	    19.57	   $74.76	      ---	       --	005	0	0	0.41	    $0.00	Y	
L	74250	X-RAY XM SM INT 1CNTRST STD             	    24.77	   $94.62	      ---	       --	005	0	0	0.22	    $0.00	Y	
L	74251	X-RAY XM SM INT 2CNTRST STD             	    95.29	  $364.01	      ---	       --	005	0	0	0.08	    $0.00	Y	
L	74261	CT COLONOGRAPHY DX                      	   108.36	  $413.94	      ---	       --	005	0	0	0.20	    $0.00	N	
L	74262	CT COLONOGRAPHY DX W/DYE                	   122.70	  $468.71	      ---	       --	005	0	0	0.18	    $0.00	N	
L	74263	CT COLONOGRAPHY SCREENING               	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	N	
L	74270	X-RAY XM COLON 1CNTRST STD              	    13.59	   $51.91	      ---	       --	005	0	0	0.22	    $0.00	Y	
L	74280	X-RAY XM COLON 2CNTRST STD              	    16.45	   $62.84	      ---	       --	005	0	0	0.22	    $0.00	Y	
L	74283	THER NMA RDCTJ INTUS/OBSTRCJ            	     0.00	    $0.00	      ---	       --	005	0	0	0.48	    $0.00	Y	
L	74290	CONTRAST X-RAY GALLBLADDER              	    10.06	   $38.43	      ---	       --	005	0	0	0.22	    $0.00	Y	
L	74300	X-RAY BILE DUCTS/PANCREAS               	    11.33	   $43.28	      ---	       --	005	0	0	0.33	    $0.00	Y	
L	74301	X-RAYS AT SURGERY ADD-ON                	     5.66	   $21.62	      ---	       --	005	0	0	0.33	    $0.00	Y	
L	74328	X-RAY BILE DUCT ENDOSCOPY               	    30.14	  $115.13	      ---	       --	005	0	0	0.33	    $0.00	Y	
L	74329	X-RAY FOR PANCREAS ENDOSCOPY            	    30.14	  $115.13	      ---	       --	005	0	0	0.33	    $0.00	Y	
L	74330	X-RAY BILE/PANC ENDOSCOPY               	    30.14	  $115.13	      ---	       --	005	0	0	0.33	    $0.00	Y	
L	74340	X-RAY GUIDE FOR GI TUBE                 	    16.54	   $63.18	      ---	       --	005	0	0	0.80	    $0.00	Y	
L	74355	X-RAY GUIDE INTESTINAL TUBE             	    26.98	  $103.06	      ---	       --	005	0	0	0.40	    $0.00	Y	
L	74360	X-RAY GUIDE GI DILATION                 	    28.53	  $108.98	      ---	       --	005	0	0	0.40	    $0.00	Y	
L	74363	X-RAY BILE DUCT DILATION                	    34.60	  $132.17	      ---	       --	005	0	0	0.40	    $0.00	Y	
L	74400	UROGRAPHY IV +-KUB TOMOG                	    17.21	   $65.74	      ---	       --	005	0	0	0.21	    $0.00	Y	
L	74410	UROGRAPHY NFS DRIP&/BOLUS               	    22.65	   $86.52	      ---	       --	005	0	0	0.21	    $0.00	Y	
L	74415	UROGRAPHY NFS DRIP&/BLS W/NF            	    26.00	   $99.32	      ---	       --	005	0	0	0.17	    $0.00	Y	
L	74420	UROGRAPHY RTRGR +-KUB                   	    14.77	   $56.42	      ---	       --	005	0	0	0.33	    $0.00	Y	
L	74425	UROGRAPHY ANTEGRADE RS&I                	    13.14	   $50.19	      ---	       --	005	0	0	0.33	    $0.00	Y	
L	74430	CONTRAST X-RAY BLADDER                  	     8.68	   $33.16	      ---	       --	005	0	0	0.41	    $0.00	Y	
L	74440	X-RAY MALE GENITAL TRACT                	     9.97	   $38.09	      ---	       --	005	0	0	0.22	    $0.00	Y	
L	74445	X-RAY EXAM OF PENIS                     	    13.59	   $51.91	      ---	       --	005	0	0	0.33	    $0.00	Y	
L	74450	X-RAY URETHRA/BLADDER                   	    10.87	   $41.52	      ---	       --	005	0	0	0.33	    $0.00	Y	
L	74455	X-RAY URETHRA/BLADDER                   	    15.86	   $60.59	      ---	       --	005	0	0	0.19	    $0.00	Y	
L	74470	X-RAY EXAM OF KIDNEY LESION             	    11.33	   $43.28	      ---	       --	005	0	0	0.34	    $0.00	Y	
L	74485	DILATION URTR/URT RS&I                  	    21.73	   $83.01	      ---	       --	005	0	0	0.27	    $0.00	Y	
L	74712	MRI FETAL SNGL/1ST GESTATION            	   105.02	  $401.18	      ---	       --	005	0	0	0.30	    $0.00	Y	
L	74713	MRI FETAL EA ADDL GESTATION             	    50.65	  $193.48	      ---	       --	005	0	0	0.38	    $0.00	Y	
L	74740	X-RAY FEMALE GENITAL TRACT              	    12.23	   $46.72	      ---	       --	005	0	0	0.24	    $0.00	Y	
L	74775	X-RAY EXAM OF PERINEUM                  	     0.00	    $0.00	      ---	       --	005	0	0	0.40	    $0.00	Y	
L	75561	CARDIAC MRI FOR MORPH W/DYE             	    94.51	  $361.03	      ---	       --	005	0	0	0.29	    $0.00	Y	
L	75565	CARD MRI VELOC FLOW MAPPING             	    11.98	   $45.76	      ---	       --	005	0	0	0.21	    $0.00	Y	
L	75571	CT HRT W/O DYE W/CA TEST                	    21.29	   $81.33	      ---	       --	005	0	0	0.27	    $0.00	Y	
L	75572	CT HRT W/3D IMAGE                       	    57.11	  $218.16	      ---	       --	005	0	0	0.29	    $0.00	Y	
L	75573	CT HRT C+ STRUX CGEN HRT DS             	    76.54	  $292.38	      ---	       --	005	0	0	0.31	    $0.00	Y	
L	75574	CT ANGIO HRT W/3D IMAGE                 	    81.71	  $312.13	      ---	       --	005	0	0	0.27	    $0.00	Y	
L	75580	N-INVAS EST C FFR SW ALY CTA            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	75600	CONTRAST EXAM THORACIC AORTA            	    46.64	  $178.16	      ---	       --	005	0	0	0.11	    $0.00	Y	
L	75605	CONTRAST EXAM THORACIC AORTA            	    28.94	  $110.55	      ---	       --	005	0	0	0.38	    $0.00	Y	
L	75625	CONTRAST EXAM ABDOMINL AORTA            	    30.10	  $114.98	      ---	       --	005	0	0	0.38	    $0.00	Y	
L	75630	X-RAY AORTA LEG ARTERIES                	    37.23	  $142.22	      ---	       --	005	0	0	0.49	    $0.00	Y	
L	75635	CT ANGIO ABDOMINAL ARTERIES             	    89.67	  $342.54	      ---	       --	005	0	0	0.30	    $0.00	Y	
L	75705	ARTERY X-RAYS SPINE                     	    55.33	  $211.36	      ---	       --	005	0	0	0.44	    $0.00	Y	
L	75710	ARTERY X-RAYS ARM/LEG                   	    35.64	  $136.14	      ---	       --	005	0	0	0.33	    $0.00	Y	
L	75716	ARTERY X-RAYS ARMS/LEGS                 	    38.48	  $146.99	      ---	       --	005	0	0	0.32	    $0.00	Y	
L	75726	ARTERY X-RAYS ABDOMEN                   	    34.10	  $130.26	      ---	       --	005	0	0	0.35	    $0.00	Y	
L	75731	ARTERY X-RAYS ADRENAL GLAND             	    36.51	  $139.47	      ---	       --	005	0	0	0.32	    $0.00	Y	
L	75733	ARTERY X-RAYS ADRENALS                  	    40.52	  $154.79	      ---	       --	005	0	0	0.33	    $0.00	Y	
L	75736	ARTERY X-RAYS PELVIS                    	    33.86	  $129.35	      ---	       --	005	0	0	0.33	    $0.00	Y	
L	75741	ARTERY X-RAYS LUNG                      	    31.16	  $119.03	      ---	       --	005	0	0	0.40	    $0.00	Y	
L	75743	ARTERY X-RAYS LUNGS                     	    35.22	  $134.54	      ---	       --	005	0	0	0.46	    $0.00	Y	
L	75746	ARTERY X-RAYS LUNG                      	    32.14	  $122.77	      ---	       --	005	0	0	0.35	    $0.00	Y	
L	75756	ARTERY X-RAYS CHEST                     	    38.06	  $145.39	      ---	       --	005	0	0	0.31	    $0.00	Y	
L	75774	ARTERY X-RAY EACH VESSEL                	    19.77	   $75.52	      ---	       --	005	0	0	0.19	    $0.00	Y	
L	75801	LYMPH VESSEL X-RAY ARM/LEG              	    33.98	  $129.80	      ---	       --	005	0	0	0.33	    $0.00	Y	
L	75803	LYMPH VESSEL X-RAY ARMS/LEGS            	    33.98	  $129.80	      ---	       --	005	0	0	0.33	    $0.00	Y	
L	75805	LYMPH VESSEL X-RAY TRUNK                	    34.23	  $130.76	      ---	       --	005	0	0	0.40	    $0.00	Y	
L	75807	LYMPH VESSEL X-RAY TRUNK                	    36.25	  $138.48	      ---	       --	005	0	0	0.40	    $0.00	Y	
L	75809	NONVASCULAR SHUNT X-RAY                 	     6.50	   $24.83	      ---	       --	005	0	0	0.23	    $0.00	Y	
L	75810	VEIN X-RAY SPLEEN/LIVER                 	   102.67	  $392.20	      ---	       --	005	0	0	0.33	    $0.00	Y	
L	75820	VEIN X-RAY ARM/LEG                      	    16.00	   $61.12	      ---	       --	005	0	0	0.28	    $0.00	Y	
L	75822	VEIN X-RAY ARMS/LEGS                    	    24.56	   $93.82	      ---	       --	005	0	0	0.36	    $0.00	Y	
L	75825	VEIN X-RAY TRUNK                        	    27.10	  $103.52	      ---	       --	005	0	0	0.39	    $0.00	Y	
L	75827	VEIN X-RAY CHEST                        	    28.60	  $109.25	      ---	       --	005	0	0	0.38	    $0.00	Y	
L	75831	VEIN X-RAY KIDNEY                       	     0.00	    $0.00	      ---	       --	005	0	0	0.37	    $0.00	Y	
L	75833	VEIN X-RAY KIDNEYS                      	     0.00	    $0.00	      ---	       --	005	0	0	0.42	    $0.00	Y	
L	75840	VEIN X-RAY ADRENAL GLAND                	     0.00	    $0.00	      ---	       --	005	0	0	0.37	    $0.00	Y	
L	75842	VEIN X-RAY ADRENAL GLANDS               	    37.97	  $145.05	      ---	       --	005	0	0	0.39	    $0.00	Y	
L	75860	VEIN X-RAY NECK                         	     0.00	    $0.00	      ---	       --	005	0	0	0.37	    $0.00	Y	
L	75870	VEIN X-RAY SKULL                        	    34.99	  $133.66	      ---	       --	005	0	0	0.37	    $0.00	Y	
L	75872	VEIN X-RAY SKULL EPIDURAL               	     0.00	    $0.00	      ---	       --	005	0	0	0.35	    $0.00	Y	
L	75880	VEIN X-RAY EYE SOCKET                   	     0.00	    $0.00	      ---	       --	005	0	0	0.23	    $0.00	Y	
L	75885	VEIN X-RAY LIVER W/HEMODYNAM            	    32.32	  $123.46	      ---	       --	005	0	0	0.42	    $0.00	Y	
L	75887	VEIN X-RAY LIVER W/O HEMODYN            	     0.00	    $0.00	      ---	       --	005	0	0	0.42	    $0.00	Y	
L	75889	VEIN X-RAY LIVER W/HEMODYNAM            	     0.00	    $0.00	      ---	       --	005	0	0	0.36	    $0.00	Y	
L	75891	VEIN X-RAY LIVER                        	     0.00	    $0.00	      ---	       --	005	0	0	0.37	    $0.00	Y	
L	75893	VENOUS SAMPLING BY CATHETER             	     0.00	    $0.00	      ---	       --	005	0	0	0.21	    $0.00	Y	
L	75894	X-RAYS TRANSCATH THERAPY                	     0.00	    $0.00	      ---	       --	005	0	0	0.33	    $0.00	Y	
L	75898	FOLLOW-UP ANGIOGRAPHY                   	    27.20	  $103.90	      ---	       --	005	0	0	0.33	    $0.00	Y	
L	75901	REMOVE CVA DEVICE OBSTRUCT              	    26.01	   $99.36	      ---	       --	005	0	0	0.12	    $0.00	Y	
L	75902	REMOVE CVA LUMEN OBSTRUCT               	    16.95	   $64.75	      ---	       --	005	0	0	0.25	    $0.00	Y	
L	75956	XRAY ENDOVASC THOR AO REPR              	    85.39	  $326.19	      ---	       --	005	0	0	0.80	    $0.00	Y	
L	75957	XRAY ENDOVASC THOR AO REPR              	    73.15	  $279.43	      ---	       --	005	0	0	0.80	    $0.00	Y	
L	75958	XRAY PLACE PROX EXT THOR AO             	    48.78	  $186.34	      ---	       --	005	0	0	0.80	    $0.00	Y	
L	75959	XRAY PLACE DIST EXT THOR AO             	    42.72	  $163.19	      ---	       --	005	0	0	0.80	    $0.00	Y	
L	75970	VASCULAR BIOPSY                         	     0.00	    $0.00	      ---	       --	005	0	0	0.40	    $0.00	Y	
L	75984	XRAY CONTROL CATHETER CHANGE            	    17.73	   $67.73	      ---	       --	005	0	0	0.31	    $0.00	Y	
L	75989	ABSCESS DRAINAGE UNDER X-RAY            	    27.36	  $104.52	      ---	       --	005	0	0	0.46	    $0.00	Y	
L	76000	FLUOROSCOPY <1 HR PHYS/QHP              	     7.32	   $27.96	      ---	       --	005	0	0	0.17	    $0.00	Y	
P	76000	FLUOROSCOPY <1 HR PHYS/QHP              	     7.32	   $27.96	      ---	       --	010	0	0	0.50	    $0.00	Y	
L	76010	X-RAY NOSE TO RECTUM                    	     6.11	   $23.34	      ---	       --	005	0	0	0.33	    $0.00	Y	
L	76014	MR SFTY IMPLT&/FB ASMT STF 1            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	76015	MR SFTY MPLT&/FB ASMT STF EA            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	76016	MR SAFETY DETER PHYS/QHP                	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	76017	MR SFTY MED PHYSICS XM CSTMZ            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	76018	MR SAFETY IMPLANT ELEC PREPJ            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	76019	MR SAFETY IMPLT POS&/IMMOBLJ            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	76080	X-RAY EXAM OF FISTULA                   	    10.94	   $41.79	      ---	       --	005	0	0	0.46	    $0.00	Y	
L	76098	X-RAY EXAM SURGICAL SPECIMEN            	     3.79	   $14.48	      ---	       --	005	0	0	0.47	    $0.00	Y	
L	76100	X-RAY EXAM OF BODY SECTION              	    14.95	   $57.11	      ---	       --	005	0	0	0.33	    $0.00	Y	
L	76120	CINE/VIDEO X-RAYS                       	    13.80	   $52.72	      ---	       --	005	0	0	0.22	    $0.00	Y	
L	76125	CINE/VIDEO X-RAYS ADD-ON                	     7.93	   $30.29	      ---	       --	005	0	0	0.34	    $0.00	Y	
L	76140	X-RAY CONSULTATION                      	     4.87	   $18.60	      ---	       --	005	0	1	0.00	    $0.00	Y	
P	76140	X-RAY CONSULTATION                      	     4.87	   $18.60	      ---	       --	010	0	1	1.00	    $0.00	Y	
L	76145	MED PHYSIC DOS EVAL RAD EXPS            	   199.52	  $762.17	      ---	       --	005	0	0	0.00	    $0.00	N	
L	76380	CAT SCAN FOLLOW-UP STUDY                	    33.32	  $127.28	      ---	       --	005	0	0	0.32	    $0.00	Y	
L	76391	MR ELASTOGRAPHY                         	    52.19	  $199.37	      ---	       --	005	0	0	0.22	    $0.00	Y	
L	76496	UNLISTED FLUOROSCOPIC PX                	     0.00	    $0.00	      ---	       --	005	0	0	0.30	    $0.00	Y	
L	76497	UNLISTED CT PROCEDURE                   	     0.00	    $0.00	      ---	       --	005	0	0	0.30	    $0.00	Y	
L	76498	UNLISTED MR PROCEDURE                   	     0.00	    $0.00	      ---	       --	005	0	0	0.30	    $0.00	Y	
L	76499	UNLISTED DX RADIOGRAPHIC PX             	     0.00	    $0.00	      ---	       --	005	0	0	0.35	    $0.00	Y	
P	76499	UNLISTED DX RADIOGRAPHIC PX             	     0.00	    $0.00	      ---	       --	005	0	0	0.35	    $0.00	Y	
L	76506	ECHO EXAM OF HEAD                       	    16.29	   $62.23	      ---	       --	005	0	0	0.26	    $0.00	Y	
L	76510	OPH US DX B-SCAN&QUAN A-SCAN            	    16.52	   $63.11	      ---	       --	005	0	0	0.51	    $0.00	Y	
L	76511	OPH US DX QUAN A-SCAN ONLY              	    13.39	   $51.15	      ---	       --	005	0	0	0.51	    $0.00	Y	
L	76512	OPH US DX B-SCAN                        	    11.28	   $43.09	      ---	       --	005	0	0	0.56	    $0.00	Y	
L	76513	OPH US DX ANT SGM US UNI/BI             	    17.39	   $66.43	      ---	       --	005	0	0	0.36	    $0.00	Y	
L	76514	ECHO EXAM OF EYE THICKNESS              	     2.65	   $10.12	      ---	       --	005	0	0	0.64	    $0.00	Y	
L	76516	ECHO EXAM OF EYE                        	    11.07	   $42.29	      ---	       --	005	0	0	0.38	    $0.00	Y	
L	76519	ECHO EXAM OF EYE                        	    14.35	   $54.82	      ---	       --	005	0	0	0.36	    $0.00	Y	
L	76529	ECHO EXAM OF EYE                        	    15.38	   $58.75	      ---	       --	005	0	0	0.39	    $0.00	Y	
L	76536	US EXAM OF HEAD AND NECK                	    15.64	   $59.74	      ---	       --	005	0	0	0.23	    $0.00	Y	
L	76604	US EXAM CHEST                           	    13.92	   $53.17	      ---	       --	005	0	0	0.29	    $0.00	Y	
L	76641	ULTRASOUND BREAST COMPLETE              	    25.19	   $96.23	      ---	       --	005	0	0	0.32	    $0.00	Y	
L	76642	ULTRASOUND BREAST LIMITED               	    20.54	   $78.46	      ---	       --	005	0	0	0.37	    $0.00	Y	
L	76700	US EXAM ABDOM COMPLETE                  	    21.78	   $83.20	      ---	       --	005	0	0	0.31	    $0.00	Y	
L	76705	ECHO EXAM OF ABDOMEN                    	    15.90	   $60.74	      ---	       --	005	0	0	0.31	    $0.00	Y	
L	76706	US ABDL AORTA SCREEN AAA                	    22.37	   $85.45	      ---	       --	005	0	0	0.28	    $0.00	Y	
L	76770	US EXAM ABDO BACK WALL COMP             	    21.13	   $80.72	      ---	       --	005	0	0	0.31	    $0.00	Y	
L	76775	US EXAM ABDO BACK WALL LIM              	    13.45	   $51.38	      ---	       --	005	0	0	0.47	    $0.00	Y	
L	76776	US EXAM K TRANSPL W/DOPPLER             	    28.90	  $110.40	      ---	       --	005	0	0	0.23	    $0.00	Y	
L	76800	US EXAM SPINAL CANAL                    	    21.20	   $80.98	      ---	       --	005	0	0	0.40	    $0.00	Y	
L	76801	OB US < 14 WKS SINGLE FETUS             	    20.53	   $78.42	      ---	       --	005	0	0	0.39	    $0.00	Y	
X	76801	OB US < 14 WKS SINGLE FETUS             	   110.81	  $110.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	76802	OB US < 14 WKS ADDL FETUS               	    56.53	   $56.53	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	76802	OB US < 14 WKS ADDL FETUS               	    14.43	   $55.12	      ---	       --	005	0	0	0.64	    $0.00	Y	
L	76805	OB US >= 14 WKS SNGL FETUS              	    24.69	   $94.32	      ---	       --	005	0	0	0.33	    $0.00	Y	
X	76805	OB US >= 14 WKS SNGL FETUS              	   127.94	  $127.94	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	76810	OB US >= 14 WKS ADDL FETUS              	    82.36	   $82.36	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	76810	OB US >= 14 WKS ADDL FETUS              	    21.05	   $80.41	      ---	       --	005	0	0	0.50	    $0.00	Y	
L	76811	OB US DETAILED SNGL FETUS               	    41.54	  $158.68	      ---	       --	005	0	0	0.51	    $0.00	Y	
X	76811	OB US DETAILED SNGL FETUS               	   164.15	  $164.15	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	76812	OB US DETAILED ADDL FETUS               	   180.01	  $180.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	76812	OB US DETAILED ADDL FETUS               	    31.20	  $119.18	      ---	       --	005	0	0	0.43	    $0.00	Y	
L	76813	OB US NUCHAL MEAS 1 GEST                	    28.43	  $108.60	      ---	       --	005	0	0	0.48	    $0.00	Y	
X	76813	OB US NUCHAL MEAS 1 GEST                	   109.85	  $109.85	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	76814	OB US NUCHAL MEAS ADD-ON                	    69.52	   $69.52	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	76814	OB US NUCHAL MEAS ADD-ON                	    17.95	   $68.57	      ---	       --	005	0	0	0.61	    $0.00	Y	
L	76815	OB US LIMITED FETUS(S)                  	    16.48	   $62.95	      ---	       --	005	0	0	0.37	    $0.00	Y	
X	76815	OB US LIMITED FETUS(S)                  	    76.53	   $76.53	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	76816	OB US FOLLOW-UP PER FETUS               	   103.35	  $103.35	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	76816	OB US FOLLOW-UP PER FETUS               	    13.57	   $51.84	      ---	       --	005	0	0	0.36	    $0.00	Y	
L	76817	TRANSVAGINAL US OBSTETRIC               	    21.51	   $82.17	      ---	       --	005	0	0	0.37	    $0.00	Y	
X	76817	TRANSVAGINAL US OBSTETRIC               	    87.23	   $87.23	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	76819	FETAL BIOPHYS PROFIL W/O NST            	    78.86	   $78.86	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	76819	FETAL BIOPHYS PROFIL W/O NST            	    20.13	   $76.90	      ---	       --	005	0	0	0.42	    $0.00	Y	
L	76820	UMBILICAL ARTERY ECHO                   	    10.14	   $38.73	      ---	       --	005	0	0	0.52	    $0.00	Y	
X	76820	UMBILICAL ARTERY ECHO                   	    41.72	   $41.72	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	76821	MIDDLE CEREBRAL ARTERY ECHO             	    83.45	   $83.45	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	76821	MIDDLE CEREBRAL ARTERY ECHO             	    21.51	   $82.17	      ---	       --	005	0	0	0.37	    $0.00	Y	
L	76825	ECHO EXAM OF FETAL HEART                	    21.33	   $81.48	      ---	       --	005	0	0	0.28	    $0.00	Y	
X	76825	ECHO EXAM OF FETAL HEART                	   247.73	  $247.73	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	76826	ECHO EXAM OF FETAL HEART                	   148.67	  $148.67	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	76826	ECHO EXAM OF FETAL HEART                	    15.59	   $59.55	      ---	       --	005	0	0	0.24	    $0.00	Y	
L	76827	ECHO EXAM OF FETAL HEART                	    15.07	   $57.57	      ---	       --	005	0	0	0.36	    $0.00	Y	
X	76827	ECHO EXAM OF FETAL HEART                	    65.42	   $65.42	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	76828	ECHO EXAM OF FETAL HEART                	    45.77	   $45.77	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	76828	ECHO EXAM OF FETAL HEART                	     8.90	   $34.00	      ---	       --	005	0	0	0.51	    $0.00	Y	
L	76830	TRANSVAGINAL US NON-OB                  	    17.71	   $67.65	      ---	       --	005	0	0	0.27	    $0.00	Y	
L	76831	ECHO EXAM UTERUS                        	    19.77	   $75.52	      ---	       --	005	0	0	0.29	    $0.00	Y	
L	76856	US EXAM PELVIC COMPLETE                 	    17.71	   $67.65	      ---	       --	005	0	0	0.30	    $0.00	Y	
L	76857	US EXAM PELVIC LIMITED                  	    11.04	   $42.17	      ---	       --	005	0	0	0.50	    $0.00	Y	
L	76870	US EXAM SCROTUM                         	    15.65	   $59.78	      ---	       --	005	0	0	0.45	    $0.00	Y	
L	76872	US TRANSRECTAL                          	    17.71	   $67.65	      ---	       --	005	0	0	0.33	    $0.00	Y	
L	76873	ECHOGRAP TRANS R PROS STUDY             	    28.26	  $107.95	      ---	       --	005	1	0	0.44	    $0.00	Y	
L	76881	US COMPL JOINT R-T W/IMG                	    13.95	   $53.29	      ---	       --	005	0	0	0.25	    $0.00	Y	
P	76881	US COMPL JOINT R-T W/IMG                	    27.51	  $105.09	      ---	       --	010	0	0	0.23	    $0.00	Y	
P	76882	US LMTD JT/FCL EVL NVASC XTR            	     6.87	   $26.24	      ---	       --	010	0	0	0.64	    $0.00	Y	
L	76882	US LMTD JT/FCL EVL NVASC XTR            	     6.87	   $26.24	      ---	       --	005	0	0	0.67	    $0.00	Y	
L	76883	US NRV&ACC STRUX 1XTR COMPRE            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	N	
L	76885	US EXAM INFANT HIPS DYNAMIC             	    19.92	   $76.09	      ---	       --	005	0	0	0.24	    $0.00	Y	
L	76886	US EXAM INFANT HIPS STATIC              	    17.75	   $67.81	      ---	       --	005	0	0	0.26	    $0.00	Y	
L	76932	ECHO GUIDE FOR HEART BIOPSY             	    17.52	   $66.93	      ---	       --	005	0	0	0.40	    $0.00	Y	
L	76937	US GUIDE VASCULAR ACCESS                	     7.37	   $28.15	      ---	       --	005	0	0	0.44	    $0.00	Y	
L	76940	US GUIDE TISSUE ABLATION                	    36.57	  $139.70	      ---	       --	005	0	0	0.40	    $0.00	Y	
L	76941	ECHO GUIDE FOR TRANSFUSION              	    29.57	  $112.96	      ---	       --	005	0	0	0.54	    $0.00	Y	
L	76942	ECHO GUIDE FOR BIOPSY                   	    13.25	   $50.62	      ---	       --	005	0	0	0.52	    $0.00	Y	
L	76946	ECHO GUIDE FOR AMNIOCENTESIS            	     7.50	   $28.65	      ---	       --	005	0	0	0.58	    $0.00	Y	
L	76965	ECHO GUIDANCE RADIOTHERAPY              	    20.70	   $79.07	      ---	       --	005	0	0	0.72	    $0.00	Y	
L	76975	GI ENDOSCOPIC ULTRASOUND                	    12.54	   $47.90	      ---	       --	005	0	0	0.46	    $0.00	Y	
L	76978	US TRGT DYN MBUBB 1ST LES               	    73.15	  $279.43	      ---	       --	005	0	0	0.23	    $0.00	Y	
L	76979	US TRGT DYN MBUBB EA ADDL               	    48.69	  $186.00	      ---	       --	005	0	0	0.18	    $0.00	Y	
L	76981	USE PARENCHYMA                          	    25.55	   $97.60	      ---	       --	005	0	0	0.19	    $0.00	Y	
L	76982	USE 1ST TARGET LESION                   	    22.92	   $87.55	      ---	       --	005	0	0	0.29	    $0.00	Y	
L	76983	USE EA ADDL TARGET LESION               	    13.95	   $53.29	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	76984	DX INTRAOP THORACIC AORTA US            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	76987	DX INTRAOP EPICAR CAR US CHD            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	76988	DX NTROP EPCR US CHD IMG ACQ            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	76989	DX INTRAOP EPCAR US CHD I&R             	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	76998	US GUIDE INTRAOP                        	    30.51	  $116.55	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	76999	ECHO EXAMINATION PROCEDURE              	     0.00	    $0.00	      ---	       --	005	0	0	0.44	    $0.00	Y	
P	76999	ECHO EXAMINATION PROCEDURE              	     0.00	    $0.00	      ---	       --	010	0	0	0.44	    $0.00	Y	
L	77001	FLUOROGUIDE FOR VEIN DEVICE             	    16.64	   $63.56	      ---	       --	005	0	0	0.21	    $0.00	Y	
L	77002	NEEDLE LOCALIZATION BY XRAY             	    17.41	   $66.51	      ---	       --	005	0	0	0.29	    $0.00	Y	
L	77003	FLUOROGUIDE FOR SPINE INJECT            	    14.89	   $56.88	      ---	       --	005	0	0	0.30	    $0.00	Y	
L	77011	CT SCAN FOR LOCALIZATION                	    52.22	  $199.48	      ---	       --	005	0	0	0.27	    $0.00	Y	
L	77012	CT SCAN FOR NEEDLE BIOPSY               	    29.07	  $111.05	      ---	       --	005	0	0	0.44	    $0.00	Y	
L	77013	CT GUIDE FOR TISSUE ABLATION            	    42.10	  $160.82	      ---	       --	005	0	0	0.32	    $0.00	Y	
L	77014	CT SCAN FOR THERAPY GUIDE               	    27.53	  $105.16	      ---	       --	005	0	0	0.35	    $0.00	Y	
L	77021	MRI GUIDANCE NDL PLMT RS&I              	    96.01	  $366.76	      ---	       --	005	0	0	0.17	    $0.00	Y	
L	77022	MRI GDN PARNCHYMA TISS ABLTJ            	    44.92	  $171.59	      ---	       --	005	0	0	0.85	    $0.00	Y	
L	77046	MRI BREAST C- UNILATERAL                	    54.66	  $208.80	      ---	       --	005	0	0	0.28	    $0.00	Y	
L	77047	MRI BREAST C- BILATERAL                 	    56.04	  $214.07	      ---	       --	005	0	0	0.30	    $0.00	Y	
L	77048	MRI BREAST C-+ W/CAD UNI                	    86.79	  $331.54	      ---	       --	005	0	0	0.25	    $0.00	Y	
L	77049	MRI BREAST C-+ W/CAD BI                 	    88.44	  $337.84	      ---	       --	005	0	0	0.27	    $0.00	Y	
L	77053	X-RAY OF MAMMARY DUCT                   	    12.91	   $49.32	      ---	       --	005	0	0	0.30	    $0.00	Y	
L	77054	X-RAY OF MAMMARY DUCTS                  	    16.69	   $63.76	      ---	       --	005	0	0	0.28	    $0.00	Y	
L	77061	BREAST TOMOSYNTHESIS UNI                	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	77062	BREAST TOMOSYNTHESIS BI                 	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	77063	BREAST TOMOSYNTHESIS BI                 	    12.44	   $47.52	      ---	       --	005	0	0	0.53	    $0.00	Y	
L	77065	DX MAMMO INCL CAD UNI                   	    30.65	  $117.08	      ---	       --	005	0	0	0.28	    $0.00	Y	
L	77066	DX MAMMO INCL CAD BI                    	    38.75	  $148.03	      ---	       --	005	0	0	0.27	    $0.00	Y	
L	77067	SCR MAMMO BI INCL CAD                   	    31.27	  $119.45	      ---	       --	005	0	0	0.26	    $0.00	Y	
L	77071	MNL APPL STRS JT RADIOGRAPHY            	     6.43	   $24.56	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	77072	BONE AGE STUDIES                        	     5.15	   $19.67	      ---	       --	005	0	0	0.40	    $0.00	Y	
L	77073	BONE LENGTH STUDIES                     	     8.39	   $32.05	      ---	       --	005	0	0	0.39	    $0.00	Y	
L	77074	RADEX OSSEOUS SURVEY LMTD               	    14.77	   $56.42	      ---	       --	005	0	0	0.34	    $0.00	Y	
L	77075	RADEX OSSEOUS SURVEY COMPL              	    20.55	   $78.50	      ---	       --	005	0	0	0.30	    $0.00	Y	
L	77076	RADEX OSSEOUS SURVEY INFANT             	    16.65	   $63.60	      ---	       --	005	0	0	0.35	    $0.00	Y	
L	77077	JOINT SURVEY SINGLE VIEW                	     8.70	   $33.23	      ---	       --	005	0	0	0.42	    $0.00	Y	
L	77080	DXA BONE DENSITY AXIAL                  	     8.97	   $34.27	      ---	       --	005	0	0	0.24	    $0.00	Y	
L	77081	DXA BONE DENSITY APPENDICULR            	     6.57	   $25.10	      ---	       --	005	0	0	0.37	    $0.00	Y	
L	77085	DXA BONE DENSITY AXL VRT FX             	    12.33	   $47.10	      ---	       --	005	0	0	0.26	    $0.00	Y	
L	77086	VRT FRACTURE ASSMT VIA DXA              	     7.91	   $30.22	      ---	       --	005	0	0	0.24	    $0.00	Y	
L	77089	TBS DXA CAL W/I&R FX RISK               	     9.78	   $37.36	      ---	       --	005	0	0	1.00	    $0.00	Y	
L	77090	TBS TECHL PREP&TRANSMIS DATA            	     0.55	    $2.10	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	77091	TBS TECHL CALCULATION ONLY              	     6.91	   $26.40	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	77092	TBS I&R FX RSK QHP                      	     2.31	    $8.82	      ---	       --	005	0	0	1.00	    $0.00	Y	
L	77261	THER RADIOLOGY TX PLNG SMPL             	    16.00	   $61.12	      ---	       --	005	0	0	0.40	    $0.00	Y	
L	77262	THER RADIOLOGY TX PLNG INTRM            	    24.29	   $92.79	      ---	       --	005	0	0	0.40	    $0.00	Y	
L	77263	THER RADIOLOGY TX PLNG CPLX             	    37.76	  $144.24	      ---	       --	005	0	0	0.40	    $0.00	Y	
L	77280	THER RAD SIMULAJ FIELD SMPL             	    20.98	   $80.14	      ---	       --	005	0	0	0.12	    $0.00	Y	
L	77285	THER RAD SIMULAJ FIELD INTRM            	    33.25	  $127.02	      ---	       --	005	0	0	0.12	    $0.00	Y	
L	77290	THER RAD SIMULAJ FIELD CPLX             	    40.81	  $155.89	      ---	       --	005	0	0	0.15	    $0.00	Y	
L	77293	RESPIRATOR MOTION MGMT SIMUL            	   101.49	  $387.69	      ---	       --	005	0	0	0.21	    $0.00	Y	
L	77295	3-D RADIOTHERAPY PLAN                   	   112.50	  $429.75	      ---	       --	005	0	0	0.43	    $0.00	Y	
L	77299	UNLISTED PX THER RAD TX PLNG            	     0.00	    $0.00	      ---	       --	005	0	0	0.48	    $0.00	Y	
L	77300	RADIATION THERAPY DOSE PLAN             	    14.69	   $56.12	      ---	       --	005	0	0	0.47	    $0.00	Y	
L	77301	RADIOTHERAPY DOSE PLAN IMRT             	   323.87	 $1237.18	      ---	       --	005	0	0	0.20	    $0.00	Y	
L	77306	TELETHX ISODOSE PLAN SIMPLE             	    33.69	  $128.70	      ---	       --	005	0	0	0.47	    $0.00	Y	
L	77307	TELETHX ISODOSE PLAN CPLX               	    65.74	  $251.13	      ---	       --	005	0	0	0.50	    $0.00	Y	
L	77316	BRACHYTX ISODOSE PLAN SIMPLE            	    43.53	  $166.28	      ---	       --	005	0	0	0.37	    $0.00	Y	
L	77317	BRACHYTX ISODOSE INTERMED               	    56.92	  $217.43	      ---	       --	005	0	0	0.37	    $0.00	Y	
L	77318	BRACHYTX ISODOSE COMPLEX                	    82.04	  $313.39	      ---	       --	005	0	0	0.40	    $0.00	Y	
L	77321	SPECIAL TELETX PORT PLAN                	    21.39	   $81.71	      ---	       --	005	0	0	0.51	    $0.00	Y	
L	77331	SPECIAL RADIATION DOSIMETRY             	    13.98	   $53.40	      ---	       --	005	0	0	0.69	    $0.00	Y	
L	77332	RADIATION TREATMENT AID(S)              	     8.99	   $34.34	      ---	       --	005	0	0	0.33	    $0.00	Y	
L	77333	RADIATION TREATMENT AID(S)              	    11.97	   $45.73	      ---	       --	005	0	0	0.38	    $0.00	Y	
L	77334	RADIATION TREATMENT AID(S)              	    29.37	  $112.19	      ---	       --	005	0	0	0.44	    $0.00	Y	
L	77336	RADIATION PHYSICS CONSULT               	    14.42	   $55.08	      ---	       --	005	0	0	0.40	    $0.00	Y	
L	77338	DESIGN MLC DEVICE FOR IMRT              	   108.42	  $414.16	      ---	       --	005	0	0	0.42	    $0.00	Y	
L	77370	RADIATION PHYSICS CONSULT               	    24.92	   $95.19	      ---	       --	005	0	0	0.40	    $0.00	Y	
L	77371	SRS MULTISOURCE                         	   278.16	 $1062.57	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	77372	SRS LINEAR BASED                        	   211.05	  $806.21	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	77373	STRTCTC BDY RAD THER TX DLVR            	   250.80	  $958.06	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	77385	NTSTY MODUL RAD TX DLVR SMPL            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	77386	NTSTY MODUL RAD TX DLVR CPLX            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	77387	GUIDANCE FOR RADJ TX DLVR               	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	77399	UNLISTED PX MED RADJ PHYSICS            	     0.00	    $0.00	      ---	       --	005	0	0	0.40	    $0.00	Y	
L	77401	RADIATION TX DELIVERY SUPFC             	     4.99	   $19.06	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	77402	RADIATION TX DELIVERY SIMPLE            	    11.10	   $42.40	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	77407	RADIATION TX DELIVERY INTRM             	    10.15	   $38.77	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	77412	RADIATION TX DELIVERY COMPLX            	    11.31	   $43.20	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	77417	THER RADIOLOGY PORT IMAGE(S)            	     2.57	    $9.82	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	77423	NEUTRON BEAM TX COMPLEX                 	    22.88	   $87.40	      ---	       --	005	0	0	0.40	    $0.00	Y	
L	77424	IO RAD TX DELIVERY BY X-RAY             	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	77425	IO RAD TX DELIVER BY ELCTRNS            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	77427	RADIATION TX MANAGEMENT X5              	    29.94	  $114.37	      ---	       --	005	1	0	0.00	    $0.00	Y	
L	77431	RADIATION THERAPY MANAGEMENT            	    20.77	   $79.34	      ---	       --	005	0	0	0.40	    $0.00	Y	
L	77432	STEREOTACTIC RADIATION TRMT             	    74.43	  $284.32	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	77435	SBRT MANAGEMENT                         	   140.35	  $536.14	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	77469	IO RADIATION TX MANAGEMENT              	    64.99	  $248.26	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	77470	SPECIAL RADIATION TREATMENT             	    30.43	  $116.24	      ---	       --	005	0	0	0.72	    $0.00	N	
L	77499	UNLISTED PX THER RAD TX MGMT            	     0.00	    $0.00	      ---	       --	005	0	0	0.40	    $0.00	Y	
L	77520	PROTON TRMT SIMPLE W/O COMP             	     0.00	    $0.00	      ---	       --	005	1	0	0.00	    $0.00	Y	
L	77522	PROTON TRMT SIMPLE W/COMP               	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	77523	PROTON TRMT INTERMEDIATE                	     0.00	    $0.00	      ---	       --	005	1	0	0.00	    $0.00	Y	
L	77525	PROTON TREATMENT COMPLEX                	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	77600	HYPERTHERMIA EXT GEN SUPFC              	    44.34	  $169.38	      ---	       --	005	0	0	0.16	    $0.00	Y	
L	77610	HYPERTHERMIA NTRSTL PRB 5/<             	    44.34	  $169.38	      ---	       --	005	0	0	0.07	    $0.00	Y	
L	77615	HYPERTHERMIA NTRSTL PRB>5               	    59.55	  $227.48	      ---	       --	005	0	0	0.09	    $0.00	Y	
L	77750	INFUSE RADIOACTIVE MATERIALS            	    35.35	  $135.04	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	77761	APPLY INTRCAV RADIAT SIMPLE             	    84.42	  $322.48	      ---	       --	005	0	0	0.49	    $0.00	Y	
L	77762	APPLY INTRCAV RADIAT INTERM             	   111.89	  $427.42	      ---	       --	005	0	0	0.55	    $0.00	Y	
L	77763	APPLY INTRCAV RADIAT COMPL              	   157.98	  $603.48	      ---	       --	005	0	0	0.59	    $0.00	Y	
L	77767	HDR RDNCL SKN SURF BRACHYTX             	    53.65	  $204.94	      ---	       --	005	0	0	0.23	    $0.00	Y	
L	77768	HDR RDNCL SKN SURF BRACHYTX             	    84.31	  $322.06	      ---	       --	005	0	0	0.19	    $0.00	Y	
L	77770	HDR RDNCL NTRSTL/ICAV BRCHTX            	    76.15	  $290.89	      ---	       --	005	0	0	0.30	    $0.00	Y	
L	77771	HDR RDNCL NTRSTL/ICAV BRCHTX            	   141.56	  $540.76	      ---	       --	005	0	0	0.31	    $0.00	Y	
L	77772	HDR RDNCL NTRSTL/ICAV BRCHTX            	   212.21	  $810.64	      ---	       --	005	0	0	0.29	    $0.00	Y	
L	77778	APPLY INTERSTIT RADIAT COMPL            	   192.30	  $734.59	      ---	       --	005	0	0	0.53	    $0.00	Y	
L	77789	APPLY SURF LDR RADIONUCLIDE             	    27.94	  $106.73	      ---	       --	005	0	0	0.48	    $0.00	Y	
L	77790	RADIATION HANDLING                      	     3.69	   $14.10	      ---	       --	005	0	0	0.54	    $0.00	Y	
L	77799	UNLISTED PX CLIN BRACHYTX               	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	78013	THYROID IMAGING W/BLOOD FLOW            	    45.56	  $174.04	      ---	       --	005	0	0	0.09	    $0.00	Y	
L	78014	THYROID IMAGING W/BLOOD FLOW            	    55.89	  $213.50	      ---	       --	005	0	0	0.09	    $0.00	Y	
L	78015	THYROID MET IMAGING                     	    21.18	   $80.91	      ---	       --	005	0	0	0.13	    $0.00	Y	
L	78016	THYROID MET IMAGING/STUDIES             	    28.66	  $109.48	      ---	       --	005	0	0	0.11	    $0.00	Y	
L	78018	THYROID MET IMAGING BODY                	    33.98	  $129.80	      ---	       --	005	0	0	0.12	    $0.00	Y	
L	78020	THYROID MET UPTAKE                      	     7.65	   $29.22	      ---	       --	005	0	0	0.31	    $0.00	Y	
L	78070	PARATHYROID PLANAR IMAGING              	    25.16	   $96.11	      ---	       --	005	0	0	0.12	    $0.00	Y	
L	78071	PARATHYRD PLANAR W/WO SUBTRJ            	    81.64	  $311.86	      ---	       --	005	0	0	0.15	    $0.00	Y	
L	78072	PARATHYRD PLANAR W/SPECT&CT             	    95.53	  $364.92	      ---	       --	005	0	0	0.17	    $0.00	Y	
L	78075	ADRENAL CORTEX & MEDULLA IMG            	    57.02	  $217.82	      ---	       --	005	0	0	0.07	    $0.00	Y	
L	78099	UNLISTED ENDOCRINE PX DX NUC            	     6.68	   $25.52	      ---	       --	005	0	0	0.36	    $0.00	Y	
L	78102	BONE MARROW IMAGING LTD                 	    24.41	   $93.25	      ---	       --	005	0	0	0.14	    $0.00	Y	
L	78103	BONE MARROW IMAGING MULT                	     0.00	    $0.00	      ---	       --	005	0	0	0.15	    $0.00	Y	
L	78104	BONE MARROW IMAGING BODY                	     0.00	    $0.00	      ---	       --	005	0	0	0.14	    $0.00	Y	
L	78110	PLASMA VOLUME SINGLE                    	     9.06	   $34.61	      ---	       --	005	0	0	0.09	    $0.00	Y	
L	78111	PLASMA VOLUME MULTIPLE                  	    13.72	   $52.41	      ---	       --	005	0	0	0.10	    $0.00	Y	
L	78120	RED CELL MASS SINGLE                    	    13.59	   $51.91	      ---	       --	005	0	0	0.11	    $0.00	Y	
L	78121	RED CELL MASS MULTIPLE                  	    18.46	   $70.52	      ---	       --	005	0	0	0.14	    $0.00	Y	
L	78122	WHL BLD VOLUME DETERMINATION            	    23.12	   $88.32	      ---	       --	005	0	0	0.20	    $0.00	Y	
L	78130	RED CELL SURVIVAL STUDY                 	    22.65	   $86.52	      ---	       --	005	0	0	0.17	    $0.00	Y	
L	78140	RED CELL SEQUESTRATION                  	    22.65	   $86.52	      ---	       --	005	0	0	0.20	    $0.00	Y	
L	78185	SPLEEN IMAGING                          	    22.65	   $86.52	      ---	       --	005	0	0	0.09	    $0.00	Y	
L	78191	PLATELET SURVIVAL STUDY                 	    30.20	  $115.36	      ---	       --	005	0	0	0.17	    $0.00	Y	
L	78195	LYMPH SYSTEM IMAGING                    	    49.62	  $189.55	      ---	       --	005	0	0	0.15	    $0.00	Y	
L	78199	UNLSTD HEMATOP RET/ENDO LYMP            	     0.00	    $0.00	      ---	       --	005	0	0	0.33	    $0.00	Y	
L	78201	LIVER IMAGING STATIC ONLY               	    20.39	   $77.89	      ---	       --	005	0	0	0.10	    $0.00	Y	
L	78202	LIVER IMAGING WITH VASC FLOW            	    31.45	  $120.14	      ---	       --	005	0	0	0.11	    $0.00	Y	
L	78215	LVR&SPLEEN IMG STATIC ONLY              	    22.65	   $86.52	      ---	       --	005	0	0	0.11	    $0.00	Y	
L	78216	LVR&SPLEEN IMG W/VASC FLOW              	    29.79	  $113.80	      ---	       --	005	0	0	0.20	    $0.00	Y	
L	78226	HEPATOBILIARY SYSTEM IMAGING            	    76.18	  $291.01	      ---	       --	005	0	0	0.10	    $0.00	Y	
L	78227	HEPATOBIL SYST IMAGE W/DRUG             	   102.60	  $391.93	      ---	       --	005	0	0	0.09	    $0.00	Y	
L	78230	SALIVARY GLAND IMAGING                  	    15.86	   $60.59	      ---	       --	005	0	0	0.12	    $0.00	Y	
L	78231	SALIVARY GLND IMG SERIAL IMG            	    18.37	   $70.17	      ---	       --	005	0	0	0.18	    $0.00	Y	
L	78232	SALIVARY GLAND FUNCTION STD             	    22.65	   $86.52	      ---	       --	005	0	0	0.18	    $0.00	Y	
L	78258	ESOPHAGEAL MOTILITY                     	    33.86	  $129.35	      ---	       --	005	0	0	0.15	    $0.00	Y	
L	78261	GASTRIC MUCOSA IMAGING                  	    28.31	  $108.14	      ---	       --	005	0	0	0.12	    $0.00	Y	
L	78262	GASTROESOPHAGEAL REFLUX STD             	    28.31	  $108.14	      ---	       --	005	0	0	0.12	    $0.00	Y	
L	78264	GASTRIC EMPTYING IMAG STUDY             	    77.40	  $295.67	      ---	       --	005	0	0	0.10	    $0.00	Y	
L	78265	GASTRIC EMPTYING IMAG STUDY             	    91.57	  $349.80	      ---	       --	005	0	0	0.11	    $0.00	Y	
L	78266	GASTRIC EMPTYING IMAG STUDY             	   102.76	  $392.54	      ---	       --	005	0	0	0.10	    $0.00	Y	
L	78278	ACUTE GI BLOOD LOSS IMAGING             	    33.98	  $129.80	      ---	       --	005	0	0	0.13	    $0.00	Y	
L	78282	GI PROTEIN LOSS EXAM                    	    13.59	   $51.91	      ---	       --	005	0	0	0.33	    $0.00	Y	
L	78290	MECKELS DIVERT EXAM                     	    28.31	  $108.14	      ---	       --	005	0	0	0.09	    $0.00	Y	
L	78291	LEVEEN/SHUNT PATENCY EXAM               	    36.94	  $141.11	      ---	       --	005	0	0	0.15	    $0.00	Y	
L	78299	UNLISTED GI PX DX NUC MED               	     0.00	    $0.00	      ---	       --	005	0	0	0.35	    $0.00	Y	
L	78300	BONE IMAGING LIMITED AREA               	    21.18	   $80.91	      ---	       --	005	0	0	0.16	    $0.00	Y	
L	78305	BONE IMAGING MULTIPLE AREAS             	    29.56	  $112.92	      ---	       --	005	0	0	0.16	    $0.00	Y	
L	78306	BONE IMAGING WHOLE BODY                 	    36.92	  $141.03	      ---	       --	005	0	0	0.15	    $0.00	Y	
L	78315	BONE IMAGING 3 PHASE                    	    34.32	  $131.10	      ---	       --	005	0	0	0.13	    $0.00	Y	
L	78399	UNLISTED MUSCSKEL PX DX NUC             	     0.00	    $0.00	      ---	       --	005	0	0	0.33	    $0.00	Y	
L	78414	NON-IMAGING HEART FUNCTION              	    27.18	  $103.83	      ---	       --	005	0	0	0.35	    $0.00	Y	
L	78428	CARDIAC SHUNT IMAGING                   	     0.00	    $0.00	      ---	       --	005	0	0	0.19	    $0.00	Y	
L	78429	MYOCRD IMG PET 1 STD W/CT               	    18.97	   $72.47	      ---	       --	005	0	0	0.15	    $0.00	Y	
L	78430	MYOCRD IMG PET RST/STRS W/CT            	    18.00	   $68.76	      ---	       --	005	0	0	0.15	    $0.00	Y	
L	78431	MYOCRD IMG PET RST&STRS CT              	    20.96	   $80.07	      ---	       --	005	0	0	0.15	    $0.00	Y	
L	78432	MYOCRD IMG PET 2RTRACER                 	    22.30	   $85.19	      ---	       --	005	0	0	0.15	    $0.00	Y	
L	78433	MYOCRD IMG PET 2RTRACER CT              	    24.37	   $93.09	      ---	       --	005	0	0	0.15	    $0.00	Y	
L	78434	AQMBF PET REST & RX STRESS              	     7.07	   $27.01	      ---	       --	005	0	0	0.15	    $0.00	Y	
L	78445	VASCULAR FLOW IMAGING                   	    31.63	  $120.83	      ---	       --	005	0	0	0.12	    $0.00	Y	
L	78451	HT MUSCLE IMAGE SPECT SING              	    52.86	  $201.93	      ---	       --	005	0	0	0.18	    $0.00	Y	
L	78452	HT MUSCLE IMAGE SPECT MULT              	    91.13	  $348.12	      ---	       --	005	0	0	0.15	    $0.00	Y	
L	78453	HT MUSCLE IMAGE PLANAR SING             	    46.23	  $176.60	      ---	       --	005	0	0	0.15	    $0.00	Y	
L	78454	HT MUSC IMAGE PLANAR MULT               	    44.06	  $168.31	      ---	       --	005	0	0	0.14	    $0.00	Y	
L	78456	ACUTE VENOUS THROMBUS IMAGE             	    38.91	  $148.64	      ---	       --	005	1	0	0.14	    $0.00	Y	
L	78457	VENOUS THROMBOSIS IMAGING               	    18.12	   $69.22	      ---	       --	005	0	0	0.19	    $0.00	Y	
L	78458	VEN THROMBOSIS IMAGES BILAT             	    24.69	   $94.32	      ---	       --	005	0	0	0.20	    $0.00	Y	
L	78459	MYOCRD IMG PET SINGLE STUDY             	     0.00	    $0.00	      ---	       --	005	0	0	0.15	    $0.00	Y	
L	78466	HEART INFARCT IMAGE                     	    22.91	   $87.52	      ---	       --	005	0	0	0.16	    $0.00	Y	
L	78468	HEART INFARCT IMAGE (EF)                	    30.36	  $115.98	      ---	       --	005	0	0	0.18	    $0.00	Y	
L	78472	GATED HEART PLANAR SINGLE               	    43.92	  $167.77	      ---	       --	005	0	0	0.19	    $0.00	Y	
L	78473	GATED HEART MULTIPLE                    	    65.66	  $250.82	      ---	       --	005	0	0	0.23	    $0.00	Y	
L	78481	HEART FIRST PASS SINGLE                 	    41.37	  $158.03	      ---	       --	005	0	0	0.25	    $0.00	Y	
L	78483	HEART FIRST PASS MULTIPLE               	    56.35	  $215.26	      ---	       --	005	0	0	0.27	    $0.00	Y	
L	78494	HEART IMAGE SPECT                       	    53.34	  $203.76	      ---	       --	005	0	0	0.24	    $0.00	Y	
L	78496	HEART FIRST PASS ADD-ON                 	    10.03	   $38.31	      ---	       --	005	0	0	0.52	    $0.00	Y	
L	78499	UNLISTED CV PX DX NUC MED               	     0.00	    $0.00	      ---	       --	005	0	0	0.33	    $0.00	Y	
L	78579	LUNG VENTILATION IMAGING                	    41.34	  $157.92	      ---	       --	005	0	0	0.12	    $0.00	Y	
L	78580	LUNG PERFUSION IMAGING                  	    29.45	  $112.50	      ---	       --	005	0	0	0.14	    $0.00	Y	
L	78582	LUNG VENTILAT&PERFUS IMAGING            	    76.16	  $290.93	      ---	       --	005	0	0	0.14	    $0.00	Y	
L	78597	LUNG PERFUSION DIFFERENTIAL             	    46.49	  $177.59	      ---	       --	005	0	0	0.16	    $0.00	Y	
L	78598	LUNG PERF&VENTILAT DIFERENTL            	    71.02	  $271.30	      ---	       --	005	0	0	0.12	    $0.00	Y	
L	78599	UNLISTED RESP PX DX NUC MED             	     0.00	    $0.00	      ---	       --	005	0	0	0.33	    $0.00	Y	
L	78600	BRAIN IMAGE < 4 VIEWS                   	    30.72	  $117.35	      ---	       --	005	0	0	0.11	    $0.00	Y	
L	78601	BRAIN IMAGE W/FLOW < 4 VIEWS            	    36.07	  $137.79	      ---	       --	005	0	0	0.10	    $0.00	Y	
L	78605	BRAIN IMAGE 4+ VIEWS                    	    35.11	  $134.12	      ---	       --	005	0	0	0.12	    $0.00	Y	
L	78606	BRAIN IMAGE W/FLOW 4 + VIEWS            	    41.67	  $159.18	      ---	       --	005	0	0	0.09	    $0.00	Y	
L	78608	BRAIN IMAGING (PET)                     	     0.00	    $0.00	      ---	       --	005	0	0	0.15	    $0.00	Y	
L	78609	BRAIN IMAGING (PET)                     	     0.00	    $0.00	      ---	       --	005	0	0	0.15	    $0.00	Y	
L	78610	BRAIN FLOW IMAGING ONLY                 	    10.53	   $40.22	      ---	       --	005	0	0	0.08	    $0.00	Y	
L	78630	CEREBROSPINAL FLUID SCAN                	    44.29	  $169.19	      ---	       --	005	0	0	0.09	    $0.00	Y	
L	78635	CSF VENTRICULOGRAPHY                    	    39.10	  $149.36	      ---	       --	005	0	0	0.08	    $0.00	Y	
L	78645	CSF SHUNT EVALUATION                    	    39.10	  $149.36	      ---	       --	005	0	0	0.08	    $0.00	Y	
L	78650	CSF LEAKAGE IMAGING                     	    38.73	  $147.95	      ---	       --	005	0	0	0.08	    $0.00	Y	
L	78660	NUCLEAR EXAM OF TEAR FLOW               	    22.65	   $86.52	      ---	       --	005	0	0	0.13	    $0.00	Y	
L	78699	UNLISTED NRVS SYS PX DX NUC             	     0.00	    $0.00	      ---	       --	005	0	0	0.35	    $0.00	Y	
L	78700	KIDNEY IMAGING MORPHOL                  	    20.39	   $77.89	      ---	       --	005	0	0	0.12	    $0.00	Y	
L	78701	KIDNEY IMAGING WITH FLOW                	    31.37	  $119.83	      ---	       --	005	0	0	0.10	    $0.00	Y	
L	78707	K FLOW/FUNCT IMAGE W/O DRUG             	    50.51	  $192.95	      ---	       --	005	0	0	0.18	    $0.00	Y	
L	78708	K FLOW/FUNCT IMAGE W/DRUG               	    40.73	  $155.59	      ---	       --	005	0	0	0.31	    $0.00	Y	
L	78709	K FLOW/FUNCT IMAGE MULTIPLE             	    47.81	  $182.63	      ---	       --	005	0	0	0.17	    $0.00	Y	
L	78725	KIDNEY FUNCTION STUDY                   	    20.16	   $77.01	      ---	       --	005	0	0	0.16	    $0.00	Y	
L	78730	URINARY BLADDER RETENTION               	    17.24	   $65.86	      ---	       --	005	0	0	0.10	    $0.00	Y	
L	78740	URETERAL REFLUX STUDY                   	    17.67	   $67.50	      ---	       --	005	0	0	0.11	    $0.00	Y	
L	78761	TESTICULAR IMAGING W/FLOW               	    22.65	   $86.52	      ---	       --	005	0	0	0.15	    $0.00	Y	
L	78799	UNLISTED GU PX DX NUC MED               	     0.00	    $0.00	      ---	       --	005	0	0	0.33	    $0.00	Y	
L	78800	RP LOCLZJ TUM 1 AREA 1 D IMG            	    23.33	   $89.12	      ---	       --	005	0	0	0.16	    $0.00	Y	
L	78801	RP LOCLZJ TUM 2+AREA 1+D IMG            	    34.66	  $132.40	      ---	       --	005	0	0	0.14	    $0.00	Y	
L	78802	RP LOCLZJ TUM WHBDY 1 D IMG             	    40.55	  $154.90	      ---	       --	005	0	0	0.12	    $0.00	Y	
L	78804	RP LOCLZJ TUM WHBDY 2+D IMG             	    49.66	  $189.70	      ---	       --	005	0	0	0.08	    $0.00	Y	
L	78808	IV INJ RA DRUG DX STUDY                 	     9.49	   $36.25	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	78811	PET IMAGE LTD AREA                      	   530.63	 $2027.01	      ---	       --	005	0	0	0.15	    $0.00	Y	
L	78812	PET IMAGE SKULL-THIGH                   	   530.63	 $2027.01	      ---	       --	005	0	0	0.15	    $0.00	Y	
L	78813	PET IMAGE FULL BODY                     	   530.63	 $2027.01	      ---	       --	005	0	0	0.15	    $0.00	Y	
L	78814	PET IMAGE W/CT LMTD                     	   556.81	 $2127.01	      ---	       --	005	0	0	0.15	    $0.00	Y	
L	78815	PET IMAGE W/CT SKULL-THIGH              	   556.81	 $2127.01	      ---	       --	005	0	0	0.15	    $0.00	Y	
L	78816	PET IMAGE W/CT FULL BODY                	   556.81	 $2127.01	      ---	       --	005	0	0	0.15	    $0.00	Y	
L	78830	RP LOCLZJ TUM SPECT W/CT 1              	   113.21	  $432.46	      ---	       --	005	0	0	0.13	    $0.00	Y	
L	78831	RP LOCLZJ TUM SPECT 2 AREAS             	   165.27	  $631.33	      ---	       --	005	0	0	0.11	    $0.00	Y	
L	78832	RP LOCLZJ TUM SPECT W/CT 2              	   215.43	  $822.94	      ---	       --	005	0	0	0.10	    $0.00	Y	
L	78835	RP QUAN MEAS SINGLE AREA                	    23.20	   $88.62	      ---	       --	005	0	0	0.20	    $0.00	Y	
L	78999	UNLISTED MISC PX DX NUC MED             	     0.00	    $0.00	      ---	       --	005	0	0	0.33	    $0.00	Y	
L	79005	NUCLEAR RX ORAL ADMIN                   	    31.18	  $119.11	      ---	       --	005	0	0	0.62	    $0.00	Y	
L	79101	NUCLEAR RX IV ADMIN                     	    33.02	  $126.14	      ---	       --	005	0	0	0.65	    $0.00	Y	
L	79200	NUCLEAR RX INTRACAV ADMIN               	    27.18	  $103.83	      ---	       --	005	0	0	0.59	    $0.00	Y	
L	79300	NUCLR RX INTERSTIT COLLOID              	    67.96	  $259.61	      ---	       --	005	0	0	0.80	    $0.00	Y	
L	79403	HEMATOPOIETIC NUCLEAR TX                	    37.24	  $142.26	      ---	       --	005	0	0	0.55	    $0.00	Y	
L	79440	NUCLEAR RX INTRA-ARTICULAR              	     0.00	    $0.00	      ---	       --	005	0	0	0.64	    $0.00	Y	
L	79445	NUCLEAR RX INTRA-ARTERIAL               	    52.49	  $200.51	      ---	       --	005	0	0	0.80	    $0.00	Y	
L	79999	RP THERAPY UNLISTED PX                  	     0.00	    $0.00	      ---	       --	005	0	0	0.80	    $0.00	Y	
M	80047	METABOLIC PANEL IONIZED CA              	     8.17	    $8.17	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80048	METABOLIC PANEL TOTAL CA                	     7.27	    $7.27	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80051	ELECTROLYTE PANEL                       	     6.23	    $6.23	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80053	COMPREHEN METABOLIC PANEL               	     9.19	    $9.19	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80055	OBSTETRIC PANEL                         	    35.83	   $35.83	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80061	LIPID PANEL                             	    11.54	   $11.54	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80069	RENAL FUNCTION PANEL                    	     7.60	    $7.60	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80074	ACUTE HEPATITIS PANEL                   	    34.86	   $34.86	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80076	HEPATIC FUNCTION PANEL                  	     6.38	    $6.38	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80081	OBSTETRIC PANEL INC HIV TSTG            	    66.54	   $66.54	      ---	       --	009	0	0	0.00	    $0.00	N	
M	80143	DRUG ASSAY ACETAMINOPHEN                	    14.91	   $14.91	      ---	       --	009	0	0	0.00	    $0.00	N	
M	80145	DRUG ASSAY ADALIMUMAB                   	    38.57	   $38.57	      ---	       --	009	0	0	0.00	    $0.00	N	
M	80150	ASSAY OF AMIKACIN                       	    13.40	   $13.40	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80151	DRUG ASSAY AMIODARONE                   	    14.91	   $14.91	      ---	       --	009	0	0	0.00	    $0.00	N	
M	80155	DRUG ASSAY CAFFEINE                     	    15.40	   $15.40	      ---	       --	009	0	0	0.00	    $0.00	N	
M	80156	ASSAY CARBAMAZEPINE TOTAL               	    12.61	   $12.61	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80157	ASSAY CARBAMAZEPINE FREE                	    10.99	   $10.99	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80158	DRUG ASSAY CYCLOSPORINE                 	    16.04	   $16.04	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80159	DRUG ASSAY CLOZAPINE                    	    16.44	   $16.44	      ---	       --	009	0	0	0.00	    $0.00	N	
M	80161	ASY CARBAMAZEPIN 10,11-EPXID            	    14.91	   $14.91	      ---	       --	009	0	0	0.00	    $0.00	N	
M	80162	ASSAY OF DIGOXIN TOTAL                  	    11.80	   $11.80	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80163	ASSAY OF DIGOXIN FREE                   	    11.80	   $11.80	      ---	       --	009	0	0	0.00	    $0.00	N	
M	80164	ASSAY DIPROPYLACETIC ACD TOT            	    12.04	   $12.04	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80165	DIPROPYLACETIC ACID FREE                	    12.04	   $12.04	      ---	       --	009	0	0	0.00	    $0.00	N	
M	80167	DRUG ASSAY FELBAMATE                    	    14.91	   $14.91	      ---	       --	009	0	0	0.00	    $0.00	N	
M	80168	ASSAY OF ETHOSUXIMIDE                   	    14.52	   $14.52	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80169	DRUG ASSAY EVEROLIMUS                   	    12.21	   $12.21	      ---	       --	009	0	0	0.00	    $0.00	N	
M	80170	ASSAY OF GENTAMICIN                     	    14.56	   $14.56	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80171	DRUG SCREEN QUANT GABAPENTIN            	    14.43	   $14.43	      ---	       --	009	0	0	0.00	    $0.00	N	
M	80173	ASSAY OF HALOPERIDOL                    	    12.95	   $12.95	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80175	DRUG SCREEN QUAN LAMOTRIGINE            	    11.78	   $11.78	      ---	       --	009	0	0	0.00	    $0.00	N	
M	80176	ASSAY OF LIDOCAINE                      	    13.06	   $13.06	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80177	DRUG SCRN QUAN LEVETIRACETAM            	    11.78	   $11.78	      ---	       --	009	0	0	0.00	    $0.00	N	
M	80178	ASSAY OF LITHIUM                        	     5.88	    $5.88	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80179	DRUG ASSAY SALICYLATE                   	    14.91	   $14.91	      ---	       --	009	0	0	0.00	    $0.00	N	
M	80180	DRUG SCRN QUAN MYCOPHENOLATE            	    16.04	   $16.04	      ---	       --	009	0	0	0.00	    $0.00	N	
M	80181	DRUG ASSAY FLECAINIDE                   	    14.91	   $14.91	      ---	       --	009	0	0	0.00	    $0.00	N	
M	80183	DRUG SCRN QUANT OXCARBAZEPIN            	    11.78	   $11.78	      ---	       --	009	0	0	0.00	    $0.00	N	
M	80184	ASSAY OF PHENOBARBITAL                  	     8.40	    $8.40	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80185	ASSAY OF PHENYTOIN TOTAL                	    11.78	   $11.78	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80186	ASSAY OF PHENYTOIN FREE                 	    12.23	   $12.23	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80187	DRUG ASSAY POSACONAZOLE                 	    21.69	   $21.69	      ---	       --	009	0	0	0.00	    $0.00	N	
M	80188	ASSAY OF PRIMIDONE                      	    14.75	   $14.75	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80189	DRUG ASSAY ITRACONAZOLE                 	    21.69	   $21.69	      ---	       --	009	0	0	0.00	    $0.00	N	
M	80190	ASSAY OF PROCAINAMIDE                   	    18.24	   $18.24	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80192	ASSAY OF PROCAINAMIDE                   	    14.89	   $14.89	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80193	DRUG ASSAY LEFLUNOMIDE                  	    30.86	   $30.86	      ---	       --	009	0	0	0.00	    $0.00	N	
M	80194	ASSAY OF QUINIDINE                      	    12.98	   $12.98	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80195	ASSAY OF SIROLIMUS                      	    11.99	   $11.99	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80197	ASSAY OF TACROLIMUS                     	    12.21	   $12.21	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80198	ASSAY OF THEOPHYLLINE                   	    12.57	   $12.57	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80199	DRUG SCREEN QUANT TIAGABINE             	    19.66	   $19.66	      ---	       --	009	0	0	0.00	    $0.00	N	
M	80200	ASSAY OF TOBRAMYCIN                     	    14.33	   $14.33	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80201	ASSAY OF TOPIRAMATE                     	    10.59	   $10.59	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80202	ASSAY OF VANCOMYCIN                     	    12.04	   $12.04	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80203	DRUG SCREEN QUANT ZONISAMIDE            	    11.78	   $11.78	      ---	       --	009	0	0	0.00	    $0.00	N	
M	80204	DRUG ASSAY METHOTREXATE                 	    30.86	   $30.86	      ---	       --	009	0	0	0.00	    $0.00	N	
M	80210	DRUG ASSAY RUFINAMIDE                   	    21.69	   $21.69	      ---	       --	009	0	0	0.00	    $0.00	N	
M	80220	DRUG ASY HYDROXYCHLOROQUINE             	    18.64	   $18.64	      ---	       --	009	0	0	0.00	    $0.00	N	
M	80230	DRUG ASSAY INFLIXIMAB                   	    30.86	   $30.86	      ---	       --	009	0	0	0.00	    $0.00	N	
M	80235	DRUG ASSAY LACOSAMIDE                   	    21.69	   $21.69	      ---	       --	009	0	0	0.00	    $0.00	N	
M	80280	DRUG ASSAY VEDOLIZUMAB                  	    30.86	   $30.86	      ---	       --	009	0	0	0.00	    $0.00	N	
M	80285	DRUG ASSAY VORICONAZOLE                 	    21.69	   $21.69	      ---	       --	009	0	0	0.00	    $0.00	N	
M	80299	QUANTITATIVE ASSAY DRUG                 	    12.59	   $12.59	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80305	DRUG TEST PRSMV DIR OPT OBS             	    10.08	   $10.08	      ---	       --	009	0	0	0.00	    $0.00	Y	
M	80306	DRUG TEST PRSMV INSTRMNT                	    13.71	   $13.71	      ---	       --	009	0	0	0.00	    $0.00	N	
M	80307	DRUG TEST PRSMV CHEM ANLYZR             	    43.50	   $43.50	      ---	       --	009	0	0	0.00	    $0.00	N	
M	80400	ACTH STIMULATION PANEL                  	    32.62	   $32.62	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80402	ACTH STIMULATION PANEL                  	    86.96	   $86.96	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80406	ACTH STIMULATION PANEL                  	    78.26	   $78.26	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80408	ALDOSTERONE SUPPRESSION EVAL            	   125.50	  $125.50	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80410	CALCITONIN STIMUL PANEL                 	    80.37	   $80.37	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80412	CRH STIMULATION PANEL                   	   371.04	  $371.04	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80414	TESTOSTERONE RESPONSE PANEL             	    51.64	   $51.64	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80415	TOT ESTRADIOL RESPONSE PANEL            	    55.89	   $55.89	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80416	RENIN STIMULATION PANEL                 	   148.56	  $148.56	      ---	       --	009	0	0	0.00	    $0.00	N	
M	80417	RENIN STIMULATION PANEL                 	    43.99	   $43.99	      ---	       --	009	0	0	0.00	    $0.00	N	
M	80418	PITUITARY EVALUATION PANEL              	   579.48	  $579.48	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80420	DEXAMETHASONE PANEL                     	    81.10	   $81.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80422	GLUCAGON TOLERANCE PANEL                	    46.07	   $46.07	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80424	GLUCAGON TOLERANCE PANEL                	    50.50	   $50.50	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80426	GONADOTROPIN HORMONE PANEL              	   148.41	  $148.41	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80428	GROWTH HORMONE PANEL                    	    66.70	   $66.70	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80430	GROWTH HORMONE PANEL                    	    88.35	   $88.35	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80432	INSULIN SUPPRESSION PANEL               	   145.11	  $145.11	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80434	INSULIN TOLERANCE PANEL                 	   113.88	  $113.88	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80435	INSULIN TOLERANCE PANEL                 	   103.00	  $103.00	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80436	METYRAPONE PANEL                        	    91.16	   $91.16	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80438	TRH STIMULATION PANEL                   	    50.41	   $50.41	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80439	TRH STIMULATION PANEL                   	    67.21	   $67.21	      ---	       --	009	0	0	0.20	    $0.00	N	
M	80503	PATH CLIN CONSLTJ SF 5-20               	    23.04	   $23.04	      ---	       --	009	0	0	0.00	    $0.00	N	
M	80504	PATH CLIN CONSLTJ MOD 21-40             	    45.80	   $45.80	      ---	       --	009	0	0	0.00	    $0.00	N	
M	80505	PATH CLIN CONSLTJ HIGH 41-60            	    82.67	   $82.67	      ---	       --	009	0	0	0.00	    $0.00	N	
M	80506	PATH CLIN CONSLTJ PROLNG SVC            	    36.99	   $36.99	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81000	URINALYSIS NONAUTO W/SCOPE              	     2.58	    $2.58	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	81001	URINALYSIS AUTO W/SCOPE                 	     2.77	    $2.77	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	81002	URINALYSIS NONAUTO W/O SCOPE            	     2.15	    $2.15	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	81003	URINALYSIS AUTO W/O SCOPE               	     1.96	    $1.96	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	81005	URINALYSIS                              	     1.77	    $1.77	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	81007	URINE SCREEN FOR BACTERIA               	     2.79	    $2.79	      ---	       --	009	0	0	1.00	    $0.00	N	
M	81015	MICROSCOPIC EXAM OF URINE               	     2.50	    $2.50	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	81025	URINE PREGNANCY TEST                    	     2.80	    $2.80	      ---	       --	009	0	0	0.00	    $0.00	Y	
M	81050	URINALYSIS VOLUME MEASURE               	     1.41	    $1.41	      ---	       --	009	0	0	1.00	    $0.00	Y	
M	81099	UNLISTED URINALYSIS PX                  	     0.00	    $0.00	      ---	       --	009	0	0	0.20	    $0.00	N	
M	81105	HPA-1 GENOTYPING                        	   108.64	  $108.64	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81106	HPA-2 GENOTYPING                        	   108.64	  $108.64	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81107	HPA-3 GENOTYPING                        	   108.64	  $108.64	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81108	HPA-4 GENOTYPING                        	   108.64	  $108.64	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81109	HPA-5 GENOTYPING                        	   108.64	  $108.64	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81110	HPA-6 GENOTYPING                        	   108.64	  $108.64	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81111	HPA-9 GENOTYPING                        	   108.64	  $108.64	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81112	HPA-15 GENOTYPING                       	   108.64	  $108.64	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81120	IDH1 COMMON VARIANTS                    	   154.60	  $154.60	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81121	IDH2 COMMON VARIANTS                    	   236.63	  $236.63	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81161	DMD DUP/DELET ANALYSIS                  	   112.90	  $112.90	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81162	BRCA1&2 GEN FULL SEQ DUP/DEL            	  1622.11	 $1622.11	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81163	BRCA1&2 GENE FULL SEQ ALYS              	   374.40	  $374.40	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81164	BRCA1&2 GEN FUL DUP/DEL ALYS            	   467.38	  $467.38	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81165	BRCA1 GENE FULL SEQ ALYS                	   226.30	  $226.30	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81166	BRCA1 GENE FULL DUP/DEL ALYS            	   241.08	  $241.08	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81167	BRCA2 GENE FULL DUP/DEL ALYS            	   226.30	  $226.30	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81168	CCND1/IGH TRANSLOCATION ALYS            	   165.85	  $165.85	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81170	ABL1 GENE                               	   240.00	  $240.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81171	AFF2 GEN ALY DETC ABNL ALLEL            	   109.60	  $109.60	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81172	AFF2 GEN ALYS CHARAC ALLELES            	   219.86	  $219.86	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81173	AR GENE FULL GENE SEQUENCE              	   241.08	  $241.08	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81174	AR GENE KNOWN FAMIL VARIANT             	   148.16	  $148.16	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81175	ASXL1 FULL GENE SEQUENCE                	   541.20	  $541.20	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81176	ASXL1 GENE TARGET SEQ ALYS              	   215.01	  $215.01	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81177	ATN1 GENE DETC ABNOR ALLELES            	   109.60	  $109.60	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81178	ATXN1 GENE DETC ABNOR ALLELE            	   109.60	  $109.60	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81179	ATXN2 GENE DETC ABNOR ALLELE            	   109.60	  $109.60	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81180	ATXN3 GENE DETC ABNOR ALLELE            	   109.60	  $109.60	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81181	ATXN7 GENE DETC ABNOR ALLELE            	   109.60	  $109.60	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81182	ATXN8OS GEN DETC ABNOR ALLEL            	   109.60	  $109.60	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81183	ATXN10 GENE DETC ABNOR ALLEL            	   109.60	  $109.60	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81184	CACNA1A GEN DETC ABNOR ALLEL            	   109.60	  $109.60	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81185	CACNA1A GENE FULL GENE SEQ              	   677.01	  $677.01	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81186	CACNA1A GEN KNOWN FAMIL VRNT            	   148.16	  $148.16	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81187	CNBP GENE DETC ABNOR ALLELE             	   109.60	  $109.60	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81188	CSTB GENE DETC ABNOR ALLELE             	   109.60	  $109.60	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81189	CSTB GENE FULL GENE SEQUENCE            	   219.86	  $219.86	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81190	CSTB GENE KNOWN FAMIL VRNT              	   148.16	  $148.16	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81191	NTRK1 TRANSLOCATION ANALYSIS            	   165.85	  $165.85	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81192	NTRK2 TRANSLOCATION ANALYSIS            	   165.85	  $165.85	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81193	NTRK3 TRANSLOCATION ANALYSIS            	   165.85	  $165.85	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81194	NTRK TRANSLOCATION ANALYSIS             	   414.62	  $414.62	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81201	APC GENE FULL SEQUENCE                  	   599.94	  $599.94	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81202	APC GENE KNOWN FAM VARIANTS             	    75.15	   $75.15	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81203	APC GENE DUP/DELET VARIANTS             	   160.00	  $160.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81204	AR GENE CHARAC ALLELES                  	   109.60	  $109.60	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81206	BCR/ABL1 GENE MAJOR BP                  	    86.70	   $86.70	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81207	BCR/ABL1 GENE MINOR BP                  	    72.30	   $72.30	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81208	BCR/ABL1 GENE OTHER BP                  	   120.14	  $120.14	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81210	BRAF GENE                               	    77.96	   $77.96	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81212	BRCA1&2 185&5385&6174 VRNT              	   141.01	  $141.01	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81215	BRCA1 GENE KNOWN FAMIL VRNT             	    74.41	   $74.41	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81216	BRCA2 GENE FULL SEQ ALYS                	   148.10	  $148.10	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81217	BRCA2 GENE KNOWN FAMIL VRNT             	    74.41	   $74.41	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81218	CEBPA GENE FULL SEQUENCE                	   215.02	  $215.02	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81219	CALR GENE COM VARIANTS                  	   108.11	  $108.11	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81220	CFTR GENE COM VARIANTS                  	   180.00	  $180.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81221	CFTR GENE KNOWN FAM VARIANTS            	    75.15	   $75.15	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81222	CFTR GENE DUP/DELET VARIANTS            	   435.07	  $435.07	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81223	CFTR GENE FULL SEQUENCE                 	  1243.57	 $1243.57	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81224	CFTR GENE INTRON POLY T                 	    66.06	   $66.06	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81225	CYP2C19 GENE COM VARIANTS               	   255.30	  $255.30	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81226	CYP2D6 GENE COM VARIANTS                	   450.91	  $450.91	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81227	CYP2C9 GENE COM VARIANTS                	   135.60	  $135.60	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81232	DPYD GENE COMMON VARIANTS               	   139.85	  $139.85	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81233	BTK GENE COMMON VARIANTS                	   140.32	  $140.32	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81234	DMPK GENE DETC ABNOR ALLELE             	   109.60	  $109.60	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81235	EGFR GENE COM VARIANTS                  	   180.00	  $180.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81236	EZH2 GENE FULL GENE SEQUENCE            	   226.30	  $226.30	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81237	EZH2 GENE COMMON VARIANTS               	   140.32	  $140.32	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81238	F9 FULL GENE SEQUENCE                   	   480.00	  $480.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81239	DMPK GENE CHARAC ALLELES                	   219.86	  $219.86	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81243	FMR1 GEN ALY DETC ABNL ALLEL            	    45.63	   $45.63	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81244	FMR1 GEN ALYS CHARAC ALLELES            	    35.91	   $35.91	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81245	FLT3 GENE                               	   132.40	  $132.40	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81246	FLT3 GENE ANALYSIS                      	    66.40	   $66.40	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81250	G6PC GENE                               	    46.79	   $46.79	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81256	HFE GENE                                	    56.16	   $56.16	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81257	HBA1/HBA2 GENE                          	   102.26	  $102.26	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81258	HBA1/HBA2 GENE FAM VRNT                 	   300.20	  $300.20	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81259	HBA1/HBA2 FULL GENE SEQUENCE            	   480.00	  $480.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81260	IKBKAP GENE                             	    31.44	   $31.44	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81265	STR MARKERS SPECIMEN ANAL               	   191.15	  $191.15	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81266	STR MARKERS SPEC ANAL ADDL              	   304.81	  $304.81	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81267	CHIMERISM ANAL NO CELL SELEC            	   119.78	  $119.78	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81268	CHIMERISM ANAL W/CELL SELECT            	   119.78	  $119.78	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81269	HBA1/HBA2 GENE DUP/DEL VRNTS            	   161.92	  $161.92	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81270	JAK2 GENE                               	    66.30	   $66.30	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81271	HTT GENE DETC ABNOR ALLELES             	   109.60	  $109.60	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81272	KIT GENE TARGETED SEQ ANALYS            	   263.60	  $263.60	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81273	KIT GENE ANALYS D816 VARIANT            	    99.89	   $99.89	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81274	HTT GENE CHARAC ALLELES                 	   219.86	  $219.86	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81275	KRAS GENE VARIANTS EXON 2               	   154.60	  $154.60	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81276	KRAS GENE ADDL VARIANTS                 	   154.60	  $154.60	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81277	CYTOGENOMIC NEO MICRORA ALYS            	   928.00	  $928.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81278	IGH@/BCL2 TRANSLOCATION ALYS            	   165.85	  $165.85	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81279	JAK2 GENE TRGT SEQUENCE ALYS            	   148.16	  $148.16	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81283	IFNL3 GENE                              	    58.69	   $58.69	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81284	FXN GENE DETC ABNOR ALLELES             	   109.60	  $109.60	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81285	FXN GENE CHARAC ALLELES                 	   219.86	  $219.86	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81286	FXN GENE FULL GENE SEQUENCE             	   219.86	  $219.86	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81287	MGMT GENE PRMTR MTHYLTN ALYS            	   124.64	  $124.64	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81288	MLH1 GENE                               	   192.32	  $192.32	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81289	FXN GENE KNOWN FAMIL VARIANT            	   148.16	  $148.16	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81292	MLH1 GENE FULL SEQ                      	   515.70	  $515.70	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81293	MLH1 GENE KNOWN VARIANTS                	    75.12	   $75.12	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81294	MLH1 GENE DUP/DELETE VARIANT            	   152.16	  $152.16	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81295	MSH2 GENE FULL SEQ                      	   121.06	  $121.06	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81296	MSH2 GENE KNOWN VARIANTS                	    75.15	   $75.15	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81297	MSH2 GENE DUP/DELETE VARIANT            	   121.06	  $121.06	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81298	MSH6 GENE FULL SEQ                      	   229.69	  $229.69	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81299	MSH6 GENE KNOWN VARIANTS                	    75.15	   $75.15	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81300	MSH6 GENE DUP/DELETE VARIANT            	   129.02	  $129.02	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81301	MICROSATELLITE INSTABILITY              	   256.67	  $256.67	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81305	MYD88 GENE P.LEU265PRO VRNT             	   140.32	  $140.32	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81306	NUDT15 GENE COMMON VARIANTS             	   233.08	  $233.08	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81309	PIK3CA GENE TRGT SEQ ALYS               	   219.86	  $219.86	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81310	NPM1 GENE                               	   197.21	  $197.21	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81311	NRAS GENE VARIANTS EXON 2&3             	   236.63	  $236.63	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81312	PABPN1 GENE DETC ABNOR ALLEL            	   109.60	  $109.60	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81314	PDGFRA GENE                             	   263.60	  $263.60	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81315	PML/RARALPHA COM BREAKPOINTS            	    94.03	   $94.03	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81316	PML/RARALPHA 1 BREAKPOINT               	   184.28	  $184.28	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81317	PMS2 GENE FULL SEQ ANALYSIS             	   514.06	  $514.06	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81318	PMS2 KNOWN FAMILIAL VARIANTS            	    75.15	   $75.15	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81319	PMS2 GENE DUP/DELET VARIANTS            	   162.80	  $162.80	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81320	PLCG2 GENE COMMON VARIANTS              	   233.08	  $233.08	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81321	PTEN GENE FULL SEQUENCE                 	   479.36	  $479.36	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81322	PTEN GENE KNOWN FAM VARIANT             	    38.05	   $38.05	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81323	PTEN GENE DUP/DELET VARIANT             	    69.90	   $69.90	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81329	SMN1 GENE DOS/DELETION ALYS             	   109.60	  $109.60	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81331	SNRPN/UBE3A GENE                        	    40.85	   $40.85	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81334	RUNX1 GENE TARGETED SEQ ALYS            	   263.60	  $263.60	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81335	TPMT GENE COM VARIANTS                  	   139.84	  $139.84	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81336	SMN1 GENE FULL GENE SEQUENCE            	   241.08	  $241.08	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81337	SMN1 GEN NOWN FAMIL SEQ VRNT            	   148.16	  $148.16	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81338	MPL GENE COMMON VARIANTS                	   120.26	  $120.26	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81339	MPL GENE SEQ ALYS EXON 10               	   148.16	  $148.16	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81340	TRB@ GENE REARRANGE AMPLIFY             	   208.92	  $208.92	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81341	TRB@ GENE REARRANGE DIRPROBE            	    36.35	   $36.35	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81342	TRG GENE REARRANGEMENT ANAL             	   118.50	  $118.50	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81343	PPP2R2B GEN DETC ABNOR ALLEL            	   109.60	  $109.60	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81344	TBP GENE DETC ABNOR ALLELES             	   109.60	  $109.60	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81345	TERT GENE TARGETED SEQ ALYS             	   148.16	  $148.16	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81347	SF3B1 GENE COMMON VARIANTS              	   154.60	  $154.60	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81348	SRSF2 GENE COMMON VARIANTS              	   140.32	  $140.32	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81349	CYTOG ALYS CHRML ABNR LW-PS             	  1160.00	 $1160.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81351	TP53 GENE FULL GENE SEQUENCE            	   513.48	  $513.48	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81352	TP53 GENE TRGT SEQUENCE ALYS            	   263.61	  $263.61	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81353	TP53 GENE KNOWN FAMIL VRNT              	   246.40	  $246.40	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81357	U2AF1 GENE COMMON VARIANTS              	   154.60	  $154.60	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81360	ZRSR2 GENE COMMON VARIANTS              	   154.60	  $154.60	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81361	HBB GENE COM VARIANTS                   	   139.84	  $139.84	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81362	HBB GENE KNOWN FAM VARIANT              	   300.20	  $300.20	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81363	HBB GENE DUP/DEL VARIANTS               	   161.92	  $161.92	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81364	HBB FULL GENE SEQUENCE                  	   259.66	  $259.66	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81370	HLA I & II TYPING LR                    	   357.44	  $357.44	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81371	HLA I & II TYPE VERIFY LR               	   262.03	  $262.03	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81372	HLA I TYPING COMPLETE LR                	   240.49	  $240.49	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81373	HLA I TYPING 1 LOCUS LR                 	   101.94	  $101.94	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81374	HLA I TYPING 1 ANTIGEN LR               	    64.66	   $64.66	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81375	HLA II TYPING AG EQUIV LR               	   196.21	  $196.21	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81376	HLA II TYPING 1 LOCUS LR                	   108.64	  $108.64	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81377	HLA II TYPE 1 AG EQUIV LR               	    81.61	   $81.61	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81378	HLA I & II TYPING HR                    	   307.17	  $307.17	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81379	HLA I TYPING COMPLETE HR                	   298.12	  $298.12	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81380	HLA I TYPING 1 LOCUS HR                 	   157.55	  $157.55	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81381	HLA I TYPING 1 ALLELE HR                	   102.97	  $102.97	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81382	HLA II TYPING 1 LOC HR                  	   109.94	  $109.94	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81383	HLA II TYPING 1 ALLELE HR               	    97.01	   $97.01	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81400	MOPATH PROCEDURE LEVEL 1                	    63.96	   $63.96	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81401	MOPATH PROCEDURE LEVEL 2                	   137.00	  $137.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81402	MOPATH PROCEDURE LEVEL 3                	   150.33	  $150.33	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81403	MOPATH PROCEDURE LEVEL 4                	   185.20	  $185.20	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81404	MOPATH PROCEDURE LEVEL 5                	   274.83	  $274.83	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81405	MOPATH PROCEDURE LEVEL 6                	   301.35	  $301.35	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81406	MOPATH PROCEDURE LEVEL 7                	   282.88	  $282.88	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81407	MOPATH PROCEDURE LEVEL 8                	   846.27	  $846.27	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81408	MOPATH PROCEDURE LEVEL 9                	  2000.00	 $2000.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81412	ASHKENAZI JEWISH ASSOC DIS              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81413	CAR ION CHNNLPATH INC 10 GNS            	   519.91	  $519.91	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81414	CAR ION CHNNLPATH INC 2 GNS             	   519.91	  $519.91	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81419	EPILEPSY GEN SEQ ALYS PANEL             	  1958.85	 $1958.85	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81420	FETAL CHRMOML ANEUPLOIDY                	   232.00	  $232.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81432	HRDTRY BRST CA-RLATD DO 5+              	   543.24	  $543.24	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81434	HERED RTA DO GEN SEQ 15                 	   478.33	  $478.33	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81435	HERED COLON CA-RLATD DO 5+              	   584.90	  $584.90	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81439	HRDTRY CARDMYPY GENE PANEL              	   519.91	  $519.91	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81445	SO NEO GSAP 5-50DNA/DNA&RNA             	   597.91	  $597.91	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81448	HRDTRY PERPH NEURPHY PANEL              	   519.91	  $519.91	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81455	SO/HL 51/>GSAP DNA/DNA&RNA              	  2335.68	 $2335.68	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81457	SO NEO GSAP DNA MCRSTL INS              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81458	SO GSAP DNA CPY NMBR&MCRSTL             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81459	SO NEO GSAP DNA/DNA&RNA                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81462	SO GSAP CLL FR DNA/DNA&RNA              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81479	UNLISTED MOLECULAR PATHOLOGY            	     0.00	    $0.00	      ---	       --	006	0	0	0.00	    $0.00	N	
M	81500	ONCO (OVAR) TWO PROTEINS                	   260.50	  $260.50	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81503	ONCO (OVAR) FIVE PROTEINS               	   897.00	  $897.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81506	ENDO ASSAY SEVEN ANAL                   	    68.92	   $68.92	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81507	FETAL ANEUPLOIDY TRISOM RISK            	   636.00	  $636.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81508	FTL CGEN ABNOR TWO PROTEINS             	   272.37	  $272.37	      ---	       --	009	0	0	0.80	    $0.00	N	
M	81509	FTL CGEN ABNOR 3 PROTEINS               	  1487.37	 $1487.37	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81510	FTL CGEN ABNOR THREE ANAL               	    55.54	   $55.54	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81511	FTL CGEN ABNOR FOUR ANAL                	   272.37	  $272.37	      ---	       --	009	0	0	0.80	    $0.00	N	
M	81512	FTL CGEN ABNOR FIVE ANAL                	    69.52	   $69.52	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81513	NFCT DS BV RNA VAG FLU ALG              	   114.10	   $86.72	      ---	       --	006	0	0	0.00	    $0.00	N	
M	81514	NFCT DS BV&VAGINITIS DNA ALG            	   210.39	  $159.90	      ---	       --	006	0	0	0.00	    $0.00	N	
M	81515	NFCT DS BV&VAGINITIS DNA ALG            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81517	LIVER DS ALYS 3 BMRK SRM ALG            	   176.19	  $176.19	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81518	ONC BRST MRNA 11 GENES                  	  3098.40	 $3098.40	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81519	ONCOLOGY BREAST MRNA                    	  3098.40	 $3098.40	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81520	ONC BREAST MRNA 58 GENES                	  2231.29	 $2231.29	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81521	ONC BREAST MRNA 70 GENES                	  3098.40	 $3098.40	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81522	ONC BREAST MRNA 12 GENES                	  3098.40	 $3098.40	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81523	ONC BRST MRNA 70 CNT 31 GENE            	  3873.00	 $3873.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81528	ONCOLOGY COLORECTAL SCR                 	   404.30	  $404.30	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81541	ONC PROSTATE MRNA 46 GENES              	  3098.40	 $3098.40	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81542	ONC PROSTATE MRNA 22 CNT GEN            	  3873.00	 $3873.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81546	ONC THYR MRNA 10,196 GEN ALG            	  2880.00	 $2880.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81552	ONC UVEAL MLNMA MRNA 15 GENE            	  7776.00	 $7776.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81560	TRNSPLJ PD LVR&BWL CD154+CLL            	   640.73	  $640.73	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81595	CARDIOLOGY HRT TRNSPL MRNA              	  3240.00	 $3240.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81596	NFCT DS CHRNC HCV 6 ASSAYS              	    57.75	   $57.75	      ---	       --	009	0	0	0.00	    $0.00	N	
M	81599	UNLISTED MAAA                           	     0.00	    $0.00	      ---	       --	006	0	0	0.00	    $0.00	N	
M	82009	KETONE BODYS QUAL                       	     3.76	    $3.76	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82010	KETONE BODYS QUAN                       	     7.15	    $7.15	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82013	ACETYLCHOLINESTERASE ASSAY              	     9.93	    $9.93	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82016	ACYLCARNITINES QUAL                     	    13.19	   $13.19	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82017	ACYLCARNITINES QUANT                    	    14.99	   $14.99	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82024	ASSAY OF ACTH                           	    34.33	   $34.33	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82030	ASSAY OF ADP & AMP                      	    22.93	   $22.93	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82040	ASSAY OF SERUM ALBUMIN                  	     4.02	    $4.02	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82042	OTHER SOURCE ALBUMIN QUAN EA            	     2.83	    $2.83	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82043	UR ALBUMIN QUANTITATIVE                 	     5.08	    $5.08	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82044	UR ALBUMIN SEMIQUANTITATIVE             	     3.92	    $3.92	      ---	       --	009	0	0	1.00	    $0.00	N	
M	82045	ALBUMIN ISCHEMIA MODIFIED               	    30.17	   $30.17	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82077	ASSAY SPEC XCP UR&BREATH IA             	    13.82	   $13.82	      ---	       --	009	0	0	0.00	    $0.00	N	
M	82085	ASSAY OF ALDOLASE                       	     8.63	    $8.63	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82088	ASSAY OF ALDOSTERONE                    	    36.22	   $36.22	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82103	ALPHA-1-ANTITRYPSIN TOTAL               	    11.94	   $11.94	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82104	ALPHA-1-ANTITRYPSIN PHENO               	    12.86	   $12.86	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82105	ALPHA-FETOPROTEIN SERUM                 	    85.00	   $85.00	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82106	ALPHA-FETOPROTEIN AMNIOTIC              	    12.03	   $12.03	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82107	ALPHA-FETOPROTEIN L3                    	    57.26	   $57.26	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82108	ASSAY OF ALUMINUM                       	    19.72	   $19.72	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82120	AMINES VAGINAL FLUID QUAL               	     4.01	    $4.01	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82127	AMINO ACID SINGLE QUAL                  	    12.33	   $12.33	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82128	AMINO ACIDS MULT QUAL                   	    12.33	   $12.33	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82131	AMINO ACIDS SINGLE QUANT                	    18.36	   $18.36	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82135	ASSAY AMINOLEVULINIC ACID               	    14.63	   $14.63	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82136	AMINO ACIDS QUANT 2-5                   	    15.69	   $15.69	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82139	AMINO ACIDS QUAN 6 OR MORE              	    14.99	   $14.99	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82140	ASSAY OF AMMONIA                        	    12.95	   $12.95	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82143	AMNIOTIC FLUID SCAN                     	     7.48	    $7.48	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82150	ASSAY OF AMYLASE                        	     5.73	    $5.73	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82154	ANDROSTANEDIOL GLUCURONIDE              	    25.63	   $25.63	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82157	ASSAY OF ANDROSTENEDIONE                	    26.02	   $26.02	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82160	ASSAY OF ANDROSTERONE                   	    22.23	   $22.23	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82163	ASSAY OF ANGIOTENSIN II                 	    18.24	   $18.24	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82164	ANGIOTENSIN I ENZYME TEST               	    12.98	   $12.98	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82166	ASSAY ANTI-MULLERIAN HORM               	    38.62	   $38.62	      ---	       --	009	0	0	0.00	    $0.00	N	
M	82172	ASSAY OF APOLIPOPROTEIN                 	    13.15	   $13.15	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82175	ASSAY OF ARSENIC                        	    16.86	   $16.86	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82180	ASSAY OF ASCORBIC ACID                  	     8.79	    $8.79	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82232	ASSAY OF BETA-2 PROTEIN                 	    14.38	   $14.38	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82233	BETA-AMYLOID 1-40 (ABETA 40)            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	82234	BETA-AMYLOID 1-42 (ABETA 42)            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	82239	BILE ACIDS TOTAL                        	    14.56	   $14.56	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82240	BILE ACIDS CHOLYLGLYCINE                	    23.63	   $23.63	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82247	BILIRUBIN TOTAL                         	     4.09	    $4.09	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82248	BILIRUBIN DIRECT                        	     4.41	    $4.41	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82252	FECAL BILIRUBIN TEST                    	     4.05	    $4.05	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82261	ASSAY OF BIOTINIDASE                    	    13.86	   $13.86	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82270	OCCULT BLOOD FECES                      	     2.92	    $2.92	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	82271	OCCULT BLOOD OTHER SOURCES              	     3.54	    $3.54	      ---	       --	009	0	1	0.20	    $0.00	Y	
M	82272	OCCULT BLD FECES 1-3 TESTS              	     2.56	    $2.56	      ---	       --	009	0	0	0.50	    $0.00	Y	
M	82274	ASSAY TEST FOR BLOOD FECAL              	    14.14	   $14.14	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82286	ASSAY OF BRADYKININ                     	     4.58	    $4.58	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82300	ASSAY OF CADMIUM                        	    20.57	   $20.57	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82306	VITAMIN D 25 HYDROXY                    	    20.72	   $20.72	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82308	ASSAY OF CALCITONIN                     	    23.81	   $23.81	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82310	ASSAY OF CALCIUM                        	     4.10	    $4.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82330	ASSAY OF CALCIUM                        	    12.16	   $12.16	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82331	CALCIUM INFUSION TEST                   	     5.63	    $5.63	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82340	ASSAY OF CALCIUM IN URINE               	     5.36	    $5.36	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82355	CALCULUS ANALYSIS QUAL                  	    10.29	   $10.29	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82360	CALCULUS ASSAY QUANT                    	    11.44	   $11.44	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82365	CALCULUS SPECTROSCOPY                   	    11.46	   $11.46	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82370	X-RAY ASSAY CALCULUS                    	    11.13	   $11.13	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82373	ASSAY C-D TRANSFER MEASURE              	     9.32	    $9.32	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82374	ASSAY BLOOD CARBON DIOXIDE              	     1.36	    $1.36	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82375	ASSAY CARBOXYHB QUANT                   	    10.95	   $10.95	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82376	ASSAY CARBOXYHB QUAL                    	     5.32	    $5.32	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82378	CARCINOEMBRYONIC ANTIGEN                	    16.85	   $16.85	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82379	ASSAY OF CARNITINE                      	    14.99	   $14.99	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82380	ASSAY OF CAROTENE                       	     8.20	    $8.20	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82382	ASSAY URINE CATECHOLAMINES              	    18.72	   $18.72	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82383	ASSAY BLOOD CATECHOLAMINES              	    23.26	   $23.26	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82384	ASSAY THREE CATECHOLAMINES              	    22.45	   $22.45	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82387	ASSAY OF CATHEPSIN-D                    	    16.04	   $16.04	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82390	ASSAY OF CERULOPLASMIN                  	     9.55	    $9.55	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82397	CHEMILUMINESCENT ASSAY                  	    12.55	   $12.55	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82415	ASSAY OF CHLORAMPHENICOL                	    11.26	   $11.26	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82435	ASSAY OF BLOOD CHLORIDE                 	     3.01	    $3.01	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82436	ASSAY OF URINE CHLORIDE                 	     4.39	    $4.39	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82438	ASSAY OTHER FLUID CHLORIDES             	     4.34	    $4.34	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82441	TEST FOR CHLOROHYDROCARBONS             	     5.34	    $5.34	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82465	ASSAY BLD/SERUM CHOLESTEROL             	     3.87	    $3.87	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82480	ASSAY SERUM CHOLINESTERASE              	     7.00	    $7.00	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82482	ASSAY RBC CHOLINESTERASE                	     7.84	    $7.84	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82485	ASSAY CHONDROITIN SULFATE               	    18.36	   $18.36	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82495	ASSAY OF CHROMIUM                       	    18.03	   $18.03	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82507	ASSAY OF CITRATE                        	    24.71	   $24.71	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82523	COLLAGEN CROSSLINKS                     	    16.61	   $16.61	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82525	ASSAY OF COPPER                         	    11.03	   $11.03	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82528	ASSAY OF CORTICOSTERONE                 	    20.02	   $20.02	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82530	CORTISOL FREE                           	    14.85	   $14.85	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82533	TOTAL CORTISOL                          	    14.49	   $14.49	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82540	ASSAY OF CREATINE                       	     4.12	    $4.12	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82542	COL CHROMOTOGRAPHY QUAL/QUAN            	    15.35	   $15.35	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82550	ASSAY OF CK (CPK)                       	     5.79	    $5.79	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82552	ASSAY OF CPK IN BLOOD                   	    11.90	   $11.90	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82553	CREATINE MB FRACTION                    	    10.13	   $10.13	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82554	CREATINE ISOFORMS                       	    10.55	   $10.55	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82565	ASSAY OF CREATININE                     	     4.31	    $4.31	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82570	ASSAY OF URINE CREATININE               	     4.60	    $4.60	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82575	CREATININE CLEARANCE TEST               	     8.40	    $8.40	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82585	ASSAY OF CRYOFIBRINOGEN                 	     9.34	    $9.34	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82595	ASSAY OF CRYOGLOBULIN                   	     5.32	    $5.32	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82600	ASSAY OF CYANIDE                        	    17.24	   $17.24	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82607	VITAMIN B-12                            	    13.33	   $13.33	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82608	B-12 BINDING CAPACITY                   	    12.73	   $12.73	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82610	CYSTATIN C                              	    14.80	   $14.80	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82615	TEST FOR URINE CYSTINES                 	     7.64	    $7.64	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82626	DEHYDROEPIANDROSTERONE                  	    22.47	   $22.47	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82627	DEHYDROEPIANDROSTERONE                  	    19.62	   $19.62	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82633	DESOXYCORTICOSTERONE                    	    27.54	   $27.54	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82634	DEOXYCORTISOL                           	    26.02	   $26.02	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82638	ASSAY OF DIBUCAINE NUMBER               	    10.89	   $10.89	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82642	DIHYDROTESTOSTERONE                     	    26.02	   $26.02	      ---	       --	009	0	0	0.00	    $0.00	N	
M	82652	VIT D 1 25-DIHYDROXY                    	    33.18	   $33.18	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82653	EL-1 FECAL QUANTITATIVE                 	    22.97	   $22.97	      ---	       --	009	0	0	0.00	    $0.00	N	
M	82656	EL-1 FECAL QUAL/SEMIQ                   	    10.10	   $10.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82657	ENZYME CELL ACTIVITY                    	    17.74	   $17.74	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82658	ENZYME CELL ACTIVITY RA                 	    19.66	   $19.66	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82664	ELECTROPHORETIC TEST                    	    24.01	   $24.01	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82668	ASSAY OF ERYTHROPOIETIN                 	    16.71	   $16.71	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82670	ASSAY OF TOTAL ESTRADIOL                	    24.71	   $24.71	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82671	ASSAY OF ESTROGENS                      	    28.71	   $28.71	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82672	ASSAY OF ESTROGEN                       	    19.28	   $19.28	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82677	ASSAY OF ESTRIOL                        	    21.49	   $21.49	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82679	ASSAY OF ESTRONE                        	    22.18	   $22.18	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82681	ASSAY DIR MEAS FR ESTRADIOL             	    22.35	   $22.35	      ---	       --	009	0	0	0.00	    $0.00	N	
M	82693	ASSAY OF ETHYLENE GLYCOL                	    13.25	   $13.25	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82696	ASSAY OF ETIOCHOLANOLONE                	    20.99	   $20.99	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82705	FATS/LIPIDS FECES QUAL                  	     4.53	    $4.53	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	82710	FATS/LIPIDS FECES QUANT                 	    14.94	   $14.94	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82715	ASSAY OF FECAL FAT                      	    18.37	   $18.37	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82725	ASSAY OF BLOOD FATTY ACIDS              	    14.50	   $14.50	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82726	LONG CHAIN FATTY ACIDS                  	    16.05	   $16.05	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82728	ASSAY OF FERRITIN                       	    12.07	   $12.07	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82731	ASSAY OF FETAL FIBRONECTIN              	    56.19	   $56.19	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82735	ASSAY OF FLUORIDE                       	    16.48	   $16.48	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82746	ASSAY OF FOLIC ACID SERUM               	    13.07	   $13.07	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82747	ASSAY OF FOLIC ACID RBC                 	    11.49	   $11.49	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82759	ASSAY OF RBC GALACTOKINASE              	    19.07	   $19.07	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82760	ASSAY OF GALACTOSE                      	     9.95	    $9.95	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82775	ASSAY GALACTOSE TRANSFERASE             	    18.73	   $18.73	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82776	GALACTOSE TRANSFERASE TEST              	     7.90	    $7.90	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82784	ASSAY IGA/IGD/IGG/IGM EACH              	     6.08	    $6.08	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82785	ASSAY OF IGE                            	    14.60	   $14.60	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82787	IGG 1 2 3 OR 4 EACH                     	     7.13	    $7.13	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82800	BLOOD PH                                	     6.67	    $6.67	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82803	BLOOD GASES ANY COMBINATION             	    11.85	   $11.85	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82805	BLOOD GASES W/O2 SATURATION             	    24.30	   $24.30	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82810	BLOOD GASES O2 SAT ONLY                 	     7.82	    $7.82	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82820	HEMOGLOBIN-OXYGEN AFFINITY              	    10.67	   $10.67	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82930	GASTRIC ANALY W/PH EA SPEC              	     5.37	    $5.37	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82938	GASTRIN TEST                            	    15.73	   $15.73	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82941	ASSAY OF GASTRIN                        	    15.68	   $15.68	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82943	ASSAY OF GLUCAGON                       	    12.70	   $12.70	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82945	GLUCOSE OTHER FLUID                     	     3.29	    $3.29	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82946	GLUCAGON TOLERANCE TEST                 	    14.22	   $14.22	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82947	ASSAY GLUCOSE BLOOD QUANT               	     3.30	    $3.30	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82948	REAGENT STRIP/BLOOD GLUCOSE             	     2.71	    $2.71	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82950	GLUCOSE TEST                            	     4.19	    $4.19	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82951	GLUCOSE TOLERANCE TEST (GTT)            	    11.27	   $11.27	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82952	GTT-ADDED SAMPLES                       	     3.46	    $3.46	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82955	ASSAY OF G6PD ENZYME                    	     8.62	    $8.62	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82960	TEST FOR G6PD ENZYME                    	     5.38	    $5.38	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82962	GLUCOSE BLOOD TEST                      	     2.00	    $2.00	      ---	       --	009	0	0	1.00	    $0.00	N	
M	82963	ASSAY OF GLUCOSIDASE                    	    19.10	   $19.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82965	ASSAY OF GDH ENZYME                     	     8.42	    $8.42	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82977	ASSAY OF GGT                            	     6.40	    $6.40	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82978	ASSAY OF GLUTATHIONE                    	    12.67	   $12.67	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82979	ASSAY RBC GLUTATHIONE                   	     7.50	    $7.50	      ---	       --	009	0	0	0.20	    $0.00	N	
M	82985	ASSAY OF GLYCATED PROTEIN               	    13.41	   $13.41	      ---	       --	009	0	0	0.20	    $0.00	N	
M	83001	ASSAY OF GONADOTROPIN (FSH)             	    16.41	   $16.41	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83002	ASSAY OF GONADOTROPIN (LH)              	    16.38	   $16.38	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83003	ASSAY GROWTH HORMONE (HGH)              	    14.82	   $14.82	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83009	H PYLORI (C-13) BLOOD                   	    59.88	   $59.88	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83010	ASSAY OF HAPTOGLOBIN QUANT              	    10.99	   $10.99	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83012	ASSAY OF HAPTOGLOBINS                   	    18.72	   $18.72	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83013	H PYLORI (C-13) BREATH                  	    59.88	   $59.88	      ---	       --	009	0	0	0.00	    $0.00	Y	
M	83014	H PYLORI DRUG ADMIN                     	     6.99	    $6.99	      ---	       --	009	0	0	1.00	    $0.00	Y	
M	83015	HEAVY METAL QUAL ANY ANAL               	    12.16	   $12.16	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83018	HEAVY METAL QUANT EACH NES              	    19.52	   $19.52	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83020	HEMOGLOBIN ELECTROPHORESIS              	    10.93	   $10.93	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83021	HEMOGLOBIN CHROMOTOGRAPHY               	    15.40	   $15.40	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83026	HEMOGLOBIN COPPER SULFATE               	     2.58	    $2.58	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83030	HEMOGLOBIN F FETAL CHEMICAL             	     8.59	    $8.59	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83033	HEMOGLOBIN FTL F ASSAY QUAL             	     6.39	    $6.39	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83036	HEMOGLOBIN GLYCOSYLATED A1C             	     8.54	    $8.54	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83045	HGB METHEMOGLOBIN QUAL                  	     5.19	    $5.19	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83050	HGB METHEMOGLOBIN QUAN                  	     6.34	    $6.34	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83051	HEMOGLOBIN PLASMA                       	     6.50	    $6.50	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83060	HGB SULFHEMOGLOBIN QUAN                 	     7.35	    $7.35	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83065	HEMOGLOBIN THERMOLABILE                 	     7.20	    $7.20	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83068	HEMOGLOBIN UNSTABLE SCREEN              	     7.58	    $7.58	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83069	HEMOGLOBIN URINE                        	     3.51	    $3.51	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83070	ASSAY OF HEMOSIDERIN QUAL               	     4.22	    $4.22	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83080	ASSAY OF B HEXOSAMINIDASE EA            	    14.99	   $14.99	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83088	ASSAY OF HISTAMINE                      	    26.25	   $26.25	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83090	ASSAY OF HOMOCYSTEINE                   	    14.99	   $14.99	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83150	ASSAY OF HOMOVANILLIC ACID              	    11.40	   $11.40	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83491	ASY HYDROXYCORTICOSTEROIDS17            	    15.58	   $15.58	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83497	ASSAY OF 5-HIAA                         	    11.46	   $11.46	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83498	ASY HYDROXYPROGESTERONE 17-D            	    23.93	   $23.93	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83500	ASSAY FREE HYDROXYPROLINE               	    20.13	   $20.13	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83505	ASSAY TOTAL HYDROXYPROLINE              	    21.60	   $21.60	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83516	IMMUNOASSAY NONANTIBODY                 	     8.60	    $8.60	      ---	       --	009	0	0	0.20	    $0.00	N	
M	83518	IMMUNOASSAY DIPSTICK                    	     5.93	    $5.93	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83519	RIA NONANTIBODY                         	    12.27	   $12.27	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83520	IMMUNOASSAY QUANT NOS NONAB             	    10.24	   $10.24	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83521	IG LIGHT CHAINS FREE EACH               	    17.27	   $17.27	      ---	       --	009	0	0	0.00	    $0.00	N	
M	83525	ASSAY OF INSULIN                        	     8.00	    $8.00	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83527	ASSAY OF INSULIN                        	    11.51	   $11.51	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83528	ASSAY OF INTRINSIC FACTOR               	    15.85	   $15.85	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83529	ASAY OF INTERLEUKIN-6 (IL-6)            	    17.27	   $17.27	      ---	       --	009	0	0	0.00	    $0.00	N	
M	83540	ASSAY OF IRON                           	     5.72	    $5.72	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83550	IRON BINDING TEST                       	     6.89	    $6.89	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83570	ASSAY OF IDH ENZYME                     	     7.87	    $7.87	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83582	ASSAY OF KETOGENIC STEROIDS             	    12.60	   $12.60	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83586	ASSAY 17- KETOSTEROIDS                  	    11.38	   $11.38	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83593	FRACTIONATION KETOSTEROIDS              	    23.38	   $23.38	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83605	ASSAY OF LACTIC ACID                    	     9.41	    $9.41	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83615	LACTATE (LD) (LDH) ENZYME               	     5.37	    $5.37	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83625	ASSAY OF LDH ENZYMES                    	    11.37	   $11.37	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83630	LACTOFERRIN FECAL (QUAL)                	    17.45	   $17.45	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83631	LACTOFERRIN FECAL (QUANT)               	    17.45	   $17.45	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83632	PLACENTAL LACTOGEN                      	    17.98	   $17.98	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83633	TEST URINE FOR LACTOSE                  	     5.98	    $5.98	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83655	ASSAY OF LEAD                           	    10.63	   $10.63	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83661	L/S RATIO FETAL LUNG                    	    19.54	   $19.54	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83662	FOAM STABILITY FETAL LUNG               	    16.80	   $16.80	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83663	FLUORO POLARIZE FETAL LUNG              	    10.46	   $10.46	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83664	LAMELLAR BDY FETAL LUNG                 	     5.22	    $5.22	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83670	ASSAY OF LAP ENZYME                     	     8.15	    $8.15	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83690	ASSAY OF LIPASE                         	     6.08	    $6.08	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83695	ASSAY OF LIPOPROTEIN(A)                 	    11.51	   $11.51	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83698	ASSAY LIPOPROTEIN PLA2                  	    36.95	   $36.95	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83700	LIPOPRO BLD ELECTROPHORETIC             	    10.01	   $10.01	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83701	LIPOPROTEIN BLD HR FRACTION             	    27.02	   $27.02	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83704	LIPOPROTEIN BLD QUAN PART               	    28.05	   $28.05	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83718	ASSAY OF LIPOPROTEIN                    	     6.75	    $6.75	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83719	ASSAY OF BLOOD LIPOPROTEIN              	    10.34	   $10.34	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83721	ASSAY OF BLOOD LIPOPROTEIN              	     8.22	    $8.22	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83722	LIPOPRTN DIR MEAS SD LDL CHL            	    28.04	   $28.04	      ---	       --	009	0	0	0.00	    $0.00	N	
M	83727	ASSAY OF LRH HORMONE                    	    15.28	   $15.28	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83735	ASSAY OF MAGNESIUM                      	     5.96	    $5.96	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83775	ASSAY MALATE DEHYDROGENASE              	     6.55	    $6.55	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83785	ASSAY OF MANGANESE                      	    21.86	   $21.86	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83789	MASS SPECTROMETRY QUAL/QUAN             	    16.34	   $16.34	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83825	ASSAY OF MERCURY                        	    14.12	   $14.12	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83835	ASSAY OF METANEPHRINES                  	    15.06	   $15.06	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83857	ASSAY OF METHEMALBUMIN                  	     9.54	    $9.54	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83861	MICROFLUID ANALY TEARS                  	    17.98	   $17.98	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83864	MUCOPOLYSACCHARIDES                     	    15.94	   $15.94	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83872	ASSAY SYNOVIAL FLUID MUCIN              	     5.21	    $5.21	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83873	ASSAY OF CSF PROTEIN                    	    15.29	   $15.29	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83874	ASSAY OF MYOGLOBIN                      	    11.48	   $11.48	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83876	ASSAY MYELOPEROXIDASE                   	    15.13	   $15.13	      ---	       --	009	0	0	0.00	    $0.00	Y	
M	83880	ASSAY OF NATRIURETIC PEPTIDE            	    30.15	   $30.15	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83883	ASSAY NEPHELOMETRY NOT SPEC             	    12.09	   $12.09	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83885	ASSAY OF NICKEL                         	    21.79	   $21.79	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83915	ASSAY OF NUCLEOTIDASE                   	     9.91	    $9.91	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83916	OLIGOCLONAL BANDS                       	    21.90	   $21.90	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83918	ORGANIC ACIDS TOTAL QUANT               	    17.91	   $17.91	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83919	ORGANIC ACIDS QUAL EACH                 	    14.63	   $14.63	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83921	ORGANIC ACID SINGLE QUANT               	    14.68	   $14.68	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83930	ASSAY OF BLOOD OSMOLALITY               	     5.88	    $5.88	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83935	ASSAY OF URINE OSMOLALITY               	     6.02	    $6.02	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83945	ASSAY OF OXALATE                        	    11.56	   $11.56	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83951	ONCOPROTEIN DCP                         	    57.26	   $57.26	      ---	       --	009	0	0	0.00	    $0.00	Y	
M	83970	ASSAY OF PARATHORMONE                   	    34.84	   $34.84	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83986	ASSAY PH BODY FLUID NOS                 	     3.18	    $3.18	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83987	EXHALED BREATH CONDENSATE               	     3.18	    $3.18	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	83993	ASSAY FOR CALPROTECTIN FECAL            	    17.45	   $17.45	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	84030	ASSAY OF BLOOD PKU                      	     4.89	    $4.89	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84035	ASSAY OF PHENYLKETONES                  	     3.25	    $3.25	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84060	ASSAY ACID PHOSPHATASE                  	     6.56	    $6.56	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84066	ASSAY PROSTATE PHOSPHATASE              	     8.59	    $8.59	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84075	ASSAY ALKALINE PHOSPHATASE              	     4.13	    $4.13	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84078	ASSAY ALKALINE PHOSPHATASE              	     6.08	    $6.08	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84080	ASSAY ALKALINE PHOSPHATASES             	    13.14	   $13.14	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84081	ASSAY PHOSPHATIDYLGLYCEROL              	    14.68	   $14.68	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84085	ASSAY OF RBC PG6D ENZYME                	     7.34	    $7.34	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84087	ASSAY PHOSPHOHEXOSE ENZYMES             	     9.18	    $9.18	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84100	ASSAY OF PHOSPHORUS                     	     4.21	    $4.21	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84105	ASSAY OF URINE PHOSPHORUS               	     4.62	    $4.62	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84106	TEST FOR PORPHOBILINOGEN                	     4.65	    $4.65	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84110	ASSAY OF PORPHOBILINOGEN                	     7.50	    $7.50	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84119	TEST URINE FOR PORPHYRINS               	     9.38	    $9.38	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84120	ASSAY OF URINE PORPHYRINS               	    13.08	   $13.08	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84126	ASSAY OF FECES PORPHYRINS               	    27.73	   $27.73	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84132	ASSAY OF SERUM POTASSIUM                	     3.44	    $3.44	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84133	ASSAY OF URINE POTASSIUM                	     3.83	    $3.83	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84134	ASSAY OF PREALBUMIN                     	    12.47	   $12.47	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84135	ASSAY OF PREGNANEDIOL                   	    17.02	   $17.02	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84138	ASSAY OF PREGNANETRIOL                  	    16.84	   $16.84	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84140	ASSAY OF PREGNENOLONE                   	    18.38	   $18.38	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84143	ASSAY OF 17-HYDROXYPREGNENO             	    20.28	   $20.28	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84144	ASSAY OF PROGESTERONE                   	    18.30	   $18.30	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84145	PROCALCITONIN (PCT)                     	    22.21	   $22.21	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84146	ASSAY OF PROLACTIN                      	    17.11	   $17.11	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84150	ASSAY OF PROSTAGLANDIN                  	    27.17	   $27.17	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84152	ASSAY OF PSA COMPLEXED                  	    16.35	   $16.35	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84153	ASSAY OF PSA TOTAL                      	    16.35	   $16.35	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84154	ASSAY OF PSA FREE                       	    12.87	   $12.87	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84155	ASSAY OF PROTEIN SERUM                  	     2.96	    $2.96	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84156	ASSAY OF PROTEIN URINE                  	     3.26	    $3.26	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84157	ASSAY OF PROTEIN OTHER                  	     2.99	    $2.99	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84160	ASSAY OF PROTEIN ANY SOURCE             	     4.60	    $4.60	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84163	PAPPA SERUM                             	    13.38	   $13.38	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84165	PROTEIN E-PHORESIS SERUM                	     9.55	    $9.55	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84166	PROTEIN E-PHORESIS/URINE/CSF            	    15.85	   $15.85	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84181	WESTERN BLOT TEST                       	    15.14	   $15.14	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84182	PROTEIN WESTERN BLOT TEST               	    19.59	   $19.59	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84202	ASSAY RBC PROTOPORPHYRIN                	    12.75	   $12.75	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84203	TEST RBC PROTOPORPHYRIN                 	     7.79	    $7.79	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84206	ASSAY OF PROINSULIN                     	    19.39	   $19.39	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84207	ASSAY OF VITAMIN B-6                    	    24.97	   $24.97	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84210	ASSAY OF PYRUVATE                       	    11.58	   $11.58	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84220	ASSAY OF PYRUVATE KINASE                	     8.39	    $8.39	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84228	ASSAY OF QUININE                        	    10.34	   $10.34	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84233	ASSAY OF ESTROGEN                       	    61.99	   $61.99	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84234	ASSAY OF PROGESTERONE                   	    53.13	   $53.13	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84235	ASSAY OF ENDOCRINE HORMONE              	    56.98	   $56.98	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84238	ASSAY NONENDOCRINE RECEPTOR             	    32.50	   $32.50	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84244	ASSAY OF RENIN                          	    19.55	   $19.55	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84252	ASSAY OF VITAMIN B-2                    	    17.99	   $17.99	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84255	ASSAY OF SELENIUM                       	    22.69	   $22.69	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84260	ASSAY OF SEROTONIN                      	    27.54	   $27.54	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84270	ASSAY OF SEX HORMONE GLOBUL             	    18.72	   $18.72	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84275	ASSAY OF SIALIC ACID                    	    11.94	   $11.94	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84285	ASSAY OF SILICA                         	    20.92	   $20.92	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84295	ASSAY OF SERUM SODIUM                   	     3.51	    $3.51	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84300	ASSAY OF URINE SODIUM                   	     4.32	    $4.32	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84302	ASSAY OF SWEAT SODIUM                   	     4.32	    $4.32	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84305	ASSAY OF SOMATOMEDIN                    	    18.39	   $18.39	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84307	ASSAY OF SOMATOSTATIN                   	    16.25	   $16.25	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84311	SPECTROPHOTOMETRY                       	     6.48	    $6.48	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84315	BODY FLUID SPECIFIC GRAVITY             	     2.62	    $2.62	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84375	CHROMATOGRAM ASSAY SUGARS               	    21.34	   $21.34	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84376	SUGARS SINGLE QUAL                      	     4.69	    $4.69	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84377	SUGARS MULTIPLE QUAL                    	     4.89	    $4.89	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84378	SUGARS SINGLE QUANT                     	    10.24	   $10.24	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84379	SUGARS MULTIPLE QUANT                   	    10.24	   $10.24	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84392	ASSAY OF URINE SULFATE                  	     4.39	    $4.39	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84393	TAU PHOSPHORYLATED EA                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	84394	TOTAL TAU                               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	84402	ASSAY OF FREE TESTOSTERONE              	    22.64	   $22.64	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84403	ASSAY OF TOTAL TESTOSTERONE             	    22.80	   $22.80	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84410	TESTOSTERONE BIOAVAILABLE               	    45.58	   $45.58	      ---	       --	009	0	0	0.00	    $0.00	N	
M	84425	ASSAY OF VITAMIN B-1                    	    18.87	   $18.87	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84430	ASSAY OF THIOCYANATE                    	    10.34	   $10.34	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84432	ASSAY OF THYROGLOBULIN                  	    14.28	   $14.28	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84436	ASSAY OF TOTAL THYROXINE                	     5.18	    $5.18	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84437	ASSAY OF NEONATAL THYROXINE             	     5.75	    $5.75	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84439	ASSAY OF FREE THYROXINE                 	     7.91	    $7.91	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84442	ASSAY OF THYROID ACTIVITY               	    13.14	   $13.14	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84443	ASSAY THYROID STIM HORMONE              	    14.76	   $14.76	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84445	ASSAY OF TSI GLOBULIN                   	    45.20	   $45.20	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84446	ASSAY OF VITAMIN E                      	    12.00	   $12.00	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84450	TRANSFERASE (AST) (SGOT)                	     4.41	    $4.41	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84460	ALANINE AMINO (ALT) (SGPT)              	     4.58	    $4.58	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84466	ASSAY OF TRANSFERRIN                    	    11.01	   $11.01	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84478	ASSAY OF TRIGLYCERIDES                  	     5.02	    $5.02	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84479	ASSAY OF THYROID (T3 OR T4)             	     5.68	    $5.68	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84480	ASSAY TRIIODOTHYRONINE (T3)             	    12.59	   $12.59	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84481	FREE ASSAY (FT-3)                       	    11.93	   $11.93	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84482	T3 REVERSE                              	    14.01	   $14.01	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84484	ASSAY OF TROPONIN QUANT                 	     8.47	    $8.47	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84485	ASSAY DUODENAL FLUID TRYPSIN            	     6.40	    $6.40	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84488	TEST FECES FOR TRYPSIN                  	     6.49	    $6.49	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84490	ASSAY OF FECES FOR TRYPSIN              	     7.94	    $7.94	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84510	ASSAY OF TYROSINE                       	     9.25	    $9.25	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84512	ASSAY OF TROPONIN QUAL                  	     8.07	    $8.07	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84520	ASSAY OF UREA NITROGEN                  	     3.15	    $3.15	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84525	UREA NITROGEN SEMI-QUANT                	     4.10	    $4.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84540	ASSAY OF URINE/UREA-N                   	     3.31	    $3.31	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84545	UREA-N CLEARANCE TEST                   	     5.88	    $5.88	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84550	ASSAY OF BLOOD/URIC ACID                	     4.01	    $4.01	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84560	ASSAY OF URINE/URIC ACID                	     4.22	    $4.22	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84577	ASSAY OF FECES/UROBILINOGEN             	    13.58	   $13.58	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84578	TEST URINE UROBILINOGEN                 	     3.54	    $3.54	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84580	ASSAY OF URINE UROBILINOGEN             	     7.64	    $7.64	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84583	ASSAY OF URINE UROBILINOGEN             	     4.84	    $4.84	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84585	ASSAY OF URINE VMA                      	    13.78	   $13.78	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84588	ASSAY OF VASOPRESSIN                    	    30.17	   $30.17	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84590	ASSAY OF VITAMIN A                      	    10.21	   $10.21	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84591	ASSAY OF NOS VITAMIN                    	    12.63	   $12.63	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84597	ASSAY OF VITAMIN K                      	    12.20	   $12.20	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84600	ASSAY OF VOLATILES                      	    14.29	   $14.29	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84620	XYLOSE TOLERANCE TEST                   	    10.53	   $10.53	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84630	ASSAY OF ZINC                           	    10.12	   $10.12	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84681	ASSAY OF C-PEPTIDE                      	    17.83	   $17.83	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84702	CHORIONIC GONADOTROPIN TEST             	    13.24	   $13.24	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84703	CHORIONIC GONADOTROPIN ASSAY            	     6.46	    $6.46	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84704	HCG FREE BETACHAIN TEST                 	    13.38	   $13.38	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84830	OVULATION TESTS                         	     9.70	    $9.70	      ---	       --	009	0	0	0.20	    $0.00	N	
M	84999	UNLISTED CHEMISTRY PROCEDURE            	     0.00	    $0.00	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85002	BLEEDING TIME TEST                      	     4.01	    $4.01	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85004	AUTOMATED DIFF WBC COUNT                	     5.17	    $5.17	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85007	BL SMEAR W/DIFF WBC COUNT               	     2.71	    $2.71	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	85008	BL SMEAR W/O DIFF WBC COUNT             	     0.52	    $0.52	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	85009	MANUAL DIFF WBC COUNT B-COAT            	     4.05	    $4.05	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	85013	SPUN MICROHEMATOCRIT                    	     2.03	    $2.03	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	85014	HEMATOCRIT                              	     2.11	    $2.11	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	85018	HEMOGLOBIN                              	     2.07	    $2.07	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	85025	COMPLETE CBC W/AUTO DIFF WBC            	     6.75	    $6.75	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	85027	COMPLETE CBC AUTOMATED                  	     5.71	    $5.71	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	85032	MANUAL CELL COUNT EACH                  	     3.83	    $3.83	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85041	AUTOMATED RBC COUNT                     	     2.67	    $2.67	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	85044	MANUAL RETICULOCYTE COUNT               	     2.64	    $2.64	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	85045	AUTOMATED RETICULOCYTE COUNT            	     3.55	    $3.55	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85046	RETICYTE/HGB CONCENTRATE                	     4.61	    $4.61	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85048	AUTOMATED LEUKOCYTE COUNT               	     2.26	    $2.26	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	85049	AUTOMATED PLATELET COUNT                	     3.77	    $3.77	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85055	RETICULATED PLATELET ASSAY              	    28.59	   $28.59	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85060	BLOOD SMEAR INTERPRETATION              	    12.63	   $12.63	      ---	       --	009	0	0	1.00	    $0.00	N	
M	85097	BONE MARROW INTERPRETATION              	    35.25	   $35.25	      ---	       --	009	0	0	1.00	    $0.00	N	
M	85130	CHROMOGENIC SUBSTRATE ASSAY             	    10.57	   $10.57	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85170	BLOOD CLOT RETRACTION                   	     3.94	    $3.94	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	85175	BLOOD CLOT LYSIS TIME                   	     4.95	    $4.95	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85210	CLOT FACTOR II PROTHROM SPEC            	    11.54	   $11.54	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85220	BLOOC CLOT FACTOR V TEST                	    15.69	   $15.69	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85230	CLOT FACTOR VII PROCONVERTIN            	    15.91	   $15.91	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85240	CLOT FACTOR VIII AHG 1 STAGE            	    15.86	   $15.86	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85244	CLOT FACTOR VIII RELTD ANTGN            	    18.15	   $18.15	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85245	CLOT FACTOR VIII VW RISTOCTN            	    20.39	   $20.39	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85246	CLOT FACTOR VIII VW ANTIGEN             	    20.39	   $20.39	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85247	CLOT FACTOR VIII MULTIMETRIC            	    20.39	   $20.39	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85250	CLOT FACTOR IX PTC/CHRSTMAS             	    16.93	   $16.93	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85260	CLOT FACTOR X STUART-POWER              	    15.91	   $15.91	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85270	CLOT FACTOR XI PTA                      	    15.91	   $15.91	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85280	CLOT FACTOR XII HAGEMAN                 	    17.20	   $17.20	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85290	CLOT FACTOR XIII FIBRIN STAB            	    14.52	   $14.52	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85291	CLOT FACTOR XIII FIBRIN SCRN            	     7.91	    $7.91	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85292	CLOT FACTOR FLETCHER FACT               	    16.83	   $16.83	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85293	CLOT FACTOR WGHT KININOGEN              	    16.83	   $16.83	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85300	ANTITHROMBIN III ACTIVITY               	    10.47	   $10.47	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85301	ANTITHROMBIN III ANTIGEN                	     9.61	    $9.61	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85302	CLOT INHIBIT PROT C ANTIGEN             	    10.68	   $10.68	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85303	CLOT INHIBIT PROT C ACTIVITY            	    12.30	   $12.30	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85305	CLOT INHIBIT PROT S TOTAL               	    10.32	   $10.32	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85306	CLOT INHIBIT PROT S FREE                	    13.62	   $13.62	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85307	ASSAY ACTIVATED PROTEIN C               	    13.62	   $13.62	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85335	FACTOR INHIBITOR TEST                   	    11.44	   $11.44	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85337	THROMBOMODULIN                          	    11.35	   $11.35	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85345	COAGULATION TIME LEE & WHITE            	     3.83	    $3.83	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	85347	COAGULATION TIME ACTIVATED              	     3.65	    $3.65	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85348	COAGULATION TIME OTR METHOD             	     3.59	    $3.59	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85360	EUGLOBULIN LYSIS                        	     7.47	    $7.47	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85362	FIBRIN DEGRADATION PRODUCTS             	     5.91	    $5.91	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85366	FIBRINOGEN TEST                         	     8.57	    $8.57	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85370	FIBRINOGEN TEST                         	    10.10	   $10.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85378	FIBRIN DEGRADE SEMIQUANT                	     6.50	    $6.50	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85379	FIBRIN DEGRADATION QUANT                	     9.05	    $9.05	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85380	FIBRIN DEGRADJ D-DIMER                  	     4.72	    $4.72	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85384	FIBRINOGEN ACTIVITY                     	     7.63	    $7.63	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85385	FIBRINOGEN ANTIGEN                      	     9.25	    $9.25	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85390	FIBRINOLYSINS SCREEN I&R                	     5.63	    $5.63	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85396	CLOTTING ASSAY WHOLE BLOOD              	    17.73	   $17.73	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85397	CLOTTING FUNCT ACTIVITY                 	    24.68	   $24.68	      ---	       --	009	0	0	0.00	    $0.00	N	
M	85400	FIBRINOLYTIC PLASMIN                    	     6.84	    $6.84	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85410	FIBRINOLYTIC ANTIPLASMIN                	     6.85	    $6.85	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85415	FIBRINOLYTIC PLASMINOGEN                	    15.28	   $15.28	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85420	FIBRINOLYTIC PLASMINOGEN                	     5.81	    $5.81	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85421	FIBRINOLYTIC PLASMINOGEN                	     6.12	    $6.12	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85441	HEINZ BODIES DIRECT                     	     3.73	    $3.73	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85445	HEINZ BODIES INDUCED                    	     6.06	    $6.06	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85460	HEMOGLOBIN FETAL                        	     6.28	    $6.28	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85461	HEMOGLOBIN FETAL                        	     4.17	    $4.17	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85475	HEMOLYSIN ACID                          	     7.89	    $7.89	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85520	HEPARIN ASSAY                           	    11.47	   $11.47	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85525	HEPARIN NEUTRALIZATION                  	    10.10	   $10.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85530	HEPARIN-PROTAMINE TOLERANCE             	    11.64	   $11.64	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85536	IRON STAIN PERIPHERAL BLOOD             	     5.75	    $5.75	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85540	WBC ALKALINE PHOSPHATASE                	     7.65	    $7.65	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85547	RBC MECHANICAL FRAGILITY                	     7.65	    $7.65	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85549	MURAMIDASE                              	    16.67	   $16.67	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85555	RBC OSMOTIC FRAGILITY                   	     5.98	    $5.98	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85557	RBC OSMOTIC FRAGILITY                   	    11.87	   $11.87	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85576	BLOOD PLATELET AGGREGATION              	    11.90	   $11.90	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85597	PHOSPHOLIPID PLTLT NEUTRALIZ            	    15.98	   $15.98	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85598	HEXAGNAL PHOSPH PLTLT NEUTRL            	    15.98	   $15.98	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85610	PROTHROMBIN TIME                        	     3.49	    $3.49	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	85611	PROTHROMBIN TEST                        	     3.51	    $3.51	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85612	VIPER VENOM PROTHROMBIN TIME            	    10.42	   $10.42	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85613	RUSSELL VIPER VENOM DILUTED             	     8.45	    $8.45	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85635	REPTILASE TEST                          	     8.75	    $8.75	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85651	RBC SED RATE NONAUTOMATED               	     2.37	    $2.37	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	85652	RBC SED RATE AUTOMATED                  	     2.40	    $2.40	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	85660	RBC SICKLE CELL TEST                    	     4.52	    $4.52	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	85670	THROMBIN TIME PLASMA                    	     4.99	    $4.99	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85675	THROMBIN TIME TITER                     	     6.08	    $6.08	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85705	THROMBOPLASTIN INHIBITION               	     8.56	    $8.56	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85730	THROMBOPLASTIN TIME PARTIAL             	     5.34	    $5.34	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85732	THROMBOPLASTIN TIME PARTIAL             	     5.75	    $5.75	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85810	BLOOD VISCOSITY EXAMINATION             	    10.37	   $10.37	      ---	       --	009	0	0	0.20	    $0.00	N	
M	85999	UNLISTED HEMATOLOGY&COAGJ PX            	     0.00	    $0.00	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86000	AGGLUTININS FEBRILE ANTIGEN             	     5.32	    $5.32	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86001	ALLERGEN SPECIFIC IGG                   	     5.68	    $5.68	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86003	ALLG SPEC IGE CRUDE XTRC EA             	     4.64	    $4.64	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86008	ALLG SPEC IGE RECOMB EA                 	    15.94	   $15.94	      ---	       --	009	0	0	0.00	    $0.00	N	
M	86015	ACTIN ANTIBODY EACH                     	    11.53	   $11.53	      ---	       --	009	0	0	0.00	    $0.00	N	
M	86021	WBC ANTIBODY IDENTIFICATION             	    13.38	   $13.38	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86022	PLATELET ANTIBODIES                     	    16.33	   $16.33	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86023	IMMUNOGLOBULIN ASSAY                    	    11.07	   $11.07	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86036	ANCA SCREEN EACH ANTIBODY               	    12.05	   $12.05	      ---	       --	009	0	0	0.00	    $0.00	N	
M	86037	ANCA TITER EACH ANTIBODY                	    12.05	   $12.05	      ---	       --	009	0	0	0.00	    $0.00	N	
M	86038	ANTINUCLEAR ANTIBODIES                  	    10.63	   $10.63	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86039	ANTINUCLEAR ANTIBODIES (ANA)            	     9.92	    $9.92	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86041	ACETYLCHOLN RCPTR BNDNG ANTB            	    18.40	   $18.40	      ---	       --	009	0	0	0.00	    $0.00	N	
M	86042	ACETYLCHOLN RCPTR BLCKG ANTB            	    18.40	   $18.40	      ---	       --	009	0	0	0.00	    $0.00	N	
M	86043	ACETYLCHOLN RCPTR MODLG ANTB            	    12.05	   $12.05	      ---	       --	009	0	0	0.00	    $0.00	N	
M	86051	AQUAPORIN-4 ANTB ELISA                  	    11.53	   $11.53	      ---	       --	009	0	0	0.00	    $0.00	N	
M	86052	AQUAPORIN-4 ANTB CBA EACH               	    12.05	   $12.05	      ---	       --	009	0	0	0.00	    $0.00	N	
M	86053	AQAPRN-4 ANTB FLO CYTMTRY EA            	    12.05	   $12.05	      ---	       --	009	0	0	0.00	    $0.00	N	
M	86060	ANTISTREPTOLYSIN O TITER                	     6.49	    $6.49	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86063	ANTISTREPTOLYSIN O SCREEN               	     5.13	    $5.13	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86077	PHYS BLOOD BANK SERV XMATCH             	    34.52	   $34.52	      ---	       --	009	0	0	1.00	    $0.00	Y	
M	86078	PHYS BLOOD BANK SERV REACTJ             	    43.85	   $43.85	      ---	       --	009	0	0	1.00	    $0.00	Y	
M	86079	PHYS BLOOD BANK SERV AUTHRJ             	    43.56	   $43.56	      ---	       --	009	0	0	1.00	    $0.00	Y	
M	86140	C-REACTIVE PROTEIN                      	     4.60	    $4.60	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86141	C-REACTIVE PROTEIN HS                   	    11.06	   $11.06	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86146	BETA-2 GLYCOPROTEIN ANTIBODY            	    20.47	   $20.47	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86147	CARDIOLIPIN ANTIBODY EA IG              	    17.82	   $17.82	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86148	ANTI-PHOSPHOLIPID ANTIBODY              	    14.28	   $14.28	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86155	CHEMOTAXIS ASSAY                        	    14.21	   $14.21	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86156	COLD AGGLUTININ SCREEN                  	     6.46	    $6.46	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86157	COLD AGGLUTININ TITER                   	     7.17	    $7.17	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86160	COMPLEMENT ANTIGEN                      	    10.51	   $10.51	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86161	COMPLEMENT/FUNCTION ACTIVITY            	    10.67	   $10.67	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86162	COMPLEMENT TOTAL (CH50)                 	    18.07	   $18.07	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86171	COMPLEMENT FIXATION EACH                	     8.90	    $8.90	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86200	CCP ANTIBODY                            	     7.10	    $7.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86215	DEOXYRIBONUCLEASE ANTIBODY              	    11.77	   $11.77	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86225	DNA ANTIBODY NATIVE                     	    12.21	   $12.21	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86226	DNA ANTIBODY SINGLE STRAND              	    10.76	   $10.76	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86231	EMA EACH IG CLASS                       	    12.09	   $12.09	      ---	       --	009	0	0	0.00	    $0.00	N	
M	86235	NUCLEAR ANTIGEN ANTIBODY                	    14.59	   $14.59	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86255	FLUORESCENT ANTIBODY SCREEN             	     8.63	    $8.63	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86256	FLUORESCENT ANTIBODY TITER              	    10.39	   $10.39	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86258	DGP ANTIBODY EACH IG CLASS              	    11.53	   $11.53	      ---	       --	009	0	0	0.00	    $0.00	N	
M	86277	GROWTH HORMONE ANTIBODY                 	    13.99	   $13.99	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86280	HEMAGGLUTINATION INHIBITION             	     7.28	    $7.28	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86294	IMMUNOASSAY TUMOR QUAL                  	    20.45	   $20.45	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86300	IMMUNOASSAY TUMOR CA 15-3               	    18.50	   $18.50	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86301	IMMUNOASSAY TUMOR CA 19-9               	    18.50	   $18.50	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86304	IMMUNOASSAY TUMOR CA 125                	    18.50	   $18.50	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86305	HUMAN EPIDIDYMIS PROTEIN 4              	    18.50	   $18.50	      ---	       --	009	0	0	0.00	    $0.00	N	
M	86308	HETEROPHILE ANTIBODY SCREEN             	     4.49	    $4.49	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86309	HETEROPHILE ANTIBODY TITER              	     5.75	    $5.75	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86310	HETEROPHILE ANTIBODY ABSRBJ             	     6.55	    $6.55	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86316	IMMUNOASSAY TUMOR OTHER                 	    18.50	   $18.50	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86317	IMMUNOASSAY INFECTIOUS AGENT            	    10.49	   $10.49	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86318	IA INFECTIOUS AGENT ANTIBODY            	    14.10	   $14.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86320	SERUM IMMUNOELECTROPHORESIS             	    23.93	   $23.93	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86325	OTHER IMMUNOELECTROPHORESIS             	    19.88	   $19.88	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86328	IA NFCT AB SARSCOV2 COVID19             	    45.23	   $45.23	      ---	       --	009	0	0	0.00	    $0.00	N	
M	86329	IMMUNODIFFUSION NES                     	    12.49	   $12.49	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86331	IMMUNODIFFUSION OUCHTERLONY             	     5.90	    $5.90	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86332	IMMUNE COMPLEX ASSAY                    	    21.66	   $21.66	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86334	IMMUNOFIX E-PHORESIS SERUM              	    19.86	   $19.86	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86335	IMMUNFIX E-PHORSIS/URINE/CSF            	    26.09	   $26.09	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86336	INHIBIN A                               	    13.85	   $13.85	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86337	INSULIN ANTIBODIES                      	    19.03	   $19.03	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86340	INTRINSIC FACTOR ANTIBODY               	    13.40	   $13.40	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86341	ISLET CELL ANTIBODY                     	    18.09	   $18.09	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86343	LEUKOCYTE HISTAMINE RELEASE             	    11.07	   $11.07	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86344	LEUKOCYTE PHAGOCYTOSIS                  	     8.31	    $8.31	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86353	LYMPHOCYTE TRANSFORMATION               	    43.58	   $43.58	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86355	B CELLS TOTAL COUNT                     	    33.53	   $33.53	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86356	MONONUCLEAR CELL ANTIGEN                	    23.80	   $23.80	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86357	NK CELLS TOTAL COUNT                    	    33.37	   $33.37	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86359	T CELLS TOTAL COUNT                     	    33.53	   $33.53	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86360	T CELL ABSOLUTE COUNT/RATIO             	    41.76	   $41.76	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86361	T CELL ABSOLUTE COUNT                   	    23.80	   $23.80	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86362	MOG-IGG1 ANTB CBA EACH                  	    12.05	   $12.05	      ---	       --	009	0	0	0.00	    $0.00	N	
M	86363	MOG-IGG1 ANTB FLO CYTMTRY EA            	    12.05	   $12.05	      ---	       --	009	0	0	0.00	    $0.00	N	
M	86364	TISS TRNSGLTMNASE EA IG CLAS            	    11.53	   $11.53	      ---	       --	009	0	0	0.00	    $0.00	N	
M	86366	MUSCLE-SPECIFIC KINASE ANTB             	    18.40	   $18.40	      ---	       --	009	0	0	0.00	    $0.00	N	
M	86367	STEM CELLS TOTAL COUNT                  	    41.07	   $41.07	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86376	MICROSOMAL ANTIBODY EACH                	    12.93	   $12.93	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86381	MITOCHONDRIAL ANTIBODY EACH             	    25.45	   $25.45	      ---	       --	009	0	0	0.00	    $0.00	N	
M	86382	NEUTRALIZATION TEST VIRAL               	    15.03	   $15.03	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86384	NITROBLUE TETRAZOLIUM DYE               	    10.89	   $10.89	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86403	PARTICLE AGGLUT ANTBDY SCRN             	     9.23	    $9.23	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86406	PARTICLE AGGLUT ANTBDY TITR             	     9.45	    $9.45	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86408	NEUTRLZG ANTB SARSCOV2 SCR              	    42.13	   $42.13	      ---	       --	009	0	0	0.00	    $0.00	N	
M	86409	NEUTRLZG ANTB SARSCOV2 TITER            	    79.61	   $79.61	      ---	       --	009	0	0	0.00	    $0.00	N	
M	86413	SARS-COV-2 ANTB QUANTITATIVE            	    51.43	   $51.43	      ---	       --	009	0	0	0.00	    $0.00	N	
M	86430	RHEUMATOID FACTOR TEST QUAL             	     5.04	    $5.04	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86431	RHEUMATOID FACTOR QUANT                 	     5.02	    $5.02	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86480	TB TEST CELL IMMUN MEASURE              	    43.39	   $43.39	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86481	TB AG RESPONSE T-CELL SUSP              	    69.78	   $69.78	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86485	SKIN TEST CANDIDA                       	     0.00	    $0.00	      ---	       --	009	0	0	1.00	    $0.00	Y	
M	86486	SKIN TEST UNLISTED ANTIGN EA            	     4.48	    $4.48	      ---	       --	009	0	0	1.00	    $0.00	Y	
M	86510	HISTOPLASMOSIS SKIN TEST                	     5.16	    $5.16	      ---	       --	009	0	0	1.00	    $0.00	Y	
M	86580	TB INTRADERMAL TEST                     	     3.36	    $3.36	      ---	       --	009	0	0	1.00	    $0.00	Y	
M	86581	STRPTCS PNEUM ANTB SEROT IA             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	86590	STREPTOKINASE ANTIBODY                  	    10.13	   $10.13	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86592	SYPHILIS TEST NON-TREP QUAL             	     3.18	    $3.18	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86593	SYPHILIS TEST NON-TREP QUANT            	     3.91	    $3.91	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86596	VOLTAGE-GTD CA CHNL ANTB EA             	    12.05	   $12.05	      ---	       --	009	0	0	0.00	    $0.00	N	
M	86602	ANTINOMYCES ANTIBODY                    	     9.05	    $9.05	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86603	ADENOVIRUS ANTIBODY                     	    11.44	   $11.44	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86606	ASPERGILLUS ANTIBODY                    	    13.38	   $13.38	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86609	BACTERIUM ANTIBODY                      	    11.45	   $11.45	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86611	BARTONELLA ANTIBODY                     	     9.05	    $9.05	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86612	BLASTOMYCES ANTIBODY                    	    11.47	   $11.47	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86615	BORDETELLA ANTIBODY                     	    11.72	   $11.72	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86617	LYME DISEASE ANTIBODY                   	    13.77	   $13.77	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86618	LYME DISEASE ANTIBODY                   	    15.14	   $15.14	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86619	BORRELIA ANTIBODY                       	    11.89	   $11.89	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86622	BRUCELLA ANTIBODY                       	     7.94	    $7.94	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86625	CAMPYLOBACTER ANTIBODY                  	    11.66	   $11.66	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86628	CANDIDA ANTIBODY                        	    10.67	   $10.67	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86631	CHLAMYDIA ANTIBODY                      	    10.51	   $10.51	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86632	CHLAMYDIA IGM ANTIBODY                  	    11.28	   $11.28	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86635	COCCIDIOIDES ANTIBODY                   	    10.20	   $10.20	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86638	Q FEVER ANTIBODY                        	    10.78	   $10.78	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86641	CRYPTOCOCCUS ANTIBODY                   	    12.81	   $12.81	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86644	CMV ANTIBODY                            	    12.38	   $12.38	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86645	CMV ANTIBODY IGM                        	    14.36	   $14.36	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86648	DIPHTHERIA ANTIBODY                     	    13.52	   $13.52	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86651	ENCEPHALITIS CALIFORN ANTBDY            	    11.72	   $11.72	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86652	ENCEPHALTIS EAST EQNE ANBDY             	    11.72	   $11.72	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86653	ENCEPHALTIS ST LOUIS ANTBODY            	    11.72	   $11.72	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86654	ENCEPHALTIS WEST EQNE ANTBDY            	    11.72	   $11.72	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86658	ENTEROVIRUS ANTIBODY                    	    11.58	   $11.58	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86663	EPSTEIN-BARR ANTIBODY                   	    11.66	   $11.66	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86664	EPSTEIN-BARR NUCLEAR ANTIGEN            	    13.60	   $13.60	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86665	EPSTEIN-BARR CAPSID VCA                 	    15.82	   $15.82	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86666	EHRLICHIA ANTIBODY                      	     9.05	    $9.05	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86668	FRANCISELLA TULARENSIS                  	    11.32	   $11.32	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86671	FUNGUS NES ANTIBODY                     	    10.89	   $10.89	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86674	GIARDIA LAMBLIA ANTIBODY                	    13.08	   $13.08	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86677	HELICOBACTER PYLORI ANTIBODY            	    12.95	   $12.95	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86682	HELMINTH ANTIBODY                       	    11.56	   $11.56	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86684	HEMOPHILUS INFLUENZA ANTIBDY            	    14.08	   $14.08	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86687	HTLV-I ANTIBODY                         	     7.46	    $7.46	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86688	HTLV-II ANTIBODY                        	    12.45	   $12.45	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86689	HTLV/HIV CONFIRMJ ANTIBODY              	    17.20	   $17.20	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86692	HEPATITIS DELTA AGENT ANTBDY            	    15.25	   $15.25	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86694	HERPES SIMPLEX NES ANTBDY               	    10.41	   $10.41	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86695	HERPES SIMPLEX TYPE 1 TEST              	    11.72	   $11.72	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86696	HERPES SIMPLEX TYPE 2 TEST              	    17.20	   $17.20	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86698	HISTOPLASMA ANTIBODY                    	    11.11	   $11.11	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86701	HIV-1ANTIBODY                           	     7.90	    $7.90	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86702	HIV-2 ANTIBODY                          	    11.81	   $11.81	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86703	HIV-1/HIV-2 1 RESULT ANTBDY             	    11.96	   $11.96	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86704	HEP B CORE ANTIBODY TOTAL               	    10.71	   $10.71	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86705	HEP B CORE ANTIBODY IGM                 	    10.37	   $10.37	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86706	HEP B SURFACE ANTIBODY                  	     9.51	    $9.51	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86707	HEPATITIS BE ANTIBODY                   	     4.68	    $4.68	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86708	HEPATITIS A ANTIBODY                    	    11.01	   $11.01	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86709	HEPATITIS A IGM ANTIBODY                	     9.91	    $9.91	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86710	INFLUENZA VIRUS ANTIBODY                	    12.05	   $12.05	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86711	JOHN CUNNINGHAM ANTIBODY                	    13.51	   $13.51	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86713	LEGIONELLA ANTIBODY                     	    13.60	   $13.60	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86717	LEISHMANIA ANTIBODY                     	    10.89	   $10.89	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86720	LEPTOSPIRA ANTIBODY                     	    12.23	   $12.23	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86723	LISTERIA MONOCYTOGENES                  	    11.72	   $11.72	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86727	LYMPH CHORIOMENINGITIS AB               	    11.44	   $11.44	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86732	MUCORMYCOSIS ANTIBODY                   	    12.00	   $12.00	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86735	MUMPS ANTIBODY                          	    11.59	   $11.59	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86738	MYCOPLASMA ANTIBODY                     	    11.77	   $11.77	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86741	NEISSERIA MENINGITIDIS                  	    11.72	   $11.72	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86744	NOCARDIA ANTIBODY                       	    12.79	   $12.79	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86747	PARVOVIRUS ANTIBODY                     	    13.36	   $13.36	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86750	MALARIA ANTIBODY                        	    11.72	   $11.72	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86753	PROTOZOA ANTIBODY NOS                   	    11.01	   $11.01	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86756	RESPIRATORY VIRUS ANTIBODY              	    11.19	   $11.19	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86757	RICKETTSIA ANTIBODY                     	    17.20	   $17.20	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86759	ROTAVIRUS ANTIBODY                      	    14.36	   $14.36	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86762	RUBELLA ANTIBODY                        	    12.79	   $12.79	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86765	RUBEOLA ANTIBODY                        	    11.45	   $11.45	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86768	SALMONELLA ANTIBODY                     	    11.72	   $11.72	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86769	SARS-COV-2 COVID-19 ANTIBODY            	    42.13	   $42.13	      ---	       --	009	0	0	0.00	    $0.00	N	
M	86771	SHIGELLA ANTIBODY                       	    14.36	   $14.36	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86774	TETANUS ANTIBODY                        	    13.15	   $13.15	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86777	TOXOPLASMA ANTIBODY                     	    12.79	   $12.79	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86778	TOXOPLASMA ANTIBODY IGM                 	    12.80	   $12.80	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86780	TREPONEMA PALLIDUM                      	    11.40	   $11.40	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86784	TRICHINELLA ANTIBODY                    	    11.17	   $11.17	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86787	VARICELLA-ZOSTER ANTIBODY               	    11.38	   $11.38	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86788	WEST NILE VIRUS AB IGM                  	    14.98	   $14.98	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86789	WEST NILE VIRUS ANTIBODY                	    12.79	   $12.79	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86790	VIRUS ANTIBODY NOS                      	    11.45	   $11.45	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86793	YERSINIA ANTIBODY                       	    11.72	   $11.72	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86794	ZIKA VIRUS IGM ANTIBODY                 	    14.97	   $14.97	      ---	       --	009	0	0	0.00	    $0.00	N	
M	86800	THYROGLOBULIN ANTIBODY                  	    11.14	   $11.14	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86803	HEPATITIS C AB TEST                     	    12.57	   $12.57	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86804	HEP C AB TEST CONFIRM                   	    13.77	   $13.77	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86805	LYMPHOCYTOTOXICITY ASSAY                	    48.52	   $48.52	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86806	LYMPHOCYTOTOXICITY ASSAY                	    36.74	   $36.74	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86807	CYTOTOXIC ANTIBODY SCREENING            	    38.24	   $38.24	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86808	CYTOTOXIC ANTIBODY SCREENING            	    26.38	   $26.38	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86812	HLA TYPING A B OR C                     	    22.94	   $22.94	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86813	HLA TYPING A B OR C                     	    51.55	   $51.55	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86816	HLA TYPING DR/DQ                        	    24.76	   $24.76	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86817	HLA TYPING DR/DQ                        	    57.81	   $57.81	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86821	LYMPHOCYTE CULTURE MIXED                	    19.49	   $19.49	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86825	HLA X-MATH NON-CYTOTOXIC                	    87.44	   $87.44	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86826	HLA X-MATCH NONCYTOTOXC ADDL            	    29.15	   $29.15	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86828	HLA CLASS I&II ANTIBODY QUAL            	    43.09	   $43.09	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86829	HLA CLASS I/II ANTIBODY QUAL            	    23.37	   $23.37	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86830	HLA CLASS I PHENOTYPE QUAL              	    10.27	   $10.27	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86831	HLA CLASS II PHENOTYPE QUAL             	    10.27	   $10.27	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86832	HLA CLASS I HIGH DEFIN QUAL             	    10.27	   $10.27	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86833	HLA CLASS II HIGH DEFIN QUAL            	    10.27	   $10.27	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86834	HLA CLASS I SEMIQUANT PANEL             	    10.27	   $10.27	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86835	HLA CLASS II SEMIQUANT PANEL            	    10.27	   $10.27	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86849	IMMUNOLOGY PROCEDURE                    	     0.00	    $0.00	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86850	RBC ANTIBODY SCREEN                     	     2.60	    $2.60	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86860	RBC ANTIBODY ELUTION                    	    19.83	   $19.83	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86870	RBC ANTIBODY IDENTIFICATION             	    16.52	   $16.52	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86880	COOMBS TEST DIRECT                      	     4.79	    $4.79	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86885	COOMBS TEST INDIRECT QUAL               	     5.09	    $5.09	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86886	COOMBS TEST INDIRECT TITER              	     4.22	    $4.22	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86900	BLOOD TYPING SEROLOGIC ABO              	     2.38	    $2.38	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86901	BLOOD TYPING SEROLOGIC RH(D)            	     2.46	    $2.46	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86902	BLOOD TYPE ANTIGEN DONOR EA             	     3.28	    $3.28	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86904	BLOOD TYPING PATIENT SERUM              	     6.84	    $6.84	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86905	BLOOD TYPING RBC ANTIGENS               	     3.35	    $3.35	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86906	BLD TYPING SEROLOGIC RH PHNT            	     5.21	    $5.21	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86920	COMPATIBILITY TEST SPIN                 	     0.00	    $0.00	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86921	COMPATIBILITY TEST INCUBATE             	     0.00	    $0.00	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86922	COMPATIBILITY TEST ANTIGLOB             	     0.00	    $0.00	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86923	COMPATIBILITY TEST ELECTRIC             	     0.00	    $0.00	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	86927	PLASMA FRESH FROZEN                     	     0.00	    $0.00	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	86930	FROZEN BLOOD PREP                       	     0.00	    $0.00	      ---	       --	009	0	0	1.00	    $0.00	Y	
M	86931	FROZEN BLOOD THAW                       	     0.00	    $0.00	      ---	       --	009	0	0	1.00	    $0.00	Y	
M	86932	FROZEN BLOOD FREEZE/THAW                	     0.00	    $0.00	      ---	       --	009	0	0	1.00	    $0.00	Y	
M	86940	HEMOLYSINS/AGGLUTININS AUTO             	     7.29	    $7.29	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86941	HEMOLYSINS/AGGLUTININS                  	    10.58	   $10.58	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86945	BLOOD PRODUCT/IRRADIATION               	    25.16	   $25.16	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	86960	VOL REDUCTION OF BLOOD/PROD             	     0.00	    $0.00	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	86970	RBC PRETX INCUBATJ W/CHEMICL            	    17.28	   $17.28	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86971	RBC PRETX INCUBATJ W/ENZYMES            	    17.28	   $17.28	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86972	RBC PRETX INCUBATJ W/DENSITY            	    16.65	   $16.65	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86975	RBC SERUM PRETX INCUBJ DRUGS            	    16.65	   $16.65	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86976	RBC SERUM PRETX ID DILUTION             	    16.65	   $16.65	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86977	RBC SERUM PRETX INCUBJ/INHIB            	    16.65	   $16.65	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86978	RBC PRETREATMENT SERUM                  	    19.97	   $19.97	      ---	       --	009	0	0	0.20	    $0.00	N	
M	86999	UNLISTED TRANSFUSION MED PX             	     0.00	    $0.00	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	87003	SMALL ANIMAL INOCULATION                	    14.97	   $14.97	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87015	SPECIMEN INFECT AGNT CONCNTJ            	     5.81	    $5.81	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87040	BLOOD CULTURE FOR BACTERIA              	     8.98	    $8.98	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	87045	FECES CULTURE AEROBIC BACT              	     7.85	    $7.85	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	87046	STOOL CULTR AEROBIC BACT EA             	     2.61	    $2.61	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	87070	CULTURE OTHR SPECIMN AEROBIC            	     7.51	    $7.51	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	87071	CULTURE AEROBIC QUANT OTHER             	     5.22	    $5.22	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	87073	CULTURE BACTERIA ANAEROBIC              	     5.22	    $5.22	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	87075	CULTR BACTERIA EXCEPT BLOOD             	     8.42	    $8.42	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87076	CULTURE ANAEROBE IDENT EACH             	     7.18	    $7.18	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87077	CULTURE AEROBIC IDENTIFY                	     6.65	    $6.65	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87081	CULTURE SCREEN ONLY                     	     5.68	    $5.68	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	87084	CULTURE OF SPECIMEN BY KIT              	     9.38	    $9.38	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87086	URINE CULTURE/COLONY COUNT              	     5.65	    $5.65	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87088	URINE BACTERIA CULTURE                  	     6.08	    $6.08	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87101	SKIN FUNGI CULTURE                      	     6.85	    $6.85	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87102	FUNGUS ISOLATION CULTURE                	     7.44	    $7.44	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87103	BLOOD FUNGUS CULTURE                    	     8.01	    $8.01	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87106	FUNGI IDENTIFICATION YEAST              	     8.12	    $8.12	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87107	FUNGI IDENTIFICATION MOLD               	     9.18	    $9.18	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87109	MYCOPLASMA                              	    13.68	   $13.68	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87110	CHLAMYDIA CULTURE                       	    17.29	   $17.29	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87116	MYCOBACTERIA CULTURE                    	     9.12	    $9.12	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87118	MYCOBACTERIC IDENTIFICATION             	    11.68	   $11.68	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87140	CULTURE TYPE IMMUNOFLUORESC             	     4.95	    $4.95	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87143	CULTURE TYPING GLC/HPLC                 	    11.13	   $11.13	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87147	CULTURE TYPE IMMUNOLOGIC                	     3.63	    $3.63	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87149	DNA/RNA DIRECT PROBE                    	    16.24	   $16.24	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87150	DNA/RNA AMPLIFIED PROBE                 	    23.05	   $23.05	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87152	CULTURE TYPE PULSE FIELD GEL            	     5.70	    $5.70	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87153	DNA/RNA SEQUENCING                      	   102.54	  $102.54	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87154	CUL TYP ID BLD PTHGN 6+ TRGT            	   218.06	  $218.06	      ---	       --	009	0	0	0.00	    $0.00	N	
M	87158	CULTURE TYPING ADDED METHOD             	     5.70	    $5.70	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87164	DARK FIELD EXAM SPEC COLLJ              	     9.55	    $9.55	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	87166	DARK FIELD EXAM W/O COLLJ               	    10.04	   $10.04	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87168	MACROSCOPIC EXAM ARTHROPOD              	     3.80	    $3.80	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87169	MACROSCOPIC EXAM PARASITE               	     3.80	    $3.80	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87172	PINWORM EXAM                            	     3.80	    $3.80	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87176	TISSUE HOMOGENIZATION CULTR             	     5.23	    $5.23	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87177	OVA AND PARASITES SMEARS                	     7.18	    $7.18	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87181	MICROBE SUSCEPTIBLE DIFFUSE             	     1.16	    $1.16	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87184	MICROBE SUSCEPTIBLE DISK                	     4.23	    $4.23	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87185	MICROBE SUSCEPTIBLE ENZYME              	     1.21	    $1.21	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87186	MICROBE SUSCEPTIBLE MIC                 	     7.51	    $7.51	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87187	MICROBE SUSCEPTIBLE MLC                 	    11.28	   $11.28	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87188	MICROBE SUSCEPT MACROBROTH              	     5.90	    $5.90	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87190	MICROBE SUSCEPT MYCOBACTERI             	     4.56	    $4.56	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87197	BACTERICIDAL LEVEL SERUM                	    13.36	   $13.36	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87205	SMEAR GRAM STAIN                        	     3.46	    $3.46	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	87206	SMEAR FLUORESCENT/ACID STAI             	     4.79	    $4.79	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	87207	SMEAR SPECIAL STAIN                     	     5.33	    $5.33	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87209	SMEAR COMPLEX STAIN                     	    15.98	   $15.98	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87210	SMEAR WET MOUNT SALINE/INK              	     3.56	    $3.56	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	87220	TISSUE EXAM FOR FUNGI                   	     3.73	    $3.73	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	87230	ASSAY TOXIN OR ANTITOXIN                	    17.55	   $17.55	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87250	VIRUS INOCULATE EGGS/ANIMAL             	    17.39	   $17.39	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87252	VIRUS INOCULATION TISSUE                	    21.29	   $21.29	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87253	VIRUS INOCULATE TISSUE ADDL             	    16.00	   $16.00	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87254	VIRUS INOCULATION SHELL VIA             	     5.41	    $5.41	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87255	GENET VIRUS ISOLATE HSV                 	    30.10	   $30.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87260	ADENOVIRUS AG IF                        	    10.10	   $10.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87265	PERTUSSIS AG IF                         	    10.10	   $10.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87267	ENTEROVIRUS ANTIBODY DFA                	    10.10	   $10.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87269	GIARDIA AG IF                           	    10.10	   $10.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87270	CHLAMYDIA TRACHOMATIS AG IF             	    10.10	   $10.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87271	CYTOMEGALOVIRUS DFA                     	    10.10	   $10.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87272	CRYPTOSPORIDIUM AG IF                   	    10.10	   $10.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87273	HERPES SIMPLEX 2 AG IF                  	    10.10	   $10.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87274	HERPES SIMPLEX 1 AG IF                  	    10.10	   $10.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87275	INFLUENZA B AG IF                       	     5.93	    $5.93	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87276	INFLUENZA A AG IF                       	     5.97	    $5.97	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87278	LEGION PNEUMOPHILIA AG IF               	    10.10	   $10.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87279	PARAINFLUENZA AG IF                     	    10.10	   $10.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87280	RESPIRATORY SYNCYTIAL AG IF             	     8.84	    $8.84	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87281	PNEUMOCYSTIS CARINII AG IF              	    10.10	   $10.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87283	RUBEOLA AG IF                           	    10.10	   $10.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87285	TREPONEMA PALLIDUM AG IF                	    10.10	   $10.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87290	VARICELLA ZOSTER AG IF                  	    10.10	   $10.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87299	ANTIBODY DETECTION NOS IF               	    10.10	   $10.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87300	AG DETECTION POLYVAL IF                 	     5.14	    $5.14	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87301	ADENOVIRUS AG IA                        	    10.10	   $10.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87305	ASPERGILLUS AG IA                       	     8.66	    $8.66	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87320	CHLMYD TRACH AG IA                      	    10.10	   $10.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87324	CLOSTRIDIUM AG IA                       	     8.39	    $8.39	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87327	CRYPTOCOCCUS NEOFORM AG IA              	    10.10	   $10.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87328	CRYPTOSPORIDIUM AG IA                   	     8.62	    $8.62	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87329	GIARDIA AG IA                           	     8.28	    $8.28	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87332	CYTOMEGALOVIRUS AG IA                   	    10.10	   $10.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87335	E COLI 0157 AG IA                       	    10.10	   $10.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87336	ENTAMOEB HIST DISPR AG IA               	    10.10	   $10.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87337	ENTAMOEB HIST GROUP AG IA               	    10.10	   $10.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87338	HPYLORI STOOL AG IA                     	    12.79	   $12.79	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87339	H PYLORI AG IA                          	    10.10	   $10.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87340	HEPATITIS B SURFACE AG IA               	     9.12	    $9.12	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87341	HEP B SURFACE AG NEUTRLZJ IA            	     9.18	    $9.18	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87350	HEPATITIS BE AG IA                      	    10.24	   $10.24	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87380	HEPATITIS DELTA AGENT AG IA             	    14.69	   $14.69	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87385	HISTOPLASMA CAPSUL AG IA                	    10.10	   $10.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87389	HIV-1 AG W/HIV-1&-2 AB AG IA            	    20.26	   $20.26	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87390	HIV-1 AG IA                             	    16.50	   $16.50	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87391	HIV-2 AG IA                             	    17.52	   $17.52	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87400	INFLUENZA A/B EACH AG IA                	     5.79	    $5.79	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87420	RESP SYNCYTIAL VIRUS AG IA              	     2.92	    $2.92	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87425	ROTAVIRUS AG IA                         	     8.86	    $8.86	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87426	SARSCOV CORONAVIRUS AG IA               	    35.33	   $35.33	      ---	       --	009	0	0	0.00	    $0.00	N	
M	87427	SHIGA-LIKE TOXIN AG IA                  	     8.82	    $8.82	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87428	SARSCOV & INF VIR A&B AG IA             	    63.59	   $63.59	      ---	       --	009	0	0	0.00	    $0.00	N	
M	87430	STREP A AG IA                           	     8.18	    $8.18	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87449	NOS EACH ORGANISM AG IA                 	     8.40	    $8.40	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87451	POLYVALENT MULT ORG EA AG IA            	     5.93	    $5.93	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87467	HEPATITIS B SURFACE AG QUAN             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	87469	BABESIA MICROTI AMP PRB                 	    35.09	   $35.09	      ---	       --	009	0	0	0.00	    $0.00	N	
M	87471	BARTONELLA DNA AMP PROBE                	    31.19	   $31.19	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87472	BARTONELLA DNA QUANT                    	    38.08	   $38.08	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87475	LYME DIS DNA DIR PROBE                  	    17.82	   $17.82	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87476	LYME DIS DNA AMP PROBE                  	    31.19	   $31.19	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87480	CANDIDA DNA DIR PROBE                   	    17.83	   $17.83	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87481	CANDIDA DNA AMP PROBE                   	    31.19	   $31.19	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87482	CANDIDA DNA QUANT                       	    44.59	   $44.59	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87483	CNS DNA AMP PROBE TYPE 12-25            	   370.47	  $370.47	      ---	       --	009	0	0	0.00	    $0.00	N	
M	87485	CHLMYD PNEUM DNA DIR PROBE              	    17.82	   $17.82	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87486	CHLMYD PNEUM DNA AMP PROBE              	    31.19	   $31.19	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87487	CHLMYD PNEUM DNA QUANT                  	    38.08	   $38.08	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87490	CHLMYD TRACH DNA DIR PROBE              	    17.17	   $17.17	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87491	CHLMYD TRACH DNA AMP PROBE              	    25.59	   $25.59	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87492	CHLMYD TRACH DNA QUANT                  	    38.06	   $38.06	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87493	C DIFF AMPLIFIED PROBE                  	    28.64	   $28.64	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87495	CYTOMEG DNA DIR PROBE                   	    21.83	   $21.83	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87496	CYTOMEG DNA AMP PROBE                   	    31.19	   $31.19	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87497	CYTOMEG DNA QUANT                       	    38.08	   $38.08	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87498	ENTEROVIRUS PROBE&REVRS TRNS            	    31.19	   $31.19	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87500	VANOMYCIN DNA AMP PROBE                 	    31.19	   $31.19	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87501	INFLUENZA DNA AMP PROB 1+               	    45.61	   $45.61	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87502	INFLUENZA DNA AMP PROBE                 	    76.64	   $76.64	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87503	INFLUENZA DNA AMP PROB ADDL             	    22.61	   $22.61	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87505	NFCT AGENT DETECTION GI                 	   114.04	  $114.04	      ---	       --	009	0	0	0.00	    $0.00	N	
M	87506	IADNA-DNA/RNA PROBE TQ 6-11             	   210.39	  $210.39	      ---	       --	009	0	0	0.00	    $0.00	N	
M	87507	IADNA-DNA/RNA PROBE TQ 12-25            	   370.47	  $370.47	      ---	       --	009	0	0	0.00	    $0.00	N	
M	87510	GARDNER VAG DNA DIR PROBE               	    17.83	   $17.83	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87511	GARDNER VAG DNA AMP PROBE               	    31.19	   $31.19	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87512	GARDNER VAG DNA QUANT                   	    37.12	   $37.12	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87516	HEPATITIS B DNA AMP PROBE               	    31.19	   $31.19	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87517	HEPATITIS B DNA QUANT                   	    38.08	   $38.08	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87520	HEPATITIS C RNA DIR PROBE               	    21.83	   $21.83	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87521	HEPATITIS C PROBE&RVRS TRNSC            	    31.19	   $31.19	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87522	HEPATITIS C REVRS TRNSCRPJ              	    31.51	   $31.51	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87523	HEPATITIS D QUANTIFICATION              	    42.84	   $42.84	      ---	       --	009	0	0	0.00	    $0.00	N	
M	87525	HEPATITIS G DNA DIR PROBE               	    21.83	   $21.83	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87526	HEPATITIS G DNA AMP PROBE               	    31.41	   $31.41	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87527	HEPATITIS G DNA QUANT                   	    37.12	   $37.12	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87528	HSV DNA DIR PROBE                       	    17.82	   $17.82	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87529	HSV DNA AMP PROBE                       	    24.56	   $24.56	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87530	HSV DNA QUANT                           	    38.08	   $38.08	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87531	HHV-6 DNA DIR PROBE                     	    21.83	   $21.83	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87532	HHV-6 DNA AMP PROBE                     	    31.19	   $31.19	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87533	HHV-6 DNA QUANT                         	    37.12	   $37.12	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87534	HIV-1 DNA DIR PROBE                     	    17.83	   $17.83	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87535	HIV-1 PROBE&REVERSE TRNSCRPJ            	    31.19	   $31.19	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87536	HIV-1 QUANT&REVRSE TRNSCRPJ             	    75.64	   $75.64	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87537	HIV-2 DNA DIR PROBE                     	    17.82	   $17.82	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87538	HIV-2 PROBE&REVRSE TRNSCRIPJ            	    31.19	   $31.19	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87539	HIV-2 QUANT&REVRSE TRNSCRIPJ            	    46.63	   $46.63	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87540	LEGION PNEUMO DNA DIR PROB              	    17.83	   $17.83	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87541	LEGION PNEUMO DNA AMP PROB              	    31.19	   $31.19	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87542	LEGION PNEUMO DNA QUANT                 	    37.12	   $37.12	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87550	MYCOBACTERIA DNA DIR PROBE              	    17.83	   $17.83	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87551	MYCOBACTERIA DNA AMP PROBE              	    38.21	   $38.21	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87552	MYCOBACTERIA DNA QUANT                  	    38.08	   $38.08	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87555	M.TUBERCULO DNA DIR PROBE               	    21.50	   $21.50	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87556	M.TUBERCULO DNA AMP PROBE               	    33.34	   $33.34	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87557	M.TUBERCULO DNA QUANT                   	    38.08	   $38.08	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87560	M.AVIUM-INTRA DNA DIR PROB              	    21.83	   $21.83	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87561	M.AVIUM-INTRA DNA AMP PROB              	    31.19	   $31.19	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87562	M.AVIUM-INTRA DNA QUANT                 	    38.08	   $38.08	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87563	M. GENITALIUM AMP PROBE                 	    35.09	   $35.09	      ---	       --	009	0	0	0.00	    $0.00	N	
M	87564	MTB RIFAMPIN RST AMP PRB TQ             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	87580	M.PNEUMON DNA DIR PROBE                 	    17.83	   $17.83	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87581	M.PNEUMON DNA AMP PROBE                 	    31.19	   $31.19	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87582	M.PNEUMON DNA QUANT                     	    45.46	   $45.46	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87590	N.GONORRHOEAE DNA DIR PROB              	    12.61	   $12.61	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87591	N.GONORRHOEAE DNA AMP PROB              	    25.36	   $25.36	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87592	N.GONORRHOEAE DNA QUANT                 	    38.08	   $38.08	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87593	ORTHOPOXVIRUS AMP PRB EACH              	    35.09	   $35.09	      ---	       --	009	0	0	0.00	    $0.00	N	
M	87594	PNEUMCYSTS JIROVECII AMP PRB            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	87624	HPV HI-RISK TYP POOLED RSLT             	    31.19	   $31.19	      ---	       --	009	0	0	0.00	    $0.00	N	
M	87625	HPV TYPES 16 & 18 ONLY                  	    32.44	   $32.44	      ---	       --	009	0	0	0.00	    $0.00	N	
M	87626	HPV SEP HI-RSK TYP&POOL RSLT            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
M	87631	RESP VIRUS 3-5 TARGETS                  	    61.07	   $61.07	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87632	RESP VIRUS 6-11 TARGETS                 	   154.59	  $154.59	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87633	RESP VIRUS 12-25 TARGETS                	   370.47	  $370.47	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87634	RSV DNA/RNA AMP PROBE                   	    62.39	   $62.39	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87635	SARS-COV-2 COVID-19 AMP PRB             	    51.31	   $51.31	      ---	       --	009	0	0	0.00	    $0.00	N	
M	87636	SARSCOV2 & INF A&B AMP PRB              	   142.63	  $142.63	      ---	       --	009	0	0	0.00	    $0.00	N	
M	87637	SARSCOV2&INF A&B&RSV AMP PRB            	   142.63	  $142.63	      ---	       --	009	0	0	0.00	    $0.00	N	
M	87640	STAPH A DNA AMP PROBE                   	    31.19	   $31.19	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87641	MR-STAPH DNA AMP PROBE                  	    30.88	   $30.88	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87650	STREP A DNA DIR PROBE                   	    17.83	   $17.83	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87651	STREP A DNA AMP PROBE                   	    31.19	   $31.19	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87652	STREP A DNA QUANT                       	    37.12	   $37.12	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87653	STREP B DNA AMP PROBE                   	    30.52	   $30.52	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87660	TRICHOMONAS VAGIN DIR PROBE             	    17.83	   $17.83	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87661	TRICHOMONAS VAGINALIS AMPLIF            	    30.54	   $30.54	      ---	       --	009	0	0	0.00	    $0.00	N	
M	87662	ZIKA VIRUS DNA/RNA AMP PROBE            	    45.61	   $45.61	      ---	       --	009	0	0	0.00	    $0.00	N	
M	87797	DETECT AGENT NOS DNA DIR                	    21.83	   $21.83	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87798	DETECT AGENT NOS DNA AMP                	    30.15	   $30.15	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87799	DETECT AGENT NOS DNA QUANT              	    38.08	   $38.08	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87800	DETECT AGNT MULT DNA DIREC              	    22.17	   $22.17	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87801	DETECT AGNT MULT DNA AMPLI              	    38.80	   $38.80	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87802	STREP B ASSAY W/OPTIC                   	    10.10	   $10.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87803	CLOSTRIDIUM TOXIN A W/OPTIC             	    10.10	   $10.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87804	INFLUENZA ASSAY W/OPTIC                 	     8.85	    $8.85	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87806	HIV AG W/HIV1&2 ANTB W/OPTIC            	    26.21	   $26.21	      ---	       --	009	0	0	0.00	    $0.00	N	
M	87807	RSV ASSAY W/OPTIC                       	     8.57	    $8.57	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87808	TRICHOMONAS ASSAY W/OPTIC               	    10.10	   $10.10	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	87809	ADENOVIRUS ASSAY W/OPTIC                	    10.10	   $10.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87810	CHLMYD TRACH ASSAY W/OPTIC              	    10.10	   $10.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87811	SARS-COV-2 COVID19 W/OPTIC              	    41.38	   $41.38	      ---	       --	009	0	0	0.00	    $0.00	N	
M	87850	N. GONORRHOEAE ASSAY W/OPTIC            	    10.10	   $10.10	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87880	STREP A ASSAY W/OPTIC                   	     6.99	    $6.99	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87899	AGENT NOS ASSAY W/OPTIC                 	     4.87	    $4.87	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87900	PHENOTYPE INFECT AGENT DRUG             	   115.86	  $115.86	      ---	       --	009	0	0	0.20	    $0.00	Y	
M	87901	NFCT AGT GNTYP ALYS HIV1 REV            	   228.84	  $228.84	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87902	NFCT AGT GNTYP ALYS HEP C               	   228.84	  $228.84	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87903	PHENOTYPE DNA HIV W/CULTURE             	   434.36	  $434.36	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87904	PHENOTYPE DNA HIV W/CLT ADD             	    23.17	   $23.17	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87905	SIALIDASE ENZYME ASSAY                  	    10.86	   $10.86	      ---	       --	009	0	0	0.00	    $0.00	Y	
M	87906	NFCT AGT GNTYP ALYS HIV1                	   114.42	  $114.42	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87910	NFCT AGT GNTYP ALYS CMV                 	    23.38	   $23.38	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87912	NFCT AGT GNTYP ALYS HEP B               	    23.38	   $23.38	      ---	       --	009	0	0	0.20	    $0.00	N	
M	87913	NFCT AGT GNTYP ALYS SARSCOV2            	   257.45	  $257.45	      ---	       --	009	0	0	0.00	    $0.00	N	
M	87999	UNLISTED MICROBIOLOGY PX                	     0.00	    $0.00	      ---	       --	009	0	0	0.20	    $0.00	N	
M	88104	CYTOPATH FL NONGYN SMEARS               	    25.82	   $25.82	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88106	CYTOPATH FL NONGYN FILTER               	    25.82	   $25.82	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88108	CYTOPATH CONCENTRATE TECH               	    28.92	   $28.92	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88112	CYTOPATH CELL ENHANCE TECH              	    60.92	   $60.92	      ---	       --	009	0	0	0.38	    $0.00	N	
M	88120	CYTP URNE 3-5 PROBES EA SPEC            	   363.41	  $363.41	      ---	       --	009	0	0	0.89	    $0.00	N	
M	88121	CYTP URINE 3-5 PROBES CMPTR             	   307.14	  $307.14	      ---	       --	009	0	0	0.88	    $0.00	N	
M	88130	SEX CHROMATIN IDENTIFICATION            	    15.97	   $15.97	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88140	SEX CHROMATIN IDENTIFICATION            	     7.10	    $7.10	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88141	CYTOPATH C/V INTERPRET                  	    10.53	   $10.53	      ---	       --	009	0	0	1.00	    $0.00	N	
M	88142	CYTOPATH C/V THIN LAYER                 	    18.00	   $18.00	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88143	CYTOPATH C/V THIN LAYER REDO            	    18.43	   $18.43	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88147	CYTOPATH C/V AUTOMATED                  	    12.39	   $12.39	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88148	CYTOPATH C/V AUTO RESCREEN              	    13.50	   $13.50	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88150	CYTOPATH C/V MANUAL                     	    11.50	   $11.50	      ---	       --	009	0	0	0.80	    $0.00	Y	
M	88152	CYTOPATH C/V AUTO REDO                  	    11.50	   $11.50	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88153	CYTOPATH C/V REDO                       	    11.50	   $11.50	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88155	CYTOPATH C/V INDEX ADD-ON               	     6.52	    $6.52	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88160	CYTOPATH SMEAR OTHER SOURCE             	    31.95	   $31.95	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88161	CYTOPATH SMEAR OTHER SOURCE             	    20.66	   $20.66	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88162	CYTOPATH SMEAR OTHER SOURCE             	    48.70	   $48.70	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88164	CYTOPATH TBS C/V MANUAL                 	     9.65	    $9.65	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88165	CYTOPATH TBS C/V REDO                   	    11.50	   $11.50	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88166	CYTOPATH TBS C/V AUTO REDO              	    11.50	   $11.50	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88167	CYTOPATH TBS C/V SELECT                 	    11.50	   $11.50	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88172	CYTP DX EVAL FNA 1ST EA SITE            	    28.29	   $28.29	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88173	CYTOPATH EVAL FNA REPORT                	    51.98	   $51.98	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88174	CYTOPATH C/V AUTO IN FLUID              	    18.29	   $18.29	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88175	CYTOPATH C/V AUTO FLUID REDO            	    23.50	   $23.50	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88177	CYTP FNA EVAL EA ADDL                   	    21.74	   $21.74	      ---	       --	009	0	0	0.22	    $0.00	N	
M	88182	CELL MARKER STUDY                       	    87.98	   $87.98	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88184	FLOWCYTOMETRY/ TC 1 MARKER              	    42.18	   $42.18	      ---	       --	009	0	0	0.00	    $0.00	N	
M	88185	FLOWCYTOMETRY/TC ADD-ON                 	    20.68	   $20.68	      ---	       --	009	0	0	0.00	    $0.00	N	
M	88187	FLOWCYTOMETRY/READ 2-8                  	    32.96	   $32.96	      ---	       --	009	0	0	1.00	    $0.00	N	
M	88188	FLOWCYTOMETRY/READ 9-15                 	    55.88	   $55.88	      ---	       --	009	0	0	1.00	    $0.00	N	
M	88189	FLOWCYTOMETRY/READ 16 & >               	    69.18	   $69.18	      ---	       --	009	0	0	1.00	    $0.00	N	
M	88199	UNLISTED CYTOPATHOLOGY PX               	     0.00	    $0.00	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88230	TISSUE CULTURE LYMPHOCYTE               	   100.98	  $100.98	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88233	TISSUE CULTURE SKIN/BIOPSY              	   125.08	  $125.08	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88235	TISSUE CULTURE PLACENTA                 	    75.03	   $75.03	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88237	TISSUE CULTURE BONE MARROW              	    99.64	   $99.64	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88239	TISSUE CULTURE TUMOR                    	   131.12	  $131.12	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88240	CELL CRYOPRESERVE/STORAGE               	     7.99	    $7.99	      ---	       --	009	0	0	0.80	    $0.00	Y	
M	88241	FROZEN CELL PREPARATION                 	     7.99	    $7.99	      ---	       --	009	0	0	0.80	    $0.00	Y	
M	88245	CHROMOSOME ANALYSIS 20-25               	   151.72	  $151.72	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88248	CHROMOSOME ANALYSIS 50-100              	   153.93	  $153.93	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88249	CHROMOSOME ANALYSIS 100                 	   153.93	  $153.93	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88261	CHROMOSOME ANALYSIS 5                   	   190.00	  $190.00	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88262	CHROMOSOME ANALYSIS 15-20               	   107.81	  $107.81	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88263	CHROMOSOME ANALYSIS 45                  	   133.59	  $133.59	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88264	CHROMOSOME ANALYSIS 20-25               	   115.68	  $115.68	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88267	CHROMOSOME ANALYS PLACENTA              	   159.80	  $159.80	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88269	CHROMOSOME ANALYS AMNIOTIC              	   147.84	  $147.84	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88271	CYTOGENETICS DNA PROBE                  	    16.80	   $16.80	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88272	CYTOGENETICS 3-5                        	    29.15	   $29.15	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88273	CYTOGENETICS 10-30                      	    28.56	   $28.56	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88274	CYTOGENETICS 25-99                      	    33.90	   $33.90	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88275	CYTOGENETICS 100-300                    	    31.68	   $31.68	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88280	CHROMOSOME KARYOTYPE STUDY              	    19.17	   $19.17	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88283	CHROMOSOME BANDING STUDY                	     9.71	    $9.71	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88285	CHROMOSOME COUNT ADDITIONAL             	     7.60	    $7.60	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88289	CHROMOSOME STUDY ADDITIONAL             	    12.08	   $12.08	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88291	CYTO/MOLECULAR REPORT                   	    13.62	   $13.62	      ---	       --	009	0	0	1.00	    $0.00	N	
M	88299	UNLISTED CYTOGENETIC STUDY              	     0.00	    $0.00	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88300	SURGICAL PATH GROSS                     	     8.37	    $8.37	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88302	TISSUE EXAM BY PATHOLOGIST              	    20.94	   $20.94	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88304	TISSUE EXAM BY PATHOLOGIST              	    30.48	   $30.48	      ---	       --	009	0	0	0.80	    $0.00	Y	
M	88305	TISSUE EXAM BY PATHOLOGIST              	    40.99	   $40.99	      ---	       --	009	0	0	0.80	    $0.00	Y	
M	88307	TISSUE EXAM BY PATHOLOGIST              	    87.64	   $87.64	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88309	TISSUE EXAM BY PATHOLOGIST              	   185.47	  $185.47	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88311	DECALCIFY TISSUE                        	     7.90	    $7.90	      ---	       --	009	0	0	0.80	    $0.00	Y	
M	88312	SPECIAL STAINS GROUP 1                  	    32.83	   $32.83	      ---	       --	009	0	0	0.80	    $0.00	Y	
M	88313	SPECIAL STAINS GROUP 2                  	    34.26	   $34.26	      ---	       --	009	0	0	0.80	    $0.00	Y	
M	88314	HISTOCHEMICAL STAINS ADD-ON             	    43.23	   $43.23	      ---	       --	009	0	0	0.80	    $0.00	Y	
M	88319	ENZYME HISTOCHEMISTRY                   	    68.78	   $68.78	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88321	CONSLTJ&REPRT SLD PREP ELSWR            	    60.98	   $60.98	      ---	       --	009	0	0	1.00	    $0.00	N	
M	88323	CONSLTJ&REPRT MATRL PREP SLD            	    88.41	   $88.41	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88325	CONSLTJ COMPRE RVW REC REPRT            	   101.51	  $101.51	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88329	PATH CONSLTJ DRG SURG                   	    32.48	   $32.48	      ---	       --	009	0	0	0.80	    $0.00	Y	
M	88331	PATH CONSLTJ SURG 1 BLK 1SPC            	    44.52	   $44.52	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88332	PATH CONSLTJ SURG EA ADD BLK            	    19.39	   $19.39	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88333	PATH CONSLTJ SURG CYTO XM 1             	    79.42	   $79.42	      ---	       --	009	0	0	0.63	    $0.00	N	
M	88334	PATH CONSLTJ SURG CYTO XM EA            	    49.68	   $49.68	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88341	IMHCHEM/IMCYTCHM EA ADD ANTB            	    60.62	   $60.62	      ---	       --	009	0	0	0.31	    $0.00	N	
M	88342	IMHCHEM/IMCYTCHM 1ST ANTB               	    53.79	   $53.79	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88344	IMHCHEM/IMCYTCHM EA MLT ANTB            	   104.92	  $104.92	      ---	       --	009	0	0	0.33	    $0.00	N	
M	88346	IMFLUOR 1ST 1ANTB STAIN PX              	    56.05	   $56.05	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88348	ELECTRON MICROSCOPY DX                  	   237.71	  $237.71	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88350	IMFLUOR EA ADDL 1ANTB STN PX            	    64.66	   $64.66	      ---	       --	009	0	0	0.38	    $0.00	N	
M	88355	M/PHMTRC ALYS SKELETAL MUSC             	   117.31	  $117.31	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88356	ANALYSIS NERVE                          	   180.81	  $180.81	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88358	ANALYSIS TUMOR                          	    66.78	   $66.78	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88360	TUMOR IMMUNOHISTOCHEM/MANUAL            	    56.74	   $56.74	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88361	TUMOR IMMUNOHISTOCHEM/COMPUT            	    80.16	   $80.16	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88362	NERVE TEASING PREPARATIONS              	   180.51	  $180.51	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88363	XM ARCHIVE TISSUE MOLEC ANAL            	    17.77	   $17.77	      ---	       --	009	0	0	0.00	    $0.00	N	
M	88364	INSITU HYBRIDIZATION (FISH)             	    87.58	   $87.58	      ---	       --	009	0	0	0.21	    $0.00	N	
M	88365	INSITU HYBRIDIZATION (FISH)             	    87.58	   $87.58	      ---	       --	009	0	0	0.21	    $0.00	N	
M	88366	INSITU HYBRIDIZATION (FISH)             	   133.38	  $133.38	      ---	       --	009	0	0	0.40	    $0.00	N	
M	88367	INSITU HYBRIDIZATION AUTO               	    96.07	   $96.07	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88368	INSITU HYBRIDIZATION MANUAL             	    75.41	   $75.41	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88369	M/PHMTRC ALYSISHQUANT/SEMIQ             	    65.87	   $65.87	      ---	       --	009	0	0	0.32	    $0.00	N	
M	88371	PROTEIN WESTERN BLOT TISSUE             	    19.76	   $19.76	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88372	PROTEIN ANALYSIS W/PROBE                	    20.97	   $20.97	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88373	M/PHMTRC ALYS ISHQUANT/SEMIQ            	    54.01	   $54.01	      ---	       --	009	0	0	0.33	    $0.00	N	
M	88374	M/PHMTRC ALYS ISHQUANT/SEMIQ            	   185.00	  $185.00	      ---	       --	009	0	0	0.21	    $0.00	N	
M	88375	OPTICAL ENDOMICROSCPY INTERP            	    23.24	   $23.24	      ---	       --	009	0	0	0.00	    $0.00	N	
M	88377	M/PHMTRC ALYS ISHQUANT/SEMIQ            	   192.08	  $192.08	      ---	       --	009	0	0	0.29	    $0.00	N	
M	88380	MICRODISSECTION LASER                   	   118.82	  $118.82	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88381	MICRODISSECTION MANUAL                  	   112.83	  $112.83	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88387	MACROSCOPIC XM DSJ&PREP TISS            	    30.33	   $30.33	      ---	       --	009	0	0	0.20	    $0.00	N	
M	88399	UNLISTED SURGICAL PATH PX               	     0.00	    $0.00	      ---	       --	009	0	0	0.80	    $0.00	N	
M	88720	BILIRUBIN TOTAL TRANSCUT                	     4.30	    $4.30	      ---	    $4.30	009	1	0	0.00	    $0.00	Y	
M	88749	UNLISTED IN VIVO LAB SERVICE            	     0.00	    $0.00	      ---	       --	009	0	0	1.00	    $0.00	Y	
M	89049	CHCT FOR MAL HYPERTHERMIA               	   217.68	  $217.68	      ---	       --	009	0	0	0.80	    $0.00	N	
M	89050	BODY FLUID CELL COUNT                   	     3.55	    $3.55	      ---	       --	009	0	0	0.80	    $0.00	Y	
P	89050	BODY FLUID CELL COUNT                   	     5.22	    $5.22	      ---	       --	009	0	0	0.80	    $0.00	N	
M	89051	BODY FLUID CELL COUNT                   	     4.86	    $4.86	      ---	       --	009	0	0	0.80	    $0.00	N	
M	89055	LEUKOCYTE ASSESSMENT FECAL              	     3.80	    $3.80	      ---	       --	009	0	0	0.00	    $0.00	N	
M	89060	EXAM SYNOVIAL FLUID CRYSTALS            	     6.36	    $6.36	      ---	       --	009	0	0	0.80	    $0.00	N	
M	89125	SPECIMEN FAT STAIN                      	     4.70	    $4.70	      ---	       --	009	0	0	0.80	    $0.00	Y	
M	89160	EXAM FECES FOR MEAT FIBERS              	     3.88	    $3.88	      ---	       --	009	0	0	0.80	    $0.00	N	
M	89190	NASAL SMEAR FOR EOSINOPHILS             	     4.63	    $4.63	      ---	       --	009	0	0	0.80	    $0.00	N	
M	89220	SPUTUM SPECIMEN COLLECTION              	    10.33	   $10.33	      ---	       --	009	0	0	0.80	    $0.00	Y	
M	89230	COLLECT SWEAT FOR TEST                  	     2.20	    $2.20	      ---	       --	009	0	0	0.20	    $0.00	N	
M	89240	UNLISTED MISC PATH TEST                 	     0.00	    $0.00	      ---	       --	009	0	0	0.20	    $0.00	N	
M	89398	UNLISTED REPROD MED LAB PROC            	     0.00	    $0.00	      ---	       --	009	0	0	0.20	    $0.00	N	
I	90284	HUMAN IG SC                             	    17.04	   $17.04	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	90371	HEP B IG IM                             	   147.68	  $147.68	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90375	RABIES IG IM/SC                         	   294.37	  $294.37	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90376	RABIES IG HEAT TREATED                  	   457.03	  $457.03	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90377	RABIES IG HT&SOL HUMAN IM/SC            	   245.61	  $245.61	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90378	RSV MAB IM 50MG                         	  1757.32	 $1757.32	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90380	RSV MONOC ANTB SEASN .5ML IM            	   560.59	  $560.59	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90381	RSV MONOC ANTB SEASN 1 ML IM            	   560.59	  $560.59	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90382	RSV MONOC ANTB SEASN .7ML IM            	     0.00	    $0.00	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90396	VARICELLA-ZOSTER IG IM                  	  2285.22	 $2285.22	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90471	IMMUNIZATION ADMIN                      	     4.46	    $4.46	      ---	       --	030	0	0	0.00	    $0.00	Y	
X	90471	IMMUNIZATION ADMIN                      	    18.76	   $18.76	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	90480	ADMN SARSCOV2 VACC 1 DOSE               	    40.00	   $40.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	90480	ADMN SARSCOV2 VACC 1 DOSE               	    40.00	   $40.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	90585	BCG VACCINE PERCUT                      	   181.13	  $181.13	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90587	DENGUE VACC QUAD 3 DOSE SUBQ            	    70.46	   $70.46	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90589	CHIKUNGUNYA VACCINE LIVE IM             	   279.46	  $279.46	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90593	CHIKUNGUNYA VACC RECOMB IM              	     0.00	    $0.00	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90611	SMALLPOX&MONKEYPOX VAC 0.5ML            	   274.46	  $274.46	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90619	MENACWY-TT VACCINE IM                   	   175.68	  $175.68	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90620	MENB-4C VACCINE IM                      	   240.84	  $240.84	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90621	MENB-FHBP VACC 2/3 DOSE IM              	   211.03	  $211.03	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90622	VACCINIA VRS VAC 0.3 ML PERQ            	     0.01	    $0.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	90623	MENACWY-TT MENB-FHBP VACC IM            	   234.46	  $234.46	      ---	       --	030	0	0	0.00	    $0.00	Y	
1	90625	CHOLERA VACCINE LIVE ORAL               	   229.46	  $229.46	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90626	TIC-BRN ENCEPH VAC 0.25ML IM            	   308.36	  $308.36	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90627	TIC-BRN ENCEPH VAC 0.5ML IM             	   308.36	  $308.36	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90632	HEPA VACCINE ADULT IM                   	    76.62	   $76.62	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90633	HEPA VACC PED/ADOL 2 DOSE IM            	    42.74	   $42.74	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90635	H5N1 VACC DRV CLL CUL ADJ IM            	     0.00	    $0.00	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90636	HEP A/HEP B VACC ADULT IM               	   135.39	  $135.39	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90644	HIB-MENCY VACC 6WK-18M0 IM              	    27.67	   $27.67	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90647	HIB PRP-OMP VACC 3 DOSE IM              	    34.29	   $34.29	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90648	HIB PRP-T VACCINE 4 DOSE IM             	    17.03	   $17.03	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90649	4VHPV VACCINE 3 DOSE IM                 	   164.72	  $164.72	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90650	2VHPV VACCINE 3 DOSE IM                 	   132.59	  $132.59	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90651	9VHPV VACCINE 2/3 DOSE IM               	   311.32	  $311.32	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90653	IIV ADJUVANT VACCINE IM                 	    87.95	   $87.95	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90655	IIV3 VACC NO PRSV 0.25 ML IM            	    30.51	   $30.51	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90656	IIV3 VACC NO PRSV 0.5 ML IM             	    26.81	   $26.81	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90657	IIV3 VACCINE SPLT 0.25 ML IM            	    15.39	   $15.39	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90658	IIV3 VACCINE SPLT 0.5 ML IM             	    26.32	   $26.32	      ---	       --	030	0	0	0.00	    $0.00	Y	
1	90660	LAIV3 VACCINE INTRANASAL                	    33.33	   $33.33	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90661	CCIIV3 VAC ABX FR 0.5 ML IM             	    41.31	   $41.31	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90662	IIV NO PRSV INCREASED AG IM             	    87.95	   $87.95	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90670	PCV13 VACCINE IM                        	   262.45	  $262.45	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90671	PCV15 VACCINE IM                        	   265.61	  $265.61	      ---	       --	030	0	0	0.00	    $0.00	Y	
1	90672	LAIV4 VACCINE INTRANASAL                	    32.25	   $32.25	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90673	RIV3 VACCINE NO PRESERV IM              	    87.95	   $87.95	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90674	CCIIV4 VAC NO PRSV 0.5 ML IM            	    38.63	   $38.63	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90675	RABIES VACCINE IM                       	   322.13	  $322.13	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90677	PCV20 VACCINE IM                        	   317.36	  $317.36	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90678	RSV VACC PREF BIVALENT IM               	   311.26	  $311.26	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90679	RSV VACC PREF RECOMB ADJT IM            	   298.46	  $298.46	      ---	       --	030	0	0	0.00	    $0.00	Y	
1	90680	RV5 VACC 3 DOSE LIVE ORAL               	   102.53	  $102.53	      ---	       --	030	0	0	0.00	    $0.00	Y	
1	90681	RV1 VACC 2 DOSE LIVE ORAL               	   116.97	  $116.97	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90682	RIV4 VACC RECOMBINANT DNA IM            	    77.86	   $77.86	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90683	RSV VACC MRNA LIPID NANO IM             	   290.00	  $290.00	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90684	PCV21 VACCINE IM                        	   332.35	  $332.35	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90685	IIV4 VACC NO PRSV 0.25 ML IM            	    22.82	   $22.82	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90686	IIV4 VACC NO PRSV 0.5 ML IM             	    26.81	   $26.81	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90687	IIV4 VACCINE SPLT 0.25 ML IM            	    14.90	   $14.90	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90688	IIV4 VACCINE SPLT 0.5 ML IM             	    25.34	   $25.34	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90689	VACC IIV4 NO PRSRV 0.25ML IM            	     0.00	    $0.00	      ---	       --	030	0	0	0.00	    $0.00	Y	
1	90690	TYPHOID VACCINE ORAL                    	   111.13	  $111.13	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90691	TYPHOID VACCINE IM                      	   127.07	  $127.07	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90694	VACC AIIV4 NO PRSRV 0.5ML IM            	    81.82	   $81.82	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90696	DTAP-IPV VACCINE 4-6 YRS IM             	    65.23	   $65.23	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90697	DTAP-IPV-HIB-HEPB VACCINE IM            	   156.62	  $156.62	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90698	DTAP-IPV/HIB VACCINE IM                 	   120.77	  $120.77	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90700	DTAP VACCINE < 7 YRS IM                 	    32.25	   $32.25	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90702	DT VACCINE UNDER 7 YRS IM               	    69.05	   $69.05	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90707	MMR VACCINE SC                          	    97.41	   $97.41	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90710	MMRV VACCINE SC                         	   279.62	  $279.62	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90713	POLIOVIRUS IPV SC/IM                    	    48.44	   $48.44	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90714	TD VACC NO PRESV 7 YRS+ IM              	    38.42	   $38.42	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90715	TDAP VACCINE 7 YRS/> IM                 	    43.53	   $43.53	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90716	VAR VACCINE LIVE SUBQ                   	   186.71	  $186.71	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90717	YELLOW FEVER VACCINE SUBQ               	   228.43	  $228.43	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90723	DTAP-HEP B-IPV VACCINE IM               	   104.33	  $104.33	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90732	PPSV23 VACC 2 YRS+ SUBQ/IM              	   137.93	  $137.93	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90733	MPSV4 VACCINE SUBQ                      	   126.88	  $126.88	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90734	MENACWYD/MENACWYCRM VACC IM             	   168.65	  $168.65	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90736	HZV VACCINE LIVE SUBQ                   	   217.13	  $217.13	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90738	INACTIVATED JE VACC IM                  	   299.54	  $299.54	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90739	HEPB VACC 2/4 DOSE ADULT IM             	   182.02	  $182.02	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90740	HEPB VACC 3 DOSE IMMUNSUP IM            	   168.88	  $168.88	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90743	HEPB VACC 2 DOSE ADOLESC IM             	    79.61	   $79.61	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90744	HEPB VACC 3 DOSE PED/ADOL IM            	    36.13	   $36.13	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90746	HEPB VACCINE 3 DOSE ADULT IM            	    74.84	   $74.84	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90747	HEPB VACC 4 DOSE IMMUNSUP IM            	   145.21	  $145.21	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90748	HIB-HEPB VACCINE IM                     	    46.35	   $46.35	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90750	HZV VACC RECOMBINANT IM                 	   219.97	  $219.97	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90756	CCIIV4 VACC ABX FREE IM                 	    36.83	   $36.83	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90758	ZAIRE EBOLAVIRUS VAC LIVE IM            	     0.00	    $0.00	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	90759	HEP B VAC 3AG 10MCG 3 DOS IM            	    78.28	   $78.28	      ---	       --	030	0	0	0.00	    $0.00	Y	
Y	90785	PSYTX COMPLEX INTERACTIVE               	    13.36	   $13.36	      ---	       --	009	0	0	0.00	    $0.00	N	
X	90785	PSYTX COMPLEX INTERACTIVE               	    13.36	   $13.36	      ---	       --	009	1	0	0.00	    $0.00	Y	
Q	90785	PSYTX COMPLEX INTERACTIVE               	     4.73	    $3.88	      ---	       --	007	0	0	0.00	    $0.00	N	
N	90785	PSYTX COMPLEX INTERACTIVE               	     4.73	    $3.88	      ---	    $4.92	007	1	0	0.00	    $0.00	Y	
N	90791	PSYCH DIAGNOSTIC EVALUATION             	   156.19	  $128.08	      ---	  $162.44	007	1	0	0.00	    $0.00	Y	
Q	90791	PSYCH DIAGNOSTIC EVALUATION             	   156.19	  $128.08	      ---	       --	007	0	0	0.00	    $0.00	N	
X	90791	PSYCH DIAGNOSTIC EVALUATION             	   163.08	  $163.08	      ---	       --	009	1	0	0.00	    $0.00	Y	
Y	90791	PSYCH DIAGNOSTIC EVALUATION             	   163.08	  $163.08	      ---	       --	009	0	0	0.00	    $0.00	N	
E	90791	PSYCH DIAGNOSTIC EVALUATION             	   163.08	  $163.08	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	90792	PSYCH DIAG EVAL W/MED SRVCS             	   175.74	  $175.74	      ---	  $175.74	009	1	0	0.00	    $0.00	Y	
X	90792	PSYCH DIAG EVAL W/MED SRVCS             	   175.74	  $175.74	      ---	       --	009	1	0	0.00	    $0.00	Y	
N	90792	PSYCH DIAG EVAL W/MED SRVCS             	   125.91	  $103.25	      ---	  $130.95	007	1	0	0.00	    $0.00	Y	
N	90832	PSYTX W PT 30 MINUTES                   	    64.47	   $52.87	      ---	   $67.05	007	1	0	0.00	    $0.00	Y	
X	90832	PSYTX W PT 30 MINUTES                   	    67.83	   $67.83	      ---	       --	009	1	0	0.00	    $0.00	Y	
V	90832	PSYTX W PT 30 MINUTES                   	    64.47	   $52.87	      ---	   $67.05	007	1	0	0.00	    $0.00	Y	
Q	90832	PSYTX W PT 30 MINUTES                   	    18.98	   $18.98	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	90832	PSYTX W PT 30 MINUTES                   	    67.83	   $67.83	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	90832	PSYTX W PT 30 MINUTES                   	    67.83	   $67.83	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	90833	PSYTX W PT W E/M 30 MIN                 	    62.12	   $62.12	      ---	   $62.12	009	1	0	0.00	    $0.00	Y	
X	90833	PSYTX W PT W E/M 30 MIN                 	    62.12	   $62.12	      ---	       --	009	1	0	0.00	    $0.00	Y	
N	90833	PSYTX W PT W E/M 30 MIN                 	    42.06	   $34.49	      ---	   $43.74	007	1	0	0.00	    $0.00	Y	
N	90834	PSYTX W PT 45 MINUTES                   	    81.90	   $67.16	      ---	   $85.18	007	1	0	0.00	    $0.00	Y	
X	90834	PSYTX W PT 45 MINUTES                   	    89.64	   $89.64	      ---	       --	009	1	0	0.00	    $0.00	Y	
Q	90834	PSYTX W PT 45 MINUTES                   	    81.90	   $67.16	      ---	       --	007	0	0	0.00	    $0.00	N	
Y	90834	PSYTX W PT 45 MINUTES                   	    89.64	   $89.64	      ---	       --	009	0	0	0.00	    $0.00	N	
E	90834	PSYTX W PT 45 MINUTES                   	    89.64	   $89.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	90836	PSYTX W PT W E/M 45 MIN                 	    78.73	   $78.73	      ---	   $78.73	009	1	0	0.00	    $0.00	Y	
X	90836	PSYTX W PT W E/M 45 MIN                 	    78.73	   $78.73	      ---	       --	009	1	0	0.00	    $0.00	Y	
N	90836	PSYTX W PT W E/M 45 MIN                 	    68.32	   $56.02	      ---	   $71.05	007	1	0	0.00	    $0.00	Y	
N	90837	PSYTX W PT 60 MINUTES                   	   119.54	   $98.02	      ---	  $124.32	007	1	0	0.00	    $0.00	Y	
X	90837	PSYTX W PT 60 MINUTES                   	   131.97	  $131.97	      ---	       --	009	1	0	0.00	    $0.00	Y	
Q	90837	PSYTX W PT 60 MINUTES                   	    38.01	   $38.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	90837	PSYTX W PT 60 MINUTES                   	   131.97	  $131.97	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	90837	PSYTX W PT 60 MINUTES                   	   131.97	  $131.97	      ---	       --	009	0	0	0.00	    $0.00	Y	
G	90837	PSYTX W PT 60 MINUTES                   	    51.00	   $51.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	90838	PSYTX W PT W E/M 60 MIN                 	   104.13	  $104.13	      ---	  $104.13	009	1	0	0.00	    $0.00	Y	
X	90838	PSYTX W PT W E/M 60 MIN                 	   104.13	  $104.13	      ---	       --	009	1	0	0.00	    $0.00	Y	
N	90838	PSYTX W PT W E/M 60 MIN                 	   110.45	   $90.57	      ---	  $114.87	007	1	0	0.00	    $0.00	Y	
N	90839	PSYTX CRISIS INITIAL 60 MIN             	    38.01	   $38.01	      ---	   $38.01	009	1	0	0.00	    $0.00	Y	
X	90839	PSYTX CRISIS INITIAL 60 MIN             	   126.55	  $126.55	      ---	       --	009	1	0	0.00	    $0.00	Y	
Q	90839	PSYTX CRISIS INITIAL 60 MIN             	    38.01	   $38.01	      ---	       --	009	0	0	0.00	    $0.00	N	
Y	90839	PSYTX CRISIS INITIAL 60 MIN             	   126.55	  $126.55	      ---	       --	009	0	0	0.00	    $0.00	N	
E	90839	PSYTX CRISIS INITIAL 60 MIN             	   126.55	  $126.55	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	90840	PSYTX CRISIS EA ADDL 30 MIN             	    62.46	   $62.46	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	90840	PSYTX CRISIS EA ADDL 30 MIN             	    62.46	   $62.46	      ---	       --	009	0	0	0.00	    $0.00	N	
Q	90840	PSYTX CRISIS EA ADDL 30 MIN             	    18.98	   $18.98	      ---	       --	009	0	0	0.00	    $0.00	N	
X	90840	PSYTX CRISIS EA ADDL 30 MIN             	    62.46	   $62.46	      ---	       --	009	1	0	0.00	    $0.00	Y	
N	90840	PSYTX CRISIS EA ADDL 30 MIN             	    18.98	   $18.98	      ---	   $18.98	009	1	0	0.00	    $0.00	Y	
Y	90845	PSYCHOANALYSIS                          	    77.50	   $77.50	      ---	       --	009	0	0	0.00	    $0.00	N	
X	90846	FAMILY PSYTX W/O PT 50 MIN              	    86.64	   $86.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
Q	90846	FAMILY PSYTX W/O PT 50 MIN              	    86.64	   $86.64	      ---	       --	009	0	0	0.00	    $0.00	N	
N	90846	FAMILY PSYTX W/O PT 50 MIN              	    86.64	   $86.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	90846	FAMILY PSYTX W/O PT 50 MIN              	    86.64	   $86.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
G	90846	FAMILY PSYTX W/O PT 50 MIN              	    51.00	   $51.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
G	90847	FAMILY PSYTX W/PT 50 MIN                	    51.00	   $51.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	90847	FAMILY PSYTX W/PT 50 MIN                	    89.65	   $89.65	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	90847	FAMILY PSYTX W/PT 50 MIN                	    89.65	   $89.65	      ---	   $89.65	009	1	0	0.00	    $0.00	Y	
Q	90847	FAMILY PSYTX W/PT 50 MIN                	    89.65	   $89.65	      ---	       --	009	0	0	0.00	    $0.00	N	
X	90847	FAMILY PSYTX W/PT 50 MIN                	    89.65	   $89.65	      ---	       --	009	1	0	0.00	    $0.00	Y	
Y	90847	FAMILY PSYTX W/PT 50 MIN                	    89.65	   $89.65	      ---	       --	009	0	0	0.00	    $0.00	N	
Y	90849	MULTIPLE FAMILY GROUP PSYTX             	    33.88	   $33.88	      ---	       --	009	0	0	0.00	    $0.00	N	
X	90849	MULTIPLE FAMILY GROUP PSYTX             	    33.88	   $33.88	      ---	       --	009	0	0	0.00	    $0.00	Y	
Q	90849	MULTIPLE FAMILY GROUP PSYTX             	    31.85	   $31.85	      ---	       --	009	0	0	0.00	    $0.00	N	
N	90849	MULTIPLE FAMILY GROUP PSYTX             	    31.85	   $31.85	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	90849	MULTIPLE FAMILY GROUP PSYTX             	    33.88	   $33.88	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	90853	GROUP PSYCHOTHERAPY                     	    23.96	   $23.96	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	90853	GROUP PSYCHOTHERAPY                     	     4.23	    $3.47	      ---	    $4.40	007	1	1	0.00	    $0.00	Y	
Q	90853	GROUP PSYCHOTHERAPY                     	    14.48	   $14.48	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	90853	GROUP PSYCHOTHERAPY                     	    23.96	   $23.96	      ---	       --	009	1	1	0.00	    $0.00	Y	
Y	90853	GROUP PSYCHOTHERAPY                     	    23.96	   $23.96	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	90865	NARCOSYNTHESIS                          	   135.19	  $135.19	      ---	  $135.19	009	1	1	0.00	    $0.00	N	
Y	90867	TCRANIAL MAGN STIM TX PLAN              	   123.15	  $123.15	      ---	       --	009	0	0	0.00	    $0.00	N	
N	90867	TCRANIAL MAGN STIM TX PLAN              	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	90868	TCRANIAL MAGN STIM TX DELI              	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
Y	90868	TCRANIAL MAGN STIM TX DELI              	   123.15	  $123.15	      ---	       --	009	0	0	0.00	    $0.00	N	
Y	90869	TCRAN MAGN STIM REDETEMINE              	   123.15	  $123.15	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	90869	TCRAN MAGN STIM REDETEMINE              	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	90870	ELECTROCONVULSIVE THERAPY               	    92.40	   $75.77	      ---	   $96.10	007	1	0	0.00	    $0.00	Y	
Y	90870	ELECTROCONVULSIVE THERAPY               	    75.77	   $75.77	      ---	   $75.77	009	1	0	0.00	    $0.00	Y	
Y	90880	HYPNOTHERAPY                            	    93.88	   $93.88	      ---	       --	009	0	0	0.00	    $0.00	N	
X	90880	HYPNOTHERAPY                            	    93.88	   $93.88	      ---	       --	009	1	1	0.00	    $0.00	Y	
Q	90880	HYPNOTHERAPY                            	    63.55	   $52.11	      ---	       --	007	0	0	0.00	    $0.00	N	
N	90880	HYPNOTHERAPY                            	    63.55	   $52.11	      ---	   $66.09	007	1	1	0.00	    $0.00	Y	
Y	90882	ENVIRONMENTAL MANIPULATION              	    36.71	   $36.71	      ---	       --	009	0	0	0.00	    $0.00	N	
Y	90885	PSY EVALUATION OF RECORDS               	    38.91	   $38.91	      ---	   $38.91	009	1	1	0.00	    $0.00	N	
Y	90887	CONSULTATION WITH FAMILY                	    76.92	   $76.92	      ---	       --	009	0	0	0.00	    $0.00	N	
Y	90889	PREPARATION OF REPORT                   	    36.71	   $36.71	      ---	       --	009	0	0	0.00	    $0.00	N	
N	90899	UNLISTED PSYC SVC/THERAPY               	     0.00	    $0.00	      ---	       --	007	1	0	0.00	    $0.00	Y	
N	90935	HEMODIALYSIS ONE EVALUATION             	    69.02	   $56.60	      ---	   $71.78	007	1	0	0.00	    $0.00	Y	
N	90937	HEMODIALYSIS REPEATED EVAL              	   187.02	  $153.36	      ---	  $194.50	007	1	0	0.00	    $0.00	Y	
N	90940	HEMODIALYSIS ACCESS STUDY               	   126.23	  $103.51	      ---	  $131.28	007	1	0	0.00	    $0.00	Y	
N	90945	DIALYSIS ONE EVALUATION                 	    88.00	   $72.16	      ---	   $91.52	007	1	0	0.00	    $0.00	Y	
N	90947	DIALYSIS REPEATED EVAL                  	   132.00	  $108.24	      ---	  $137.28	007	1	0	0.00	    $0.00	Y	
N	90951	ESRD SERV 4 VISITS P MO <2YR            	    82.10	  $821.00	  $895.71	       --	001	0	0	0.00	    $0.00	Y	
N	90952	ESRD SERV 2-3 VSTS P MO <2YR            	     0.00	    $0.00	      ---	       --	001	0	0	0.00	    $0.00	Y	
N	90953	ESRD SERV 1 VISIT P MO <2YRS            	     0.00	    $0.00	      ---	       --	001	0	0	0.00	    $0.00	Y	
N	90954	ESRD SERV 4 VSTS P MO 2-11              	    66.41	  $664.10	  $724.53	       --	001	0	0	0.00	    $0.00	Y	
N	90955	ESRD SRV 2-3 VSTS P MO 2-11             	    37.78	  $377.80	  $412.18	       --	001	0	0	0.00	    $0.00	Y	
N	90956	ESRD SRV 1 VISIT P MO 2-11              	    25.60	  $256.00	  $279.30	       --	001	0	0	0.00	    $0.00	Y	
N	90957	ESRD SRV 4 VSTS P MO 12-19              	    53.53	  $535.30	  $584.01	       --	001	0	0	0.00	    $0.00	Y	
N	90958	ESRD SRV 2-3 VSTS P MO 12-19            	    36.19	  $361.90	  $394.83	       --	001	0	0	0.00	    $0.00	Y	
N	90959	ESRD SERV 1 VST P MO 12-19              	    23.74	  $237.40	  $259.00	       --	001	0	0	0.00	    $0.00	Y	
N	90960	ESRD SRV 4 VISITS P MO 20+              	    24.00	  $240.00	  $261.84	       --	001	0	0	0.00	    $0.00	Y	
N	90961	ESRD SRV 2-3 VSTS P MO 20+              	    19.32	  $193.20	  $210.78	       --	001	0	0	0.00	    $0.00	Y	
N	90962	ESRD SERV 1 VISIT P MO 20+              	    13.93	  $139.30	  $151.98	       --	001	0	0	0.00	    $0.00	Y	
N	90963	ESRD HOME PT SERV P MO <2YRS            	    45.97	  $459.70	  $501.53	       --	001	0	0	0.00	    $0.00	Y	
N	90964	ESRD HOME PT SERV P MO 2-11             	    38.15	  $381.50	  $416.22	       --	001	0	0	0.00	    $0.00	Y	
N	90965	ESRD HOME PT SERV P MO 12-19            	    36.30	  $363.00	  $396.03	       --	001	0	0	0.00	    $0.00	Y	
N	90966	ESRD HOME PT SERV P MO 20+              	    19.09	  $190.90	  $208.27	       --	001	0	0	0.00	    $0.00	Y	
N	90967	ESRD SVC PR DAY PT <2                   	     1.67	   $16.70	   $18.22	   $20.74	001	1	0	0.00	    $0.00	Y	
N	90968	ESRD SVC PR DAY PT 2-11                 	     1.28	   $12.80	   $13.96	   $15.90	001	1	0	0.00	    $0.00	Y	
N	90969	ESRD SVC PR DAY PT 12-19                	     1.25	   $12.50	   $13.64	   $15.53	001	1	0	0.00	    $0.00	Y	
N	90970	ESRD SVC PR DAY PT 20+                  	     0.67	    $6.70	    $7.31	    $8.32	001	1	0	0.00	    $0.00	Y	
N	90989	DIALYSIS TRAINING COMPLETE              	   667.40	  $667.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	90993	DIALYSIS TRAINING INCOMPL               	    33.98	   $27.86	      ---	   $35.34	007	1	0	0.00	    $0.00	Y	
N	90997	HEMOPERFUSION                           	   106.91	   $87.67	      ---	  $111.19	007	1	0	0.00	    $0.00	Y	
N	90999	UNLISTED DIALYSIS PROCEDURE             	     0.00	    $0.00	      ---	       --	007	1	0	0.00	    $0.00	Y	
N	91010	ESOPHAGUS MOTILITY STUDY                	    84.28	   $69.11	      ---	   $87.65	007	1	1	0.79	    $0.00	Y	
N	91013	ESOPHGL MOTIL W/STIM/PERFUS             	    25.29	   $20.74	      ---	   $26.30	007	1	0	0.00	    $0.00	N	
N	91020	GASTRIC MOTILITY STUDIES                	   112.30	   $92.09	      ---	  $116.79	007	1	1	0.82	    $0.00	Y	
N	91022	DUODENAL MOTILITY STUDY                 	   115.85	   $95.00	      ---	       --	007	0	0	0.82	    $0.00	Y	
N	91030	ACID PERFUSION OF ESOPHAGUS             	    49.34	   $40.46	      ---	   $51.31	007	1	1	0.87	    $0.00	Y	
N	91034	GASTROESOPHAGEAL REFLUX TEST            	    94.65	   $77.61	      ---	       --	007	0	0	0.78	    $0.00	Y	
N	91035	G-ESOPH REFLX TST W/ELECTROD            	   124.91	  $102.43	      ---	       --	007	0	0	0.71	    $0.00	Y	
N	91037	ESOPH IMPED FUNCTION TEST               	   163.68	  $134.22	      ---	       --	007	0	0	0.78	    $0.00	Y	
N	91038	ESOPH IMPED FUNCT TEST > 1HR            	   138.83	  $113.84	      ---	       --	007	0	0	0.71	    $0.00	Y	
N	91040	ESOPH BALLOON DISTENSION TST            	   508.05	  $416.60	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	91065	BREATH HYDROGEN/METHANE TEST            	    32.96	   $27.03	      ---	   $34.28	007	1	1	0.72	    $0.00	Y	
X	91065	BREATH HYDROGEN/METHANE TEST            	    79.98	   $79.98	      ---	       --	009	1	1	0.00	    $0.00	Y	
N	91110	GI TRC IMG INTRAL ESOPH-ILE             	   980.84	  $804.29	      ---	 $1020.07	007	1	0	0.15	    $0.00	Y	
N	91112	GI WIRELESS CAPSULE MEASURE             	  1318.38	 $1081.07	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	91113	GI TRC IMG INTRAL COLON I&R             	  1084.45	  $889.25	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	91122	ANORECTAL MANOMETRY                     	    73.62	   $60.37	      ---	   $76.56	007	1	1	0.78	    $0.00	Y	
N	91132	ELECTROGASTROGRAPHY                     	   114.68	   $94.04	      ---	  $119.27	007	1	0	0.72	    $0.00	Y	
N	91133	ELECTROGASTROGRAPHY W/TEST              	   137.62	  $112.85	      ---	  $143.12	007	1	0	0.72	    $0.00	Y	
N	91200	LIVER ELASTOGRAPHY                      	    39.09	   $32.05	      ---	       --	007	0	0	0.39	    $0.00	Y	
N	91299	UNLISTED DX GI PROCEDURE                	     0.00	    $0.00	      ---	       --	007	1	0	0.00	    $0.00	Y	
I	91304	SARSCOV2 VAC 5MCG/0.5ML IM              	   161.54	  $161.54	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	91318	SARSCOV2 VAC 3MCG TRS-SUC IM            	    65.55	   $65.55	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	91318	SARSCOV2 VAC 3MCG TRS-SUC IM            	    65.36	   $65.36	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	91319	SARSCV2 VAC 10MCG TRS-SUC IM            	    87.78	   $87.78	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	91319	SARSCV2 VAC 10MCG TRS-SUC IM            	    87.78	   $87.78	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	91320	SARSCV2 VAC 30MCG TRS-SUC IM            	   155.90	  $155.90	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	91320	SARSCV2 VAC 30MCG TRS-SUC IM            	   131.10	  $131.10	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	91321	SARSCOV2 VAC 25 MCG/.25ML IM            	   145.92	  $145.92	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	91321	SARSCOV2 VAC 25 MCG/.25ML IM            	   147.06	  $147.06	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	91322	SARSCOV2 VAC 50 MCG/0.5ML IM            	   161.65	  $161.65	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	91322	SARSCOV2 VAC 50 MCG/0.5ML IM            	   145.92	  $145.92	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	91323	SARSCOV2 VAC 10 MCG/0.2ML IM            	     0.00	    $0.00	      ---	       --	030	0	0	0.00	    $0.00	Y	
1	92002	INTRM OPH EXAM NEW PATIENT              	    32.80	   $32.80	      ---	   $32.80	009	1	1	0.00	    $0.00	Y	
N	92002	INTRM OPH EXAM NEW PATIENT              	    45.30	   $37.15	      ---	   $47.11	007	1	1	0.00	    $0.00	Y	
N	92004	COMPRE OPH EXAM NEW PT 1/>              	    60.71	   $49.78	      ---	   $63.14	007	1	1	0.00	    $0.00	Y	
1	92004	COMPRE OPH EXAM NEW PT 1/>              	    39.44	   $39.44	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	92012	INTRM OPH EXAM EST PATIENT              	    22.59	   $22.59	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	92012	INTRM OPH EXAM EST PATIENT              	    45.30	   $37.15	      ---	   $47.11	007	1	1	0.00	    $0.00	Y	
N	92014	COMPRE OPH EXAM EST PT 1/>              	    46.87	   $38.43	      ---	   $48.74	007	1	1	0.00	    $0.00	Y	
1	92014	COMPRE OPH EXAM EST PT 1/>              	    39.44	   $39.44	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	92015	DETERMINE REFRACTIVE STATE              	     9.77	    $8.01	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92015	DETERMINE REFRACTIVE STATE              	     9.77	    $8.01	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92018	COMPL OPH EXAM GENERAL ANES             	    58.39	   $47.88	      ---	   $60.73	007	1	0	0.00	    $0.00	Y	
N	92019	LMTD OPH EXAM GENERAL ANES              	    52.56	   $43.10	      ---	   $54.66	007	1	0	0.00	    $0.00	Y	
N	92020	GONIOSCOPY                              	    23.43	   $19.21	      ---	   $24.37	007	1	1	0.00	    $0.00	Y	
1	92020	GONIOSCOPY                              	    16.40	   $16.40	      ---	   $16.40	009	1	1	0.00	    $0.00	Y	
1	92025	CPTRIZED CORNEAL TOPOGRAPHY             	    26.82	   $26.82	      ---	       --	009	0	0	0.80	    $0.00	Y	
N	92025	CPTRIZED CORNEAL TOPOGRAPHY             	    32.71	   $26.82	      ---	       --	007	0	0	0.80	    $0.00	Y	
N	92060	SENSORIMOTOR EXAMINATION                	    41.20	   $33.78	      ---	   $42.85	007	1	1	0.78	    $0.00	Y	
1	92060	SENSORIMOTOR EXAMINATION                	    41.20	   $33.78	      ---	       --	007	0	0	0.78	    $0.00	Y	
1	92071	CONTACT LENS FITTING FOR TX             	    39.07	   $32.04	      ---	   $40.63	007	1	0	0.00	    $0.00	Y	
N	92071	CONTACT LENS FITTING FOR TX             	    39.07	   $32.04	      ---	   $40.63	007	1	0	0.00	    $0.00	Y	
N	92072	FITG C-LENS KERATOCONUS 1ST             	   124.31	  $101.93	      ---	  $129.28	007	1	0	0.00	    $0.00	Y	
1	92072	FITG C-LENS KERATOCONUS 1ST             	   124.31	  $101.93	      ---	  $129.28	007	1	0	0.00	    $0.00	Y	
1	92081	LIMITED VISUAL FIELD XM                 	    16.40	   $16.40	      ---	   $16.40	009	1	1	0.00	    $0.00	Y	
N	92081	LIMITED VISUAL FIELD XM                 	    40.18	   $32.95	      ---	   $41.79	007	1	1	0.77	    $0.00	Y	
N	92082	INTERMEDIATE VISUAL FIELD XM            	    41.55	   $34.07	      ---	   $43.21	007	1	1	0.77	    $0.00	Y	
1	92082	INTERMEDIATE VISUAL FIELD XM            	    22.14	   $22.14	      ---	   $22.14	009	1	1	0.00	    $0.00	Y	
1	92083	EXTENDED VISUAL FIELD XM                	    22.14	   $22.14	      ---	   $22.14	009	1	1	0.00	    $0.00	Y	
N	92083	EXTENDED VISUAL FIELD XM                	    37.21	   $30.51	      ---	   $38.70	007	1	1	0.78	    $0.00	Y	
N	92100	SERIAL TONOMETRY                        	    35.28	   $28.93	      ---	   $36.69	007	1	0	0.00	    $0.00	Y	
1	92100	SERIAL TONOMETRY                        	    28.93	   $28.93	      ---	   $28.93	009	1	0	0.00	    $0.00	Y	
1	92132	CPTRZD OPH DX IMG ANT SGM               	    32.24	   $32.24	      ---	   $32.24	009	1	0	0.56	    $0.00	Y	
N	92132	CPTRZD OPH DX IMG ANT SGM               	    32.24	   $26.44	      ---	   $33.53	007	1	0	0.56	    $0.00	Y	
N	92133	CPTRZD OPH DX IMG PST SGM ON            	    39.33	   $32.25	      ---	   $40.90	007	1	0	0.64	    $0.00	Y	
1	92133	CPTRZD OPH DX IMG PST SGM ON            	    39.33	   $39.33	      ---	   $39.33	009	1	0	0.64	    $0.00	Y	
1	92134	CPTRZ OPH DX IMG PST SGM RTA            	    39.33	   $39.33	      ---	   $39.33	009	1	0	0.64	    $0.00	Y	
N	92134	CPTRZ OPH DX IMG PST SGM RTA            	    39.33	   $32.25	      ---	   $40.90	007	1	0	0.64	    $0.00	Y	
N	92136	OPHTHALMIC BIOMETRY                     	    81.88	   $67.14	      ---	       --	007	0	0	0.34	    $0.00	Y	
N	92137	CPTRZ OPH IMG PST SG RTA OCT            	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
1	92137	CPTRZ OPH IMG PST SG RTA OCT            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	92201	OPSCPY EXTND RTA DRAW UNI/BI            	    26.96	   $22.11	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92202	OPSCPY EXTND ON/MAC DRAW                	    17.10	   $14.02	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92227	IMG RTA DETCJ/MNTR DS STAFF             	    10.72	    $8.79	      ---	       --	007	0	0	0.00	    $0.00	Y	
1	92227	IMG RTA DETCJ/MNTR DS STAFF             	    10.72	   $10.72	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	92228	IMG RTA DETC/MNTR DS PHY/QHP            	    26.66	   $26.66	      ---	       --	009	0	0	0.56	    $0.00	Y	
N	92228	IMG RTA DETC/MNTR DS PHY/QHP            	    26.66	   $21.86	      ---	       --	007	0	0	0.56	    $0.00	Y	
N	92229	IMG RTA DETC/MNTR DS POC ALY            	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
1	92229	IMG RTA DETC/MNTR DS POC ALY            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	92230	FLUORESCEIN ANGIOSCOPY I&R              	    56.63	   $46.44	      ---	   $58.90	007	1	1	0.00	    $0.00	Y	
N	92235	FLUORESCEIN ANGRPH MLTIFRAME            	    99.67	   $81.73	      ---	  $103.66	007	1	1	0.56	    $0.00	Y	
N	92240	ICG ANGIOGRAPHY I&R UNI/BI              	    90.23	   $73.99	      ---	   $93.84	007	1	0	0.60	    $0.00	Y	
N	92242	FLUORESCEIN&ICG ANGIOGRAPHY             	   253.37	  $207.76	      ---	       --	007	0	0	0.23	    $0.00	Y	
N	92250	FUNDUS PHOTOGRAPHY W/I&R                	    42.13	   $42.13	      ---	       --	009	0	1	0.78	    $0.00	Y	
1	92250	FUNDUS PHOTOGRAPHY W/I&R                	    42.13	   $42.13	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	92260	OPHTHALMODYNAMOMETRY                    	    40.00	   $32.80	      ---	   $41.60	007	1	1	0.00	    $0.00	Y	
N	92265	NDL OCULOELECTROMYOGRAPHY 1+            	    51.51	   $42.24	      ---	   $53.57	007	1	1	0.77	    $0.00	Y	
N	92270	ELECTRO-OCULOGRAPHY W/I&R               	    40.60	   $33.29	      ---	   $42.22	007	1	1	0.78	    $0.00	Y	
N	92273	FULL FIELD ERG W/I&R                    	   149.85	  $122.88	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92274	MULTIFOCAL ERG W/I&R                    	   100.80	   $82.66	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92283	EXTND COLOR VISION XM                   	    20.48	   $16.79	      ---	   $21.30	007	1	1	0.77	    $0.00	Y	
N	92284	DX DARK ADAPTATION EXAM I&R             	    24.87	   $20.39	      ---	   $25.86	007	1	1	0.77	    $0.00	Y	
1	92284	DX DARK ADAPTATION EXAM I&R             	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
1	92310	CONTACT LENS FITTING OU                 	    36.40	   $36.40	      ---	   $36.40	009	1	1	0.00	    $0.00	Y	
N	92310	CONTACT LENS FITTING OU                 	    44.39	   $36.40	      ---	   $46.17	007	1	1	0.00	    $0.00	Y	
N	92311	CONTACT LENS FITG APHAKIA 1             	    44.72	   $36.67	      ---	   $46.51	007	1	1	0.00	    $0.00	Y	
1	92311	CONTACT LENS FITG APHAKIA 1             	    36.40	   $36.40	      ---	   $36.40	009	1	1	0.00	    $0.00	Y	
1	92312	CONTACT LENS FITG APHAKIA OU            	    36.40	   $36.40	      ---	   $36.40	009	1	1	0.00	    $0.00	Y	
N	92312	CONTACT LENS FITG APHAKIA OU            	    53.45	   $43.83	      ---	   $55.59	007	1	1	0.00	    $0.00	Y	
N	92313	C-LENS FITG CORNEOSCLRL LENS            	    40.18	   $32.95	      ---	   $41.79	007	1	1	0.00	    $0.00	Y	
1	92313	C-LENS FITG CORNEOSCLRL LENS            	     0.00	    $0.00	      ---	       --	001	0	0	0.00	    $0.00	Y	
N	92314	C-LENS FITG TECH OU                     	    43.95	   $36.04	      ---	   $45.71	007	1	1	0.00	    $0.00	Y	
N	92315	C-LENS FITG TECH APHAKIA 1              	    43.95	   $36.04	      ---	   $45.71	007	1	1	0.00	    $0.00	Y	
N	92316	C-LENS FITG TECH APHAKIA OU             	    58.15	   $47.68	      ---	   $60.48	007	1	1	0.00	    $0.00	Y	
N	92317	C-LENS FITG TECH CORNEOSCLRL            	    32.38	   $26.55	      ---	   $33.68	007	1	1	0.00	    $0.00	Y	
N	92325	MODIFICATION OF CONTACT LENS            	    14.89	   $12.21	      ---	   $15.49	007	1	1	0.00	    $0.00	Y	
N	92340	FIT SPECTACLES MONOFOCAL                	    10.77	   $10.77	      ---	       --	009	0	1	0.00	    $0.00	Y	
1	92340	FIT SPECTACLES MONOFOCAL                	    10.77	   $10.77	      ---	       --	009	0	1	0.00	    $0.00	Y	
1	92341	FIT SPECTACLES BIFOCAL                  	    15.90	   $15.90	      ---	       --	009	0	1	0.00	    $0.00	Y	
N	92341	FIT SPECTACLES BIFOCAL                  	    15.90	   $15.90	      ---	       --	009	0	1	0.00	    $0.00	Y	
N	92342	FIT SPECTACLES MULTIFOCAL               	    21.88	   $21.88	      ---	       --	009	0	1	0.00	    $0.00	Y	
1	92342	FIT SPECTACLES MULTIFOCAL               	    21.88	   $21.88	      ---	       --	009	0	1	0.00	    $0.00	Y	
1	92352	FIT APHAKIA SPECTCL MONOFOCL            	    10.77	   $10.77	      ---	       --	009	0	1	0.00	    $0.00	Y	
N	92352	FIT APHAKIA SPECTCL MONOFOCL            	    10.77	   $10.77	      ---	       --	009	0	1	0.00	    $0.00	Y	
N	92353	FIT APHAKIA SPECTCL MULTIFOC            	    15.90	   $15.90	      ---	   $15.90	009	1	1	0.00	    $0.00	N	
1	92353	FIT APHAKIA SPECTCL MULTIFOC            	    15.90	   $15.90	      ---	       --	009	0	1	0.00	    $0.00	Y	
1	92370	RPR&REFITG SPECT XCP APHAKIA            	     6.30	    $6.30	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	92370	RPR&REFITG SPECT XCP APHAKIA            	     6.30	    $6.30	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	92371	RPR&REFIT SPCT PRSTH APHAKIA            	     6.30	    $6.30	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	92371	RPR&REFIT SPCT PRSTH APHAKIA            	     6.30	    $6.30	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	92499	UNLISTED OPH SVC/PROCEDURE              	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
N	92499	UNLISTED OPH SVC/PROCEDURE              	     0.00	    $0.00	      ---	       --	008	0	1	0.00	    $0.00	Y	
N	92502	EAR AND THROAT EXAMINATION              	    75.32	   $61.76	      ---	   $78.33	007	1	1	0.00	    $0.00	Y	
X	92502	EAR AND THROAT EXAMINATION              	    85.82	   $85.82	      ---	       --	009	1	1	0.00	    $0.00	Y	
N	92504	EAR MICROSCOPY EXAMINATION              	    20.30	   $16.65	      ---	   $21.11	007	1	1	0.00	    $0.00	Y	
N	92507	TX SP LANG VOICE COMM INDIV             	    36.24	   $29.72	      ---	   $37.69	007	1	1	0.00	    $0.00	Y	
E	92507	TX SP LANG VOICE COMM INDIV             	    56.41	   $56.41	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	92508	TX SP LANG VOICE COMM GROUP             	     2.46	    $2.46	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	92508	TX SP LANG VOICE COMM GROUP             	    25.17	   $20.64	      ---	   $26.18	007	1	1	0.00	    $0.00	Y	
N	92511	NASOPHARYNGOSCOPY                       	    50.96	   $41.79	      ---	   $53.00	007	1	1	0.00	    $0.00	Y	
N	92512	NASAL FUNCTION STUDIES                  	    29.98	   $24.58	      ---	   $31.18	007	1	1	0.00	    $0.00	Y	
N	92516	FACIAL NERVE FUNCTION TEST              	    23.96	   $19.65	      ---	   $24.92	007	1	1	0.00	    $0.00	Y	
N	92520	LARYNGEAL FUNCTION STUDIES              	    36.74	   $30.13	      ---	   $38.21	007	1	1	0.00	    $0.00	Y	
N	92521	EVALUATION OF SPEECH FLUENCY            	    74.98	   $74.98	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	92521	EVALUATION OF SPEECH FLUENCY            	    62.81	   $62.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	92522	EVALUATE SPEECH PRODUCTION              	    53.84	   $53.84	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	92522	EVALUATE SPEECH PRODUCTION              	    64.11	   $64.11	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	92523	SPEECH SOUND LANG COMPREHEN             	   130.58	  $130.58	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	92523	SPEECH SOUND LANG COMPREHEN             	   107.68	  $107.68	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	92524	BEHAVRAL QUALIT ANALYS VOICE            	    53.84	   $53.84	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	92524	BEHAVRAL QUALIT ANALYS VOICE            	    62.08	   $62.08	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	92526	ORAL FUNCTION THERAPY                   	    41.24	   $33.82	      ---	   $42.89	007	1	1	0.00	    $0.00	Y	
N	92531	SPONTANEOUS NYSTAGMUS STUDY             	     0.00	    $0.00	      ---	       --	007	1	1	0.00	    $0.00	Y	
N	92532	POSITIONAL NYSTAGMUS TEST               	     0.00	    $0.00	      ---	       --	007	1	1	0.00	    $0.00	Y	
N	92533	CALORIC VESTIBULAR TEST                 	    33.98	   $27.86	      ---	   $35.34	007	1	1	0.00	    $0.00	Y	
N	92534	OPTOKINETIC NYSTAGMUS TEST              	     0.00	    $0.00	      ---	       --	007	1	1	0.00	    $0.00	Y	
N	92537	CALORIC VSTBLR TEST W/REC               	    43.08	   $35.33	      ---	       --	007	0	1	0.00	    $0.00	Y	
N	92538	CALORIC VSTBLR TEST W/REC               	    21.87	   $17.93	      ---	       --	007	0	1	0.00	    $0.00	Y	
N	92540	BASIC VESTIBULAR EVALUATION             	   100.16	   $82.13	      ---	       --	007	0	0	0.78	    $0.00	Y	
N	92541	SPONTANEOUS NYSTAGMUS TEST              	    17.77	   $14.57	      ---	   $18.48	007	1	1	0.40	    $0.00	Y	
N	92542	POSITIONAL NYSTAGMUS TEST               	    16.99	   $13.93	      ---	   $17.67	007	1	1	0.40	    $0.00	Y	
N	92544	OPTOKINETIC NYSTAGMUS TEST              	    16.99	   $13.93	      ---	   $17.67	007	1	1	0.40	    $0.00	Y	
N	92545	OSCILLATING TRACKING TEST               	    16.99	   $13.93	      ---	   $17.67	007	1	1	0.40	    $0.00	Y	
N	92546	SINUSOIDAL ROTATIONAL TEST              	    16.99	   $13.93	      ---	   $17.67	007	1	1	0.40	    $0.00	Y	
N	92547	SUPPLEMENTAL ELECTRICAL TEST            	    16.99	   $13.93	      ---	   $17.67	007	1	1	0.40	    $0.00	Y	
N	92550	TYMPANOMETRY & REFLEX THRESH            	    21.55	   $17.67	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92551	PURE TONE HEARING TEST AIR              	     1.02	   $10.20	   $11.13	   $12.67	053	1	1	0.00	    $0.00	Y	
X	92551	PURE TONE HEARING TEST AIR              	    11.37	   $11.37	      ---	       --	009	1	1	0.00	    $0.00	Y	
E	92551	PURE TONE HEARING TEST AIR              	     7.38	    $7.38	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	92552	PURE TONE AUDIOMETRY AIR                	    11.08	   $11.08	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	92552	PURE TONE AUDIOMETRY AIR                	    33.77	   $33.77	      ---	       --	009	1	1	0.00	    $0.00	Y	
N	92552	PURE TONE AUDIOMETRY AIR                	     1.53	   $15.30	   $16.69	   $19.00	053	1	1	0.00	    $0.00	Y	
N	92553	AUDIOMETRY AIR & BONE                   	     2.04	   $20.40	   $22.26	   $25.34	053	1	1	0.00	    $0.00	Y	
N	92555	SPEECH THRESHOLD AUDIOMETRY             	     1.12	   $11.20	   $12.22	   $13.91	053	1	1	0.00	    $0.00	Y	
N	92556	SPEECH AUDIOMETRY COMPLETE              	     2.70	   $27.00	   $29.46	   $33.53	053	1	1	0.00	    $0.00	Y	
N	92557	COMPREHENSIVE HEARING TEST              	    49.83	   $40.86	      ---	   $51.82	007	1	1	0.00	    $0.00	Y	
E	92557	COMPREHENSIVE HEARING TEST              	   181.49	  $181.49	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	92558	EVOKED AUDITORY TEST QUAL               	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
X	92558	EVOKED AUDITORY TEST QUAL               	     8.52	    $8.52	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	92562	LOUDNESS BALANCE TEST                   	     9.39	    $7.70	      ---	    $9.77	007	1	1	0.00	    $0.00	Y	
N	92563	TONE DECAY HEARING TEST                 	     8.73	    $7.16	      ---	    $9.08	007	1	1	0.00	    $0.00	Y	
N	92565	STENGER TEST PURE TONE                  	    11.33	    $9.29	      ---	   $11.78	007	1	1	0.00	    $0.00	Y	
N	92568	ACOUSTIC REFL THRESHOLD TST             	    11.32	    $9.28	      ---	   $11.77	007	1	1	0.00	    $0.00	Y	
N	92570	ACOUSTIC IMMITANCE TESTING              	    32.73	   $26.84	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92571	FILTERED SPEECH TEST                    	    11.62	    $9.53	      ---	   $12.08	007	1	1	0.00	    $0.00	Y	
N	92572	STAGGERED SPONDAIC WORD TEST            	     2.54	    $2.08	      ---	    $2.64	007	1	1	0.00	    $0.00	Y	
N	92575	SENSORINEURAL ACUITY LVL TST            	     9.07	    $7.44	      ---	    $9.43	007	1	1	0.00	    $0.00	Y	
N	92576	SYNTHETIC SENTENCE ID TEST              	    14.72	   $12.07	      ---	   $15.31	007	1	1	0.00	    $0.00	Y	
N	92577	STENGER TEST SPEECH                     	    16.60	   $13.61	      ---	   $17.26	007	1	1	0.00	    $0.00	Y	
N	92579	VISUAL AUDIOMETRY (VRA)                 	    31.01	   $25.43	      ---	   $32.25	007	1	1	0.00	    $0.00	Y	
N	92582	CONDITIONING PLAY AUDIOMETRY            	    38.06	   $38.06	      ---	       --	009	0	1	0.00	    $0.00	Y	
N	92587	EVOKED AUDITORY TEST LIMITED            	     4.10	   $41.00	   $44.73	   $50.92	053	1	0	0.15	    $0.00	Y	
X	92587	EVOKED AUDITORY TEST LIMITED            	    41.00	   $41.00	      ---	       --	009	1	0	0.00	    $0.00	Y	
N	92588	EVOKED AUDITORY TST COMPLETE            	    62.51	   $51.26	      ---	   $65.01	007	1	0	0.30	    $0.00	Y	
N	92590	HEARING AID XM&SLCTN MONAURL            	    41.90	   $34.36	      ---	   $43.58	007	1	1	0.00	    $0.00	Y	
N	92591	HEARING AID XM&SLCTN BINAURL            	    41.90	   $34.36	      ---	   $43.58	007	1	1	0.00	    $0.00	Y	
N	92594	ELECTRO HEARNG AID TEST ONE             	    20.32	   $20.32	      ---	       --	009	0	1	0.00	    $0.00	Y	
N	92595	ELECTRO HEARNG AID TST BOTH             	    37.30	   $37.30	      ---	       --	009	0	1	0.00	    $0.00	Y	
N	92597	ORAL SPEECH DEVICE EVAL                 	    99.87	   $81.89	      ---	  $103.86	007	1	1	0.00	    $0.00	Y	
N	92601	COCHLEAR IMPLT F/UP EXAM <7             	   140.16	  $114.93	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92602	REPROGRAM COCHLEAR IMPLT <7             	    98.24	   $80.56	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92603	COCHLEAR IMPLT F/UP EXAM 7/>            	    94.29	   $77.32	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92604	REPROGRAM COCHLEAR IMPLT 7/>            	    64.24	   $52.68	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92605	EX FOR NONSPEECH DEVICE RX              	    42.39	   $34.76	      ---	   $44.09	007	1	1	0.00	    $0.00	Y	
N	92606	NON-SPEECH DEVICE SERVICE               	    42.39	   $34.76	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92607	EX FOR SPEECH DEVICE RX 1HR             	   117.04	   $95.97	      ---	  $121.72	007	1	1	0.00	    $0.00	Y	
N	92608	EX FOR SPEECH DEVICE RX ADDL            	    22.93	   $18.80	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92609	USE OF SPEECH DEVICE SERVICE            	    63.35	   $51.95	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92610	EVALUATE SWALLOWING FUNCTION            	    59.49	   $48.78	      ---	   $61.87	007	1	1	0.00	    $0.00	Y	
N	92611	MOTION FLUOROSCOPY/SWALLOW              	    48.72	   $39.95	      ---	   $50.67	007	1	1	0.00	    $0.00	Y	
N	92612	ENDOSCOPY SWALLOW (FEES) VID            	   140.15	  $114.92	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92613	ENDOSCOPY SWALLOW (FEES) I&R            	    41.13	   $33.73	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92614	LARYNGOSCOPIC SENSORY VID               	   104.51	   $85.70	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92615	LARYNGOSCOPIC SENSORY I&R               	    34.46	   $28.26	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92616	FEES W/LARYNGEAL SENSE TEST             	   144.41	  $118.42	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92617	FEES W/LARYNGEAL SENSE I&R              	    45.70	   $37.47	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92618	EX FOR NONSPEECH DEV RX ADD             	    33.59	   $27.54	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92620	AUDITORY FUNCTION 60 MIN                	    49.70	   $40.75	      ---	   $51.69	007	1	1	0.00	    $0.00	Y	
N	92621	AUDITORY FUNCTION + 15 MIN              	    12.33	   $10.11	      ---	   $12.82	007	1	1	0.00	    $0.00	Y	
N	92622	DX ALY AUD OI SND PRCSR 1ST             	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92623	DX ALY AUD OI SND PRCSR EACH            	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92625	TINNITUS ASSESSMENT                     	    48.87	   $40.07	      ---	   $50.82	007	1	1	0.00	    $0.00	Y	
X	92625	TINNITUS ASSESSMENT                     	    62.38	   $62.38	      ---	       --	009	1	1	0.00	    $0.00	Y	
N	92626	EVAL AUD FUNCJ 1ST HOUR                 	    24.45	   $20.05	      ---	       --	007	0	1	0.00	    $0.00	Y	
N	92627	EVAL AUD FUNCJ EA ADDL 15               	    24.45	   $20.05	      ---	       --	007	0	1	0.00	    $0.00	Y	
N	92630	AUD REHAB PRE-LING HEAR LOSS            	     0.00	    $0.00	      ---	       --	007	0	1	0.00	    $0.00	Y	
N	92633	AUD REHAB POSTLING HEAR LOSS            	     0.00	    $0.00	      ---	       --	007	0	1	0.00	    $0.00	Y	
N	92650	AEP SCR AUDITORY POTENTIAL              	    31.32	   $25.68	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92651	AEP HEARING STATUS DETER I&R            	    98.32	   $80.62	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92652	AEP THRSHLD EST MLT FREQ I&R            	   127.61	  $104.64	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92653	AEP NEURODIAGNOSTIC I&R                 	    93.81	   $76.92	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92700	UNLISTED ORL SERVICE/PX                 	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92920	PRQ CARDIAC ANGIOPLAST 1 ART            	   530.64	  $435.12	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92921	PRQ CARDIAC ANGIO ADDL ART              	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92924	PRQ CARD ANGIO/ATHRECT 1 ART            	   630.81	  $517.26	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92925	PRQ CARD ANGIO/ATHRECT ADDL             	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92928	PRQ CARD STENT W/ANGIO 1 VSL            	   589.08	  $483.05	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92929	PRQ CARD STENT W/ANGIO ADDL             	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92933	PRQ CARD STENT/ATH/ANGIO                	   658.72	  $540.15	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92934	PRQ CARD STENT/ATH/ANGIO                	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92937	PRQ REVASC BYP GRAFT 1 VSL              	   588.36	  $482.46	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92938	PRQ REVASC BYP GRAFT ADDL               	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92941	PRQ CARD REVASC MI 1 VSL                	   659.98	  $541.18	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92943	PRQ CARD REVASC CHRONIC 1VSL            	   659.98	  $541.18	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92944	PRQ CARD REVASC CHRONIC ADDL            	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92950	HEART/LUNG RESUSCITATION CPR            	    11.50	  $115.00	  $125.47	  $142.83	053	1	0	0.00	    $0.00	Y	
X	92950	HEART/LUNG RESUSCITATION CPR            	   299.11	  $299.11	      ---	       --	009	1	0	0.00	    $0.00	Y	
N	92953	TEMPORARY EXTERNAL PACING               	    24.88	   $20.40	      ---	   $25.88	007	1	1	0.00	    $0.00	Y	
N	92960	CARDIOVERSION ELECTRIC EXT              	   122.46	  $122.46	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	92961	CARDIOVERSION ELECTRIC INT              	   210.71	  $172.78	      ---	  $219.14	007	1	0	0.00	    $0.00	Y	
N	92970	CARDIOASSIST INTERNAL                   	   229.87	  $188.49	      ---	  $239.06	007	1	0	0.00	    $0.00	Y	
N	92971	CARDIOASSIST EXTERNAL                   	    96.63	   $79.24	      ---	  $100.50	007	1	0	0.00	    $0.00	Y	
N	92972	PERQ TRLUML CORONRY LITHOTRP            	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92973	PRQ CORONARY MECH THROMBECT             	   178.91	  $146.71	      ---	  $186.07	007	1	0	0.00	    $0.00	Y	
N	92974	CATH PLACE CARDIO BRACHYTX              	   194.11	  $159.17	      ---	  $201.87	007	1	0	0.00	    $0.00	Y	
N	92975	DISSOLVE CLOT HEART VESSEL              	   410.72	  $336.79	      ---	  $427.15	007	1	0	0.00	    $0.00	Y	
N	92977	DISSOLVE CLOT HEART VESSEL              	   304.18	  $249.43	      ---	  $316.35	007	1	0	0.00	    $0.00	Y	
N	92978	ENDOLUMINL IVUS OCT C 1ST               	    58.95	  $225.19	      ---	       --	005	0	0	0.37	    $0.00	Y	
N	92979	ENDOLUMINL IVUS OCT C EA                	    36.07	  $137.79	      ---	       --	005	0	0	0.48	    $0.00	Y	
N	92986	REVISION OF AORTIC VALVE                	  1177.90	  $965.88	      ---	 $1225.02	007	1	0	0.00	    $0.00	Y	
O	92986	REVISION OF AORTIC VALVE                	   235.59	  $193.18	      ---	  $245.01	007	1	0	0.00	    $0.00	Y	
O	92987	REVISION OF MITRAL VALVE                	   254.60	  $208.77	      ---	  $264.78	007	1	0	0.00	    $0.00	Y	
N	92987	REVISION OF MITRAL VALVE                	  1272.99	 $1043.85	      ---	 $1323.91	007	1	0	0.00	    $0.00	Y	
N	92990	REVISION OF PULMONARY VALVE             	   998.80	  $819.02	      ---	 $1038.75	007	1	0	0.00	    $0.00	Y	
O	92990	REVISION OF PULMONARY VALVE             	   199.76	  $163.80	      ---	  $207.75	007	1	0	0.00	    $0.00	Y	
N	92997	PUL ART BALLOON REPR PERCUT             	   664.40	  $544.81	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	92998	PUL ART BALLOON REPR PERCUT             	   345.99	  $283.71	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93000	ELECTROCARDIOGRAM COMPLETE              	    35.00	   $28.70	      ---	   $36.40	007	1	1	0.00	    $0.00	Y	
X	93000	ELECTROCARDIOGRAM COMPLETE              	    28.70	   $28.70	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	93005	ELECTROCARDIOGRAM TRACING               	    16.40	   $16.40	      ---	       --	009	1	1	0.00	    $0.00	Y	
1	93005	ELECTROCARDIOGRAM TRACING               	     7.43	    $7.43	      ---	    $7.43	009	1	1	0.00	    $0.00	Y	
N	93005	ELECTROCARDIOGRAM TRACING               	    20.00	   $16.40	      ---	   $20.80	007	1	1	0.00	    $0.00	Y	
N	93010	ELECTROCARDIOGRAM REPORT                	    15.00	   $12.30	      ---	   $15.60	007	1	1	0.00	    $0.00	Y	
X	93010	ELECTROCARDIOGRAM REPORT                	    12.30	   $12.30	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	93015	CARDIOVASCULAR STRESS TEST              	    95.91	   $95.91	      ---	       --	009	1	1	0.00	    $0.00	Y	
N	93015	CARDIOVASCULAR STRESS TEST              	   116.96	   $95.91	      ---	  $121.64	007	1	1	0.00	    $0.00	Y	
N	93016	CARDIOVASCULAR STRESS TEST              	    29.96	   $24.57	      ---	   $31.16	007	1	0	0.00	    $0.00	Y	
X	93016	CARDIOVASCULAR STRESS TEST              	    24.57	   $24.57	      ---	       --	009	1	0	0.00	    $0.00	Y	
X	93017	CARDIOVASCULAR STRESS TEST              	    52.50	   $52.50	      ---	       --	009	1	1	0.00	    $0.00	Y	
N	93017	CARDIOVASCULAR STRESS TEST              	    64.02	   $52.50	      ---	   $66.58	007	1	1	0.00	    $0.00	Y	
N	93018	CARDIOVASCULAR STRESS TEST              	    22.98	   $18.84	      ---	   $23.90	007	1	1	0.00	    $0.00	Y	
X	93018	CARDIOVASCULAR STRESS TEST              	    18.84	   $18.84	      ---	       --	009	1	1	0.00	    $0.00	Y	
N	93024	ERGONOVINE PROVOCATION TEST             	   127.48	  $104.53	      ---	  $132.58	007	1	0	0.70	    $0.00	Y	
N	93025	MICROVOLT T-WAVE ASSESS                 	   284.49	  $233.28	      ---	       --	007	0	0	0.70	    $0.00	Y	
N	93040	RHYTHM ECG WITH REPORT                  	    15.94	   $13.07	      ---	   $16.58	007	1	1	0.00	    $0.00	Y	
X	93040	RHYTHM ECG WITH REPORT                  	    13.07	   $13.07	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	93041	RHYTHM ECG TRACING                      	    16.07	   $16.07	      ---	       --	009	1	1	0.00	    $0.00	Y	
1	93041	RHYTHM ECG TRACING                      	    16.07	   $16.07	      ---	   $16.07	009	1	1	0.00	    $0.00	Y	
N	93041	RHYTHM ECG TRACING                      	     6.26	    $5.13	      ---	    $6.51	007	1	1	0.00	    $0.00	Y	
N	93042	RHYTHM ECG REPORT                       	    10.40	    $8.53	      ---	   $10.82	007	1	1	0.00	    $0.00	Y	
X	93042	RHYTHM ECG REPORT                       	     8.53	    $8.53	      ---	       --	009	1	1	0.00	    $0.00	Y	
N	93050	ART PRESSURE WAVEFORM ANALYS            	    18.76	   $15.38	      ---	       --	007	0	0	0.47	    $0.00	Y	
N	93150	THERAPY ACTIVATION IPNSS                	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93151	INTERROG&PRGRMG IPNSS                   	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93152	INTERROG&PRGRMG IPNSS POLYSM            	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93153	INTERROG W/O PRGRMG IPNSS               	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93224	XTRNL ECG REC UP TO 48 HRS              	   135.17	  $110.84	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93225	XTRNL ECG REC<48 HRS REC                	    36.37	   $29.82	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93226	XTRNL ECG REC<48 HR SCAN A/R            	    68.22	   $55.94	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93227	XTRNL ECG REC<48 HR R&I                 	    30.59	   $25.08	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93228	REMOTE 30 DAY ECG REV/REPORT            	    26.28	   $21.55	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93229	REMOTE 30 DAY ECG TECH SUPP             	   823.12	  $674.96	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93241	XTRNL ECG REC>48HR<7D                   	   268.65	  $220.29	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93242	EXT ECG>48HR<7D RECORDING               	    17.11	   $14.03	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93243	EXT ECG>48HR<7D SCAN A/R                	   234.11	  $191.97	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93244	EXT ECG>48HR<7D REV&INTERPJ             	    25.68	   $21.06	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93245	EXT ECG>7D<15D REC SCAN A/R             	   282.50	  $231.65	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93246	EXT ECG>7D<15D RECORDING                	    17.11	   $14.03	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93247	EXT ECG>7D<15D SCAN A/R                 	   245.64	  $201.42	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93248	EXT ECG>7D<15D REV&INTERPJ              	    28.25	   $23.17	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93260	PRGRMG DEV EVAL IMPLTBL SYS             	    72.01	   $59.05	      ---	       --	007	0	0	0.65	    $0.00	Y	
N	93261	INTERROGATE SUBQ DEFIB                  	    66.01	   $54.13	      ---	       --	007	0	0	0.62	    $0.00	Y	
N	93264	REM MNTR WRLS P-ART PRS SNR             	    54.54	   $44.72	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93268	ECG RECORD/REVIEW                       	   172.49	  $141.44	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93270	REMOTE 30 DAY ECG REV/REPORT            	    36.37	   $29.82	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93271	ECG/MONITORING AND ANALYSIS             	    97.32	   $79.80	      ---	       --	007	0	0	0.00	    $0.00	Y	
X	93271	ECG/MONITORING AND ANALYSIS             	   139.66	  $139.66	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	93272	ECG/REVIEW INTERPRET ONLY               	    21.75	   $21.75	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	93272	ECG/REVIEW INTERPRET ONLY               	    26.52	   $21.75	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93278	ECG/SIGNAL-AVERAGED                     	    32.82	   $26.91	      ---	       --	007	0	0	0.39	    $0.00	Y	
N	93279	PRGRMG DEV EVAL PM/LDLS PM              	    59.50	   $48.79	      ---	       --	007	0	0	0.63	    $0.00	Y	
N	93280	PM DEVICE PROGR EVAL DUAL               	    70.62	   $57.91	      ---	       --	007	0	0	0.64	    $0.00	Y	
N	93281	PM DEVICE PROGR EVAL MULTI              	    82.55	   $67.69	      ---	       --	007	0	0	0.64	    $0.00	Y	
N	93282	PRGRMG EVAL IMPLANTABLE DFB             	    76.04	   $62.35	      ---	       --	007	0	0	0.65	    $0.00	Y	
N	93283	PRGRMG EVAL IMPLANTABLE DFB             	    92.56	   $75.90	      ---	       --	007	0	0	0.67	    $0.00	Y	
N	93284	PRGRMG EVAL IMPLANTABLE DFB             	   108.45	   $88.93	      ---	       --	007	0	0	0.68	    $0.00	Y	
N	93285	PRGRMG DEV EVAL SCRMS IP                	    51.50	   $42.23	      ---	       --	007	0	0	0.60	    $0.00	Y	
N	93286	PERI-PX EVAL PM/LDLS PM IP              	    29.07	   $23.84	      ---	       --	007	0	0	0.53	    $0.00	Y	
N	93287	PERI-PX DEVICE EVAL & PRGR              	    38.04	   $31.19	      ---	       --	007	0	0	0.60	    $0.00	Y	
N	93288	INTERROG EVL PM/LDLS PM IP              	    46.37	   $38.02	      ---	       --	007	0	0	0.54	    $0.00	Y	
N	93289	INTERROG DEVICE EVAL HEART              	    70.98	   $58.20	      ---	       --	007	0	0	0.64	    $0.00	Y	
N	93290	INTERROG DEV EVAL ICPMS IP              	    33.41	   $27.40	      ---	       --	007	0	0	0.65	    $0.00	Y	
N	93291	INTERROG DEV EVAL SCRMS IP              	    44.30	   $36.33	      ---	       --	007	0	0	0.58	    $0.00	Y	
N	93292	WCD DEVICE INTERROGATE                  	    44.66	   $36.62	      ---	       --	007	0	0	0.57	    $0.00	Y	
N	93293	PM PHONE R-STRIP DEVICE EVAL            	    64.40	   $52.81	      ---	       --	007	0	0	0.27	    $0.00	Y	
N	93294	REM INTERROG EVL PM/LDLS PM             	    38.22	   $31.34	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93295	DEV INTERROG REMOTE 1/2/MLT             	    69.22	   $56.76	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93296	REM INTERROG EVL PM/IDS                 	    41.41	   $33.96	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93297	REM INTERROG DEV EVAL ICPMS             	    26.28	   $21.55	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93298	REM INTERROG DEV EVAL SCRMS             	    30.82	   $25.27	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93303	ECHO TRANSTHORACIC                      	   186.16	  $152.65	      ---	  $193.61	007	1	0	0.36	    $0.00	Y	
N	93304	ECHO TRANSTHORACIC                      	   101.80	   $83.48	      ---	  $105.87	007	1	0	0.41	    $0.00	Y	
N	93306	TTE W/DOPPLER COMPLETE                  	   292.39	  $239.76	      ---	       --	007	0	0	0.26	    $0.00	Y	
N	93307	TTE W/O DOPPLER COMPLETE                	   183.05	  $150.10	      ---	       --	007	0	0	0.40	    $0.00	Y	
N	93308	TTE F-UP OR LMTD                        	    91.52	   $75.05	      ---	       --	007	0	0	0.40	    $0.00	Y	
N	93312	ECHO TRANSESOPHAGEAL                    	   189.93	  $155.74	      ---	       --	007	0	0	0.75	    $0.00	Y	
N	93315	ECHO TRANSESOPHAGEAL                    	   235.65	  $193.23	      ---	       --	007	0	0	0.75	    $0.00	Y	
N	93318	ECHO TRANSESOPHAGEAL INTRAOP            	   312.19	  $256.00	      ---	       --	007	0	0	0.75	    $0.00	Y	
N	93319	3D ECHO IMG CGEN CAR ANOMAL             	    67.13	   $55.05	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93320	DOPPLER ECHO COMPLETE                   	    93.38	   $76.57	      ---	   $97.12	007	1	0	0.40	    $0.00	Y	
N	93321	DOPPLER ECHO F-UP/LMTD STD              	    47.49	   $38.94	      ---	   $49.39	007	1	0	0.40	    $0.00	Y	
N	93325	DOPPLER ECHO COLOR FLOW MAPG            	    94.98	   $77.88	      ---	   $98.78	007	1	0	0.03	    $0.00	Y	
N	93350	STRESS TTE ONLY                         	   117.22	   $96.12	      ---	       --	007	0	0	0.50	    $0.00	Y	
N	93351	STRESS TTE COMPLETE                     	   301.57	  $247.29	      ---	       --	007	0	0	0.50	    $0.00	Y	
N	93352	ADMIN ECG CONTRAST AGENT                	    42.40	   $34.77	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93355	ECHO TRANSESOPHAGEAL (TEE)              	   235.68	  $193.26	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93356	MYOCRD STRAIN IMG SPCKL TRCK            	    44.74	   $36.69	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93451	RIGHT HEART CATH                        	   851.99	  $698.63	      ---	  $886.07	007	1	0	0.17	    $0.00	Y	
N	93452	LEFT HRT CATH W/VENTRCLGRPHY            	   930.32	  $762.86	      ---	  $967.53	007	1	0	0.28	    $0.00	Y	
N	93453	R&L HRT CATH W/VENTRICLGRPHY            	  1217.61	  $998.44	      ---	 $1266.31	007	1	0	0.28	    $0.00	Y	
N	93454	CORONARY ARTERY ANGIO S&I               	   960.55	  $787.65	      ---	  $998.97	007	1	0	0.27	    $0.00	Y	
N	93455	CORONARY ART/GRFT ANGIO S&I             	  1121.33	  $919.49	      ---	 $1166.18	007	1	0	0.27	    $0.00	Y	
N	93456	R HRT CORONARY ARTERY ANGIO             	  1201.23	  $985.01	      ---	 $1249.28	007	1	0	0.28	    $0.00	Y	
N	93457	R HRT ART/GRFT ANGIO                    	  1361.88	 $1116.74	      ---	 $1416.36	007	1	0	0.28	    $0.00	Y	
N	93458	L HRT ARTERY/VENTRICLE ANGIO            	  1158.55	  $950.01	      ---	 $1204.89	007	1	0	0.27	    $0.00	Y	
N	93459	L HRT ART/GRFT ANGIO                    	  1278.74	 $1048.57	      ---	 $1329.89	007	1	0	0.28	    $0.00	Y	
N	93460	R&L HRT ART/VENTRICLE ANGIO             	  1366.21	 $1120.29	      ---	 $1420.86	007	1	0	0.29	    $0.00	Y	
N	93461	R&L HRT ART/VENTRICLE ANGIO             	  1567.79	 $1285.59	      ---	 $1630.50	007	1	0	0.28	    $0.00	Y	
N	93462	L HRT CATH TRNSPTL PUNCTURE             	   201.39	  $165.14	      ---	  $209.45	007	1	0	0.00	    $0.00	Y	
N	93463	DRUG ADMIN & HEMODYNMIC MEAS            	   107.26	   $87.95	      ---	  $111.55	007	1	0	0.00	    $0.00	Y	
N	93464	EXERCISE W/HEMODYNAMIC MEAS             	   274.16	  $224.81	      ---	  $285.13	007	1	0	0.34	    $0.00	Y	
N	93503	INSERT/PLACE HEART CATHETER             	   154.85	  $126.98	      ---	  $161.04	007	1	0	0.00	    $0.00	Y	
N	93505	ENDOMYOCARDIAL BIOPSY                   	   289.95	  $237.76	      ---	  $301.55	007	1	0	0.78	    $0.00	Y	
N	93563	NJX CGEN CAR CTH SLCTV C ANG            	    57.20	   $46.90	      ---	   $59.49	007	1	0	0.00	    $0.00	Y	
N	93564	NJX CGEN CAR CATH SLCTV OPAC            	    58.09	   $47.63	      ---	   $60.41	007	1	0	0.00	    $0.00	Y	
N	93565	NJX CAR CTH SLCTV LV/LA ANG             	    43.94	   $36.03	      ---	   $45.70	007	1	0	0.00	    $0.00	Y	
N	93566	NJX CAR CTH SLCTV RV/RA ANG             	   188.65	  $154.69	      ---	  $196.20	007	1	0	0.00	    $0.00	Y	
N	93567	NJX CAR CTH SPRVLV AORTGRPHY            	   113.66	   $93.20	      ---	  $118.21	007	1	0	0.00	    $0.00	Y	
N	93568	NJX CAR CTH NSLC P-ART ANGRP            	   113.66	   $93.20	      ---	  $118.21	007	1	0	0.00	    $0.00	Y	
N	93569	NJX CTH SLCT P-ART ANGRP UNI            	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93571	HEART FLOW RESERVE MEASURE              	   296.11	  $242.81	      ---	  $307.95	007	1	0	0.33	    $0.00	Y	
N	93572	HEART FLOW RESERVE MEASURE              	   274.11	  $224.77	      ---	       --	007	0	0	0.28	    $0.00	Y	
N	93573	NJX CATH SLCT P-ART ANGRP BI            	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93574	NJX CATH SLCT PULM VN ANGRPH            	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93575	NJX CATH SLCT P ANGRPH MAPCA            	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93580	TRANSCATH CLOSURE OF ASD                	   736.49	  $603.92	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93581	TRANSCATH CLOSURE OF VSD                	   927.71	  $760.72	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93582	PERQ TRANSCATH CLOSURE PDA              	   689.35	  $565.27	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93583	PERQ TRANSCATH SEPTAL REDUXN            	   613.67	  $503.21	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93584	VNGRPH CHD ANOM/PERSIST SVC             	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93585	VNGRPH CHD AZYGS/HEMIAZYGS              	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93586	VNGRPH CHD CORONARY SINUS               	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93587	VNGRPH CHD VNVN CLTRL AT/ABV            	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93588	VNGRPH CHD VNVN CLTRL BELOW             	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93590	PERQ TRANSCATH CLS MITRAL               	  1006.03	 $1006.03	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	93591	PERQ TRANSCATH CLS AORTIC               	   835.12	  $835.12	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	93592	PERQ TRANSCATH CLOSURE EACH             	   367.38	  $367.38	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	93593	R HRT CATH CHD NML NT CNJ               	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93594	R HRT CATH CHD ABNL NT CNJ              	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93595	L HRT CATH CHD NM/ABN NT CNJ            	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93596	R&L HRT CATH CHD NML NT CNJ             	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93597	R&L HRT CATH CHD ABNL NT CNJ            	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93598	CAR OUTP MEAS DRG CATH CHD              	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93600	BUNDLE OF HIS RECORDING                 	   199.33	  $163.45	      ---	  $207.30	007	1	0	0.72	    $0.00	Y	
N	93602	INTRA-ATRIAL RECORDING                  	   129.12	  $105.88	      ---	  $134.28	007	1	0	0.77	    $0.00	Y	
N	93603	RIGHT VENTRICULAR RECORDING             	   194.28	  $159.31	      ---	  $202.05	007	1	0	0.71	    $0.00	Y	
N	93609	INTRA-VNTR MAPG TCHYCAR SITE            	   358.49	  $293.96	      ---	  $372.83	007	1	0	0.82	    $0.00	Y	
N	93610	INTRA-ATRIAL PACING                     	   129.12	  $105.88	      ---	  $134.28	007	1	0	0.79	    $0.00	Y	
N	93612	INTRAVENTRICULAR PACING                 	   129.12	  $105.88	      ---	  $134.28	007	1	0	0.76	    $0.00	Y	
N	93613	INTRACARDIAC EPHYS 3D MAPG              	   381.15	  $312.54	      ---	       --	007	0	0	0.76	    $0.00	Y	
N	93615	ESOPHAGEAL RECORDING                    	   100.00	   $82.00	      ---	  $104.00	007	1	0	0.80	    $0.00	Y	
N	93616	ESOPHAGEAL RECORDING W/PACG             	   114.00	   $93.48	      ---	  $118.56	007	1	0	0.90	    $0.00	Y	
N	93618	INDCTJ ARRHYTHMIA ELEC PACG             	   215.76	  $176.92	      ---	  $224.39	007	1	0	0.71	    $0.00	Y	
N	93619	COMPREHENSIVE EP EVALUATION             	   727.39	  $596.46	      ---	  $756.49	007	1	0	0.70	    $0.00	Y	
N	93620	COMP EP EVL R AT VEN PAC&REC            	   852.85	  $699.34	      ---	  $886.96	007	1	0	0.73	    $0.00	Y	
N	93621	COMP EP EVL L PAC&REC C SINS            	   852.85	  $699.34	      ---	  $886.96	007	1	0	0.70	    $0.00	Y	
N	93622	COMP EP EVAL L VENTR PAC&REC            	   852.85	  $699.34	      ---	  $886.96	007	1	0	0.70	    $0.00	Y	
N	93623	PRGRMD STIMJ&PACG IV RX NFS             	     0.00	    $0.00	      ---	       --	007	1	0	0.00	    $0.00	Y	
N	93624	EP F-UP STUDY PACG&REC                  	   348.32	  $285.62	      ---	  $362.25	007	1	0	0.79	    $0.00	Y	
N	93631	NTRAOP EPICAR&ENDCAR PAC&MAP            	   684.94	  $561.65	      ---	  $712.34	007	1	0	0.67	    $0.00	Y	
N	93640	EP EVAL 1/2CHMBR PACG CVDFB             	   589.52	  $483.41	      ---	  $613.10	007	1	0	0.59	    $0.00	Y	
N	93641	EP EVL 1/2CHMB PAC CVDFB TST            	   662.27	  $543.06	      ---	  $688.76	007	1	0	0.64	    $0.00	Y	
N	93642	EP EVL 1/2CHMB TRNSVNS CVDFB            	   640.06	  $524.85	      ---	  $665.66	007	1	0	0.63	    $0.00	Y	
N	93644	EP EVAL SUBQ IMPL DFB                   	   317.85	  $260.64	      ---	  $330.56	007	1	0	0.62	    $0.00	Y	
N	93650	ICAR CATH ABLTJ AV NODE FUNC            	   872.82	  $715.71	      ---	  $907.73	007	1	0	0.00	    $0.00	Y	
N	93653	COMPRE EP EVAL TX SVT                   	   804.22	  $659.46	      ---	  $836.39	007	1	0	0.00	    $0.00	Y	
N	93654	COMPRE EP EVAL TX VT                    	  1073.44	  $880.22	      ---	 $1116.38	007	1	0	0.00	    $0.00	Y	
N	93655	ICAR CATH ABLTJ DSCRT ARRHYT            	   402.20	  $329.80	      ---	  $418.29	007	1	0	0.00	    $0.00	Y	
N	93656	COMPRE EP EVAL ABLTJ ATR FIB            	  1073.74	  $880.47	      ---	 $1116.69	007	1	0	0.00	    $0.00	Y	
N	93657	TX L/R ATRIAL FIB ADDL                  	   402.40	  $329.97	      ---	  $418.50	007	1	0	0.00	    $0.00	Y	
N	93660	TILT TABLE EVALUATION                   	     0.00	    $0.00	      ---	       --	007	1	0	0.00	    $0.00	Y	
N	93662	INTRACARDIAC ECG (ICE)                  	   329.95	  $270.56	      ---	  $343.15	007	1	0	0.49	    $0.00	Y	
N	93702	BIS XTRACELL FLUID ANALYSIS             	   128.21	  $105.13	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93724	ELEC ALYS ANTITCHYCAR PM SYS            	   335.34	  $274.98	      ---	  $348.75	007	1	0	0.65	    $0.00	Y	
N	93745	SET-UP CARDIOVERT-DEFIBRILL             	    90.52	   $74.23	      ---	   $94.14	007	1	1	0.00	    $0.00	Y	
N	93750	INTERROGATION VAD IN PERSON             	    54.01	   $44.29	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93784	AMBL BP MNTR W/SOFTWARE                 	    59.03	   $48.40	      ---	       --	007	0	0	0.00	    $0.00	Y	
X	93784	AMBL BP MNTR W/SOFTWARE                 	    48.40	   $48.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	93786	AMBL BP MNTR W/SW REC ONLY              	    27.39	   $27.39	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	93786	AMBL BP MNTR W/SW REC ONLY              	    33.40	   $27.39	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93788	AMBL BP MNTR W/SW A/R                   	     5.87	    $4.81	      ---	       --	007	0	0	0.00	    $0.00	Y	
X	93788	AMBL BP MNTR W/SW A/R                   	     4.97	    $4.97	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	93790	AMBL BP MNTR W/SW I&R                   	    16.15	   $16.15	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	93790	AMBL BP MNTR W/SW I&R                   	    19.70	   $16.15	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93793	ANTICOAG MGMT PT WARFARIN               	    10.53	    $8.63	      ---	       --	007	0	0	0.00	    $0.00	Y	
X	93793	ANTICOAG MGMT PT WARFARIN               	    10.53	   $10.53	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	93797	PHYS/QHP OP CAR RHAB WO ECG             	    17.64	   $14.46	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93798	PHYS/QHP OP CAR RHAB W/ECG              	    27.14	   $22.25	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93799	UNLISTED CV SVC/PROCEDURE               	     0.00	    $0.00	      ---	       --	007	1	0	0.00	    $0.00	Y	
P	93799	UNLISTED CV SVC/PROCEDURE               	     0.00	    $0.00	      ---	       --	019	0	0	0.00	    $0.00	Y	
N	93880	EXTRACRANIAL BILAT STUDY                	   191.02	  $156.64	      ---	  $198.66	007	1	1	0.25	    $0.00	Y	
N	93882	EXTRACRANIAL UNI/LTD STUDY              	    92.98	   $76.24	      ---	   $96.70	007	1	1	0.14	    $0.00	Y	
N	93886	INTRACRANIAL COMPLETE STUDY             	   238.88	  $195.88	      ---	  $248.44	007	1	1	0.21	    $0.00	Y	
N	93888	INTRACRANIAL LIMITED STUDY              	   158.73	  $130.16	      ---	  $165.08	007	1	1	0.21	    $0.00	Y	
N	93892	TCD EMBOLI DETECT W/O INJ               	   274.24	  $224.88	      ---	  $285.21	007	1	1	0.40	    $0.00	Y	
N	93893	TCD STD ICR ART VEN-ART SHNT            	   268.79	  $220.41	      ---	  $279.54	007	1	1	0.40	    $0.00	Y	
N	93896	VSRCTV STD TCD ICR ART COMPL            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	93897	EMBOLI DETCJ WO IV MBUBB NJX            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	93898	VEN-ARTL SHUNT DET MBUBB NJX            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	93922	UPR/L XTREMITY ART 2 LEVELS             	    63.54	   $52.10	      ---	   $66.08	007	1	0	0.32	    $0.00	Y	
N	93923	UPR/LXTR ART STDY 3+ LVLS               	   118.73	   $97.36	      ---	  $123.48	007	1	0	0.31	    $0.00	Y	
N	93924	LWR XTR VASC STDY BILAT                 	   129.78	  $106.42	      ---	  $134.97	007	1	0	0.31	    $0.00	Y	
N	93925	LOWER EXTREMITY STUDY                   	   118.13	   $96.87	      ---	  $122.86	007	1	1	0.25	    $0.00	Y	
P	93925	LOWER EXTREMITY STUDY                   	   118.13	   $96.87	      ---	       --	019	0	1	0.25	    $0.00	Y	
P	93926	LOWER EXTREMITY STUDY                   	   103.52	   $84.89	      ---	       --	019	0	1	0.14	    $0.00	Y	
N	93926	LOWER EXTREMITY STUDY                   	   103.52	   $84.89	      ---	  $107.66	007	1	1	0.14	    $0.00	Y	
N	93930	UPPER EXTREMITY STUDY                   	   113.43	   $93.01	      ---	  $117.97	007	1	1	0.21	    $0.00	Y	
N	93931	UPPER EXTREMITY STUDY                   	   101.05	   $82.86	      ---	  $105.09	007	1	1	0.21	    $0.00	Y	
N	93970	EXTREMITY STUDY                         	   205.17	  $168.24	      ---	  $213.38	007	1	1	0.28	    $0.00	Y	
N	93971	EXTREMITY STUDY                         	   103.12	   $84.56	      ---	  $107.24	007	1	1	0.16	    $0.00	Y	
N	93975	VASCULAR STUDY                          	   229.07	  $187.84	      ---	  $238.23	007	1	1	0.35	    $0.00	Y	
N	93976	VASCULAR STUDY                          	   188.68	  $154.72	      ---	  $196.23	007	1	1	0.21	    $0.00	Y	
N	93978	VASCULAR STUDY                          	   200.18	  $164.15	      ---	  $208.19	007	1	1	0.27	    $0.00	Y	
N	93979	VASCULAR STUDY                          	    96.74	   $79.33	      ---	  $100.61	007	1	1	0.15	    $0.00	Y	
N	93980	PENILE VASCULAR STUDY                   	   201.97	  $165.62	      ---	  $210.05	007	1	0	0.30	    $0.00	Y	
N	93981	PENILE VASCULAR STUDY                   	   151.59	  $124.30	      ---	  $157.65	007	1	0	0.14	    $0.00	Y	
N	93985	DUP-SCAN HEMO COMPL BI STD              	   301.63	  $247.34	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93986	DUP-SCAN HEMO COMPL UNI STD             	   174.36	  $142.98	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	93990	DOPPLER FLOW TESTING                    	    87.50	   $71.75	      ---	   $91.00	007	1	1	0.14	    $0.00	Y	
N	93998	UNLISTD NONINVAS VASC DX STD            	     0.00	    $0.00	      ---	       --	007	1	1	0.00	    $0.00	Y	
N	94002	VENT MGMT INPAT INIT DAY                	     4.48	   $44.80	   $48.88	       --	053	0	0	0.00	    $0.00	Y	
N	94003	VENT MGMT INPAT SUBQ DAY                	     3.53	   $35.30	   $38.51	       --	053	0	0	0.00	    $0.00	Y	
N	94010	BREATHING CAPACITY TEST                 	    30.00	   $24.60	      ---	   $31.20	007	1	1	0.40	    $0.00	Y	
X	94010	BREATHING CAPACITY TEST                 	    25.01	   $25.01	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	94011	SPIROMETRY UP TO 2 YRS OLD              	    75.52	   $75.52	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	94011	SPIROMETRY UP TO 2 YRS OLD              	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	94012	SPIRMTRY W/BRNCHDIL INF-2 YR            	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
X	94012	SPIRMTRY W/BRNCHDIL INF-2 YR            	   122.50	  $122.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	94013	MEAS LUNG VOL THRU 2 YRS                	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	94014	PATIENT RECORDED SPIROMETRY             	    46.23	   $37.91	      ---	   $48.08	007	1	0	0.00	    $0.00	Y	
X	94014	PATIENT RECORDED SPIROMETRY             	    51.13	   $51.13	      ---	       --	009	1	0	0.00	    $0.00	Y	
X	94015	PATIENT RECORDED SPIROMETRY             	    29.29	   $29.29	      ---	       --	009	1	0	0.00	    $0.00	Y	
N	94015	PATIENT RECORDED SPIROMETRY             	    17.60	   $14.43	      ---	   $18.30	007	1	0	0.00	    $0.00	Y	
N	94016	REVIEW PATIENT SPIROMETRY               	    28.63	   $23.48	      ---	   $29.78	007	1	0	0.00	    $0.00	Y	
X	94016	REVIEW PATIENT SPIROMETRY               	    23.48	   $23.48	      ---	       --	009	1	0	0.00	    $0.00	Y	
X	94060	EVALUATION OF WHEEZING                  	    45.03	   $45.03	      ---	       --	009	1	1	0.00	    $0.00	Y	
N	94060	EVALUATION OF WHEEZING                  	    54.91	   $45.03	      ---	   $57.11	007	1	1	0.40	    $0.00	Y	
N	94150	VITAL CAPACITY TEST                     	     6.79	    $5.57	      ---	    $7.06	007	1	0	0.40	    $0.00	Y	
N	94200	LUNG FUNCTION TEST (MBC/MVV)            	    20.00	   $16.40	      ---	   $20.80	007	1	0	0.40	    $0.00	Y	
N	94375	RESPIRATORY FLOW VOLUME LOOP            	    28.32	   $23.22	      ---	   $29.45	007	1	0	0.40	    $0.00	Y	
X	94375	RESPIRATORY FLOW VOLUME LOOP            	    35.64	   $35.64	      ---	       --	009	1	0	0.00	    $0.00	Y	
N	94450	HYPOXIA RESPONSE CURVE                  	    29.51	   $24.20	      ---	   $30.69	007	1	0	0.40	    $0.00	Y	
N	94617	EXERCISE TST BRNCSPSM W/ECG             	   105.42	   $86.44	      ---	       --	007	0	0	0.33	    $0.00	Y	
N	94618	PULMONARY STRESS TESTING                	    36.73	   $30.12	      ---	       --	007	0	0	0.65	    $0.00	Y	
E	94618	PULMONARY STRESS TESTING                	    12.08	   $12.08	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	94619	EXERCISE TST BRNCSPSM WO ECG            	    81.14	   $66.53	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	94621	CARDIOPULM EXERCISE TESTING             	   121.48	   $99.61	      ---	  $126.34	007	1	0	0.42	    $0.00	Y	
N	94625	PHY/QHP OP PULM RHB W/O MNTR            	    72.33	   $59.31	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	94626	PHY/QHP OP PULM RHB W/MNTR              	    81.88	   $67.14	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	94640	AIRWAY INHALATION TREATMENT             	     1.17	   $11.70	   $12.76	   $14.53	053	1	0	0.00	    $0.00	Y	
X	94640	AIRWAY INHALATION TREATMENT             	    11.70	   $11.70	      ---	       --	009	1	0	0.00	    $0.00	Y	
N	94642	AEROSOL INHALATION TREATMENT            	     8.59	   $85.90	   $93.72	  $106.69	053	1	0	0.00	    $0.00	Y	
N	94644	CBT 1ST HOUR                            	     1.70	   $17.00	   $18.55	   $21.11	053	1	0	0.00	    $0.00	Y	
N	94645	CBT EACH ADDL HOUR                      	     1.24	   $12.40	   $13.53	   $15.40	053	1	0	0.00	    $0.00	Y	
N	94660	POS AIRWAY PRESSURE CPAP                	     4.08	   $40.80	   $44.51	   $50.67	053	1	1	0.00	    $0.00	Y	
N	94662	NEG PRESS VENTILATION CNP               	     2.80	   $28.00	   $30.55	   $34.78	053	1	1	0.00	    $0.00	Y	
N	94664	EVALUATE PT USE OF INHALER              	     0.86	    $8.60	    $9.38	   $10.68	053	1	1	0.00	    $0.00	Y	
X	94664	EVALUATE PT USE OF INHALER              	    16.17	   $16.17	      ---	       --	009	1	1	0.00	    $0.00	Y	
N	94667	CHEST WALL MANIPULATION                 	     1.99	   $19.90	   $21.71	   $24.72	053	1	1	0.00	    $0.00	Y	
N	94668	CHEST WALL MANIPULATION                 	     1.17	   $11.70	   $12.76	   $14.53	053	1	1	0.00	    $0.00	Y	
N	94669	MECHANICAL CHEST WALL OSCILL            	    31.66	   $25.96	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	94680	EXHALED AIR ANALYSIS O2                 	    50.00	   $41.00	      ---	   $52.00	007	1	1	0.40	    $0.00	Y	
N	94681	O2 UPTK EXP GAS ALYS W/CO2              	   100.00	   $82.00	      ---	  $104.00	007	1	1	0.40	    $0.00	Y	
N	94690	O2 UPTK EXP GAS ALYS REST               	    18.12	   $14.86	      ---	   $18.84	007	1	1	0.40	    $0.00	Y	
N	94726	PULM FUNCT TST PLETHYSMOGRAP            	    58.65	   $48.09	      ---	       --	007	0	0	0.21	    $0.00	Y	
N	94727	PULM FUNCTION TEST BY GAS               	    45.88	   $37.62	      ---	       --	007	0	0	0.27	    $0.00	Y	
N	94728	AIRWY RESIST BY OSCILLOMETRY            	    45.88	   $37.62	      ---	   $47.72	007	1	0	0.27	    $0.00	Y	
N	94729	CO/MEMBANE DIFFUSE CAPACITY             	    58.78	   $48.20	      ---	   $61.13	007	1	0	0.14	    $0.00	Y	
N	94760	MEASURE BLOOD OXYGEN LEVEL              	     6.82	    $5.59	      ---	    $7.09	007	1	0	0.00	    $0.00	Y	
X	94760	MEASURE BLOOD OXYGEN LEVEL              	     5.59	    $5.59	      ---	       --	009	1	0	0.00	    $0.00	Y	
N	94772	BREATH RECORDING INFANT                 	     4.38	   $43.80	   $47.79	   $54.40	001	1	1	0.00	    $0.00	Y	
N	94799	UNLISTED PULMONARY SVC/PX               	     0.00	    $0.00	      ---	       --	007	1	0	0.00	    $0.00	Y	
N	95004	PERQ TESTS W/ALRGNC XTRCS               	     0.19	    $1.90	    $2.07	    $2.36	053	1	1	0.00	    $0.00	Y	
P	95004	PERQ TESTS W/ALRGNC XTRCS               	     0.19	    $1.90	    $2.07	       --	052	0	1	0.00	    $0.00	Y	
X	95004	PERQ TESTS W/ALRGNC XTRCS               	     3.67	    $3.67	      ---	       --	009	1	1	0.00	    $0.00	Y	
N	95012	NITRIC OXIDE EXP GAS DETER              	    22.87	   $18.75	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	95017	ALL TSTG PERQ&IQ W/VENOMS               	     9.45	    $7.75	      ---	    $9.83	007	1	0	0.00	    $0.00	Y	
X	95017	ALL TSTG PERQ&IQ W/VENOMS               	     8.05	    $8.05	      ---	       --	009	1	0	0.00	    $0.00	Y	
X	95018	ALL TSTG PERQ&IQ DRUGS/BIOL             	    19.39	   $19.39	      ---	       --	009	1	0	0.00	    $0.00	Y	
N	95018	ALL TSTG PERQ&IQ DRUGS/BIOL             	    23.65	   $19.39	      ---	   $24.60	007	1	0	0.00	    $0.00	Y	
N	95024	IQ TESTS W/ALLERGENIC XTRCS             	     0.28	    $2.80	    $3.05	    $3.48	053	1	1	0.00	    $0.00	Y	
P	95024	IQ TESTS W/ALLERGENIC XTRCS             	     0.28	    $2.80	    $3.05	       --	052	0	1	0.00	    $0.00	Y	
X	95024	IQ TESTS W/ALLERGENIC XTRCS             	     7.51	    $7.51	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	95027	IQ TSTS SEQL&INCRL AIRBORNE             	     4.63	    $4.63	      ---	       --	009	1	1	0.00	    $0.00	Y	
P	95027	IQ TSTS SEQL&INCRL AIRBORNE             	     0.28	    $2.80	    $3.05	       --	052	0	1	0.00	    $0.00	Y	
N	95027	IQ TSTS SEQL&INCRL AIRBORNE             	     0.28	    $2.80	    $3.05	    $3.48	053	1	1	0.00	    $0.00	Y	
N	95028	IQ TSTS ALLERGY DELAYED RXN             	     0.42	    $4.20	    $4.58	    $5.22	053	1	1	0.00	    $0.00	Y	
P	95028	IQ TSTS ALLERGY DELAYED RXN             	     0.42	    $4.20	    $4.58	       --	052	0	1	0.00	    $0.00	Y	
X	95028	IQ TSTS ALLERGY DELAYED RXN             	    12.01	   $12.01	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	95044	PATCH/APPLICATION TESTS                 	     4.65	    $4.65	      ---	       --	009	1	0	0.00	    $0.00	Y	
N	95044	PATCH/APPLICATION TESTS                 	     0.37	    $3.70	    $4.04	    $4.60	053	1	0	0.00	    $0.00	Y	
N	95052	PHOTO PATCH TESTS                       	     0.46	    $4.60	    $5.02	    $5.71	053	1	0	0.00	    $0.00	Y	
N	95056	PHOTO TESTS                             	     0.32	    $3.20	    $3.49	    $3.97	053	1	1	0.00	    $0.00	Y	
X	95056	PHOTO TESTS                             	    48.33	   $48.33	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	95060	OPH MUCOUS MEMBRANE TESTS               	    35.68	   $35.68	      ---	       --	009	1	1	0.00	    $0.00	Y	
N	95060	OPH MUCOUS MEMBRANE TESTS               	     0.65	    $6.50	    $7.09	    $8.07	053	1	1	0.00	    $0.00	Y	
N	95065	DIR NSL MUCOUS MEMBRANE TEST            	     0.41	    $4.10	    $4.47	    $5.09	053	1	1	0.00	    $0.00	Y	
X	95065	DIR NSL MUCOUS MEMBRANE TEST            	    26.41	   $26.41	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	95070	INHLJ BRNCL CHALLENGE TSTG              	    41.20	   $41.20	      ---	       --	009	1	1	0.00	    $0.00	Y	
N	95070	INHLJ BRNCL CHALLENGE TSTG              	     4.12	   $41.20	   $44.95	   $51.17	053	1	1	0.00	    $0.00	Y	
N	95076	INGEST CHALLENGE INI 120 MIN            	   124.44	  $102.04	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	95079	INGEST CHALLENGE ADDL 60 MIN            	    86.06	   $70.57	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	95115	IMMUNOTHERAPY ONE INJECTION             	     0.49	    $4.90	    $5.35	    $6.09	001	1	0	0.00	    $0.00	Y	
X	95115	IMMUNOTHERAPY ONE INJECTION             	     9.45	    $9.45	      ---	       --	009	1	0	0.00	    $0.00	Y	
X	95117	IMMUNOTHERAPY INJECTIONS                	    11.05	   $11.05	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	95117	IMMUNOTHERAPY INJECTIONS                	     9.45	    $9.45	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	95144	ANTIGEN THERAPY SERVICES                	    11.22	    $9.20	      ---	       --	007	0	0	0.00	    $0.00	N	
X	95144	ANTIGEN THERAPY SERVICES                	    15.75	   $15.75	      ---	       --	009	0	0	0.00	    $0.00	N	
X	95170	ANTIGEN THERAPY SERVICES                	    10.63	   $10.63	      ---	       --	009	1	1	0.00	    $0.00	N	
N	95170	ANTIGEN THERAPY SERVICES                	    10.47	    $8.59	      ---	   $10.89	007	1	1	0.00	    $0.00	N	
N	95180	RAPID DESENSITIZATION                   	     6.10	   $61.00	   $66.55	   $75.76	053	1	1	0.00	    $0.00	Y	
X	95180	RAPID DESENSITIZATION                   	   125.57	  $125.57	      ---	       --	009	1	1	0.00	    $0.00	Y	
N	95199	UNLISTED ALL/IMMLG SVC/PX               	     0.51	    $5.10	    $5.56	    $6.33	053	1	1	0.00	    $0.00	Y	
N	95250	CONT GLUC MNTR PHYS/QHP EQP             	   168.52	  $138.19	      ---	       --	007	0	0	0.00	    $0.00	Y	
X	95250	CONT GLUC MNTR PHYS/QHP EQP             	   138.26	  $138.26	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	95251	CONT GLUC MNTR ANALYSIS I&R             	    30.84	   $30.84	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	95251	CONT GLUC MNTR ANALYSIS I&R             	    35.36	   $29.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	95700	EEG CONT REC W/VID EEG TECH             	   296.98	  $243.52	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	95705	EEG W/O VID 2-12 HR UNMNTR              	   270.57	  $221.87	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	95706	EEG WO VID 2-12HR INTMT MNTR            	   402.35	  $329.93	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	95707	EEG W/O VID 2-12HR CONT MNTR            	   780.43	  $639.95	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	95708	EEG WO VID EA 12-26HR UNMNTR            	   323.25	  $265.07	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	95709	EEG W/O VID EA 12-26HR INTMT            	   718.07	  $588.82	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	95710	EEG W/O VID EA 12-26HR CONT             	  1247.78	 $1023.18	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	95711	VEEG 2-12 HR UNMONITORED                	   270.57	  $221.87	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	95712	VEEG 2-12 HR INTMT MNTR                 	   455.03	  $373.12	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	95713	VEEG 2-12 HR CONT MNTR                  	   889.74	  $729.59	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	95714	VEEG EA 12-26 HR UNMNTR                 	   323.25	  $265.07	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	95715	VEEG EA 12-26HR INTMT MNTR              	   796.64	  $653.24	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	95716	VEEG EA 12-26HR CONT MNTR               	  1426.55	 $1169.77	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	95717	EEG PHYS/QHP 2-12 HR W/O VID            	   109.59	   $89.86	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	95718	EEG PHYS/QHP 2-12 HR W/VEEG             	   144.41	  $118.42	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	95719	EEG PHYS/QHP EA INCR W/O VID            	   169.57	  $139.05	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	95720	EEG PHY/QHP EA INCR W/VEEG              	   223.53	  $183.29	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	95721	EEG PHY/QHP>36<60 HR W/O VID            	   225.57	  $184.97	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	95722	EEG PHY/QHP>36<60 HR W/VEEG             	   273.51	  $224.28	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	95723	EEG PHY/QHP>60<84 HR W/O VID            	   279.46	  $229.16	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	95724	EEG PHY/QHP>60<84 HR W/VEEG             	   349.37	  $286.48	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	95725	EEG PHY/QHP>84 HR W/O VID               	   319.14	  $261.69	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	95726	EEG PHY/QHP>84 HR W/VEEG                	   441.52	  $362.05	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	95782	POLYSOM <6 YRS 4/> PARAMTRS             	  1154.29	  $946.52	      ---	 $1200.46	007	1	0	0.11	    $0.00	Y	
N	95783	POLYSOM <6 YRS CPAP/BILVL               	  1231.49	 $1009.82	      ---	 $1280.75	007	1	0	0.12	    $0.00	Y	
N	95800	SLP STDY UNATTENDED                     	   168.00	  $137.76	      ---	       --	007	0	0	0.18	    $0.00	Y	
N	95801	SLP STDY UNATND W/ANAL                  	   102.46	   $84.02	      ---	       --	007	0	0	0.47	    $0.00	Y	
N	95805	MULTIPLE SLEEP LATENCY TEST             	   238.68	  $195.72	      ---	  $248.23	007	1	0	0.35	    $0.00	Y	
N	95806	SLEEP STUDY UNATT&RESP EFFT             	   100.88	   $82.72	      ---	       --	007	0	0	0.45	    $0.00	Y	
N	95807	SLEEP STUDY ATTENDED                    	   257.67	  $211.29	      ---	  $267.98	007	1	0	0.39	    $0.00	Y	
N	95808	POLYSOM ANY AGE 1-3> PARAM              	   285.18	  $233.85	      ---	  $296.59	007	1	0	0.45	    $0.00	Y	
N	95810	POLYSOM 6/> YRS 4/> PARAM               	   424.48	  $348.07	      ---	  $441.46	007	1	0	0.45	    $0.00	Y	
N	95811	POLYSOM 6/>YRS CPAP 4/> PARM            	   436.24	  $357.72	      ---	  $453.69	007	1	0	0.47	    $0.00	Y	
N	95812	EEG 41-60 MINUTES                       	    99.78	   $81.82	      ---	  $103.77	007	1	1	0.51	    $0.00	Y	
N	95813	EEG EXTND MNTR 61-119 MIN               	   135.78	  $111.34	      ---	  $141.21	007	1	1	0.60	    $0.00	Y	
N	95816	EEG AWAKE AND DROWSY                    	    92.17	   $75.58	      ---	   $95.86	007	1	1	0.48	    $0.00	Y	
N	95819	EEG AWAKE AND ASLEEP                    	    79.28	   $65.01	      ---	   $82.45	007	1	1	0.53	    $0.00	Y	
N	95822	EEG COMA OR SLEEP ONLY                  	    79.28	   $65.01	      ---	   $82.45	007	1	1	0.46	    $0.00	Y	
N	95824	EEG CEREBRAL DEATH ONLY                 	    49.78	   $40.82	      ---	   $51.77	007	1	0	0.75	    $0.00	Y	
N	95829	SURGERY ELECTROCORTICOGRAM              	   271.32	  $222.48	      ---	  $282.17	007	1	0	0.97	    $0.00	Y	
N	95830	INSERT ELECTRODES FOR EEG               	    96.76	   $79.34	      ---	  $100.63	007	1	1	0.00	    $0.00	Y	
N	95836	ECOG IMPLTD BRN NPGT <30 D              	   113.12	   $92.76	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	95851	RANGE OF MOTION MEASUREMENTS            	    18.12	   $14.86	      ---	   $18.84	007	1	1	0.00	    $0.00	Y	
P	95851	RANGE OF MOTION MEASUREMENTS            	    18.12	   $14.86	      ---	       --	019	0	1	0.00	    $0.00	Y	
X	95851	RANGE OF MOTION MEASUREMENTS            	    19.73	   $19.73	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	95852	RANGE OF MOTION MEASUREMENTS            	    16.30	   $16.30	      ---	       --	009	1	1	0.00	    $0.00	Y	
N	95852	RANGE OF MOTION MEASUREMENTS            	     9.98	    $8.18	      ---	   $10.38	007	1	1	0.00	    $0.00	Y	
N	95857	CHOLINESTERASE CHALLENGE                	    36.24	   $29.72	      ---	   $37.69	007	1	1	0.00	    $0.00	Y	
N	95860	NEEDLE EMG 1 EXTREMITY                  	    80.00	   $65.60	      ---	   $83.20	007	1	1	0.81	    $0.00	Y	
N	95861	NEEDLE EMG 2 EXTREMITIES                	   120.00	   $98.40	      ---	  $124.80	007	1	1	0.78	    $0.00	Y	
N	95863	NEEDLE EMG 3 EXTREMITIES                	   135.91	  $111.45	      ---	  $141.35	007	1	1	0.77	    $0.00	Y	
N	95864	NEEDLE EMG 4 EXTREMITIES                	   200.00	  $164.00	      ---	  $208.00	007	1	1	0.67	    $0.00	Y	
N	95865	NEEDLE EMG LARYNX                       	   121.76	   $99.84	      ---	       --	007	0	0	0.75	    $0.00	Y	
N	95866	NEEDLE EMG HEMIDIAPHRAGM                	    81.06	   $66.47	      ---	       --	007	0	0	0.75	    $0.00	Y	
N	95867	NDL EMG CRANIAL NRV MUSC UNI            	    58.82	   $48.23	      ---	   $61.17	007	1	1	0.67	    $0.00	Y	
N	95868	NDL EMG CRANIAL NRV MUSC BI             	    99.28	   $81.41	      ---	  $103.25	007	1	1	0.79	    $0.00	Y	
N	95869	NDL EMG THRC PARASPINAL MUSC            	    32.00	   $26.24	      ---	   $33.28	007	1	1	0.75	    $0.00	Y	
N	95870	NDL EMG LMTD STD MUSC 1 XTR             	    24.70	   $20.25	      ---	   $25.69	007	1	0	0.76	    $0.00	Y	
N	95872	NDL EMG SINGLE FIBER ELTRD              	    89.33	   $73.25	      ---	   $92.90	007	1	1	0.77	    $0.00	Y	
N	95873	GUIDE NERV DESTR ELEC STIM              	    29.87	   $24.49	      ---	       --	007	0	0	0.77	    $0.00	Y	
N	95874	GUIDE NERV DESTR NEEDLE EMG             	    30.28	   $24.83	      ---	       --	007	0	0	0.77	    $0.00	Y	
N	95875	LIMB EXERCISE TEST                      	    62.41	   $51.18	      ---	   $64.91	007	1	1	0.77	    $0.00	Y	
N	95885	MUSC TST DONE W/NERV TST LIM            	    60.78	   $49.84	      ---	   $63.21	007	1	1	0.30	    $0.00	Y	
N	95886	MUSC TEST DONE W/N TEST COMP            	    93.71	   $76.84	      ---	   $97.46	007	1	1	0.52	    $0.00	Y	
N	95887	MUSC TST DONE W/N TST NONEXT            	    83.94	   $68.83	      ---	   $87.30	007	1	1	0.46	    $0.00	Y	
N	95905	MOTOR &/ SENS NRVE CNDJ TEST            	    86.34	   $70.80	      ---	       --	007	0	1	0.74	    $0.00	Y	
N	95907	NVR CNDJ TST 1-2 STUDIES                	   100.99	   $82.81	      ---	       --	007	0	0	0.53	    $0.00	Y	
N	95908	NRV CNDJ TST 3-4 STUDIES                	   124.62	  $102.19	      ---	       --	007	0	0	0.54	    $0.00	Y	
N	95909	NRV CNDJ TST 5-6 STUDIES                	   149.20	  $122.34	      ---	       --	007	0	0	0.54	    $0.00	Y	
N	95910	NRV CNDJ TEST 7-8 STUDIES               	   196.28	  $160.95	      ---	       --	007	0	0	0.55	    $0.00	Y	
N	95911	NRV CNDJ TEST 9-10 STUDIES              	   237.26	  $194.55	      ---	       --	007	0	0	0.57	    $0.00	Y	
N	95912	NRV CNDJ TEST 11-12 STUDIES             	   277.48	  $227.53	      ---	       --	007	0	0	0.58	    $0.00	Y	
N	95913	NRV CNDJ TEST 13/> STUDIES              	   321.28	  $263.45	      ---	       --	007	0	0	0.06	    $0.00	Y	
N	95924	ANS PARASYMP & SYMP W/TILT              	   157.10	  $128.82	      ---	       --	007	0	0	0.57	    $0.00	Y	
N	95925	SOMATOSENSORY TESTING                   	   103.35	   $84.75	      ---	  $107.48	007	1	1	0.55	    $0.00	Y	
N	95926	SOMATOSENSORY TESTING                   	   123.15	  $123.15	      ---	       --	009	0	1	0.55	    $0.00	Y	
N	95927	SOMATOSENSORY TESTING                   	   123.15	  $123.15	      ---	       --	009	0	1	0.55	    $0.00	Y	
N	95928	C MOTOR EVOKED UPPR LIMBS               	   186.77	  $153.15	      ---	  $194.24	007	1	1	0.55	    $0.00	Y	
N	95929	C MOTOR EVOKED LWR LIMBS                	   194.77	  $159.71	      ---	  $202.56	007	1	1	0.55	    $0.00	Y	
N	95930	VISUAL EP TEST CNS W/I&R                	    42.00	   $34.44	      ---	   $43.68	007	1	1	0.79	    $0.00	Y	
N	95937	NEUROMUSCULAR JUNCTION TEST             	    27.18	   $22.29	      ---	   $28.27	007	1	1	0.75	    $0.00	Y	
N	95938	SOMATOSENSORY TESTING                   	   326.42	  $267.66	      ---	  $339.48	007	1	1	0.14	    $0.00	Y	
N	95939	C MOTOR EVOKED UPR&LWR LIMBS            	   506.75	  $415.54	      ---	  $527.02	007	1	1	0.23	    $0.00	Y	
N	95940	IONM IN OPERATNG ROOM 15 MIN            	    32.99	   $27.05	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	95941	IONM REMOTE/>1 PT OR PER HR             	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	N	
N	95955	EEG DURING SURGERY                      	   135.56	  $111.16	      ---	  $140.98	007	1	0	0.50	    $0.00	Y	
N	95957	EEG DIGITAL ANALYSIS                    	   141.89	  $116.35	      ---	  $147.57	007	1	1	0.42	    $0.00	Y	
N	95958	EEG MONITORING/FUNCTION TEST            	   301.54	  $247.26	      ---	  $313.60	007	1	0	0.80	    $0.00	Y	
N	95965	MEG SPONTANEOUS                         	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	95966	MEG EVOKED SINGLE                       	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	95967	MEG EVOKED EACH ADDL                    	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	95970	ALYS NPGT W/O PRGRMG                    	    24.13	   $19.79	      ---	   $25.10	007	1	0	0.00	    $0.00	Y	
N	95971	ALYS SMPL SP/PN NPGT W/PRGRM            	    41.12	   $33.72	      ---	   $42.76	007	1	0	0.00	    $0.00	Y	
N	95972	ALYS CPLX SP/PN NPGT W/PRGRM            	    78.94	   $64.73	      ---	   $82.10	007	1	0	0.00	    $0.00	Y	
N	95976	ALYS SMPL CN NPGT PRGRMG                	    42.71	   $35.02	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	95977	ALYS CPLX CN NPGT PRGRMG                	    56.76	   $46.54	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	95983	ALYS BRN NPGT PRGRMG 15 MIN             	    53.56	   $43.92	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	95984	ALYS BRN NPGT PRGRMG ADDL 15            	    46.70	   $38.29	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	95990	SPIN/BRAIN PUMP REFIL & MAIN            	    60.39	   $49.52	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	95991	SPIN/BRAIN PUMP REFIL & MAIN            	    88.79	   $72.81	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	95992	CANALITH REPOSITIONING PROC             	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
X	95992	CANALITH REPOSITIONING PROC             	    39.39	   $39.39	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	95999	UNLISTED NEUROLOGICAL DX PX             	     0.00	    $0.00	      ---	       --	007	1	1	0.00	    $0.00	Y	
N	96020	FUNCTIONAL BRAIN MAPPING                	   172.32	  $141.30	      ---	       --	007	0	0	1.00	    $0.00	Y	
N	96105	ASSESSMENT OF APHASIA                   	    62.44	   $51.20	      ---	   $64.94	007	1	1	0.00	    $0.00	Y	
X	96105	ASSESSMENT OF APHASIA                   	    88.29	   $88.29	      ---	       --	009	1	1	0.00	    $0.00	Y	
Q	96105	ASSESSMENT OF APHASIA                   	    51.20	   $51.20	      ---	       --	009	0	0	0.00	    $0.00	N	
Y	96105	ASSESSMENT OF APHASIA                   	    88.29	   $88.29	      ---	       --	009	0	0	0.00	    $0.00	N	
Y	96110	DEVELOPMENTAL SCREEN W/SCORE            	    54.90	   $54.90	      ---	       --	009	0	0	0.00	    $0.00	N	
Q	96110	DEVELOPMENTAL SCREEN W/SCORE            	    54.90	   $54.90	      ---	       --	009	0	0	0.00	    $0.00	N	
N	96110	DEVELOPMENTAL SCREEN W/SCORE            	     5.49	   $54.90	   $59.90	       --	001	0	1	0.00	    $0.00	Y	
E	96110	DEVELOPMENTAL SCREEN W/SCORE            	     6.37	    $6.37	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	96112	DEVEL TST PHYS/QHP 1ST HR               	   142.16	  $116.57	      ---	       --	007	0	0	0.00	    $0.00	Y	
Q	96112	DEVEL TST PHYS/QHP 1ST HR               	   142.16	  $116.57	      ---	       --	007	0	0	0.00	    $0.00	N	
X	96112	DEVEL TST PHYS/QHP 1ST HR               	   116.57	  $116.57	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	96112	DEVEL TST PHYS/QHP 1ST HR               	   116.57	  $116.57	      ---	       --	009	0	0	0.00	    $0.00	N	
Y	96113	DEVEL TST PHYS/QHP EA ADDL              	    53.74	   $53.74	      ---	       --	009	0	0	0.00	    $0.00	N	
X	96113	DEVEL TST PHYS/QHP EA ADDL              	    53.74	   $53.74	      ---	       --	009	0	0	0.00	    $0.00	Y	
Q	96113	DEVEL TST PHYS/QHP EA ADDL              	    63.26	   $51.87	      ---	       --	007	0	0	0.00	    $0.00	N	
N	96113	DEVEL TST PHYS/QHP EA ADDL              	    63.26	   $51.87	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	96116	NUBHVL XM PHYS/QHP 1ST HR               	     5.62	   $56.20	   $61.31	   $69.80	053	1	1	0.00	    $0.00	Y	
Q	96116	NUBHVL XM PHYS/QHP 1ST HR               	    56.20	   $56.20	      ---	       --	009	0	0	0.00	    $0.00	N	
X	96116	NUBHVL XM PHYS/QHP 1ST HR               	    83.60	   $83.60	      ---	       --	009	1	1	0.00	    $0.00	Y	
Y	96116	NUBHVL XM PHYS/QHP 1ST HR               	    83.60	   $83.60	      ---	       --	009	0	0	0.00	    $0.00	N	
E	96116	NUBHVL XM PHYS/QHP 1ST HR               	    83.60	   $83.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	96121	NUBHVL XM PHY/QHP EA ADDL HR            	    70.17	   $70.17	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	96121	NUBHVL XM PHY/QHP EA ADDL HR            	    70.17	   $70.17	      ---	       --	009	0	0	0.00	    $0.00	N	
X	96121	NUBHVL XM PHY/QHP EA ADDL HR            	    70.17	   $70.17	      ---	       --	009	0	0	0.00	    $0.00	Y	
Q	96121	NUBHVL XM PHY/QHP EA ADDL HR            	    85.57	   $70.17	      ---	       --	007	0	0	0.00	    $0.00	N	
N	96121	NUBHVL XM PHY/QHP EA ADDL HR            	    85.57	   $70.17	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	96125	COGNITIVE TEST BY HC PRO                	    91.47	   $91.47	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	96125	COGNITIVE TEST BY HC PRO                	    93.77	   $93.77	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	96125	COGNITIVE TEST BY HC PRO                	    93.77	   $93.77	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	96127	BRIEF EMOTIONAL/BEHAV ASSMT             	     4.81	    $4.81	      ---	       --	009	0	0	0.00	    $0.00	N	
X	96127	BRIEF EMOTIONAL/BEHAV ASSMT             	     4.81	    $4.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
Q	96127	BRIEF EMOTIONAL/BEHAV ASSMT             	     5.87	    $4.81	      ---	       --	007	0	0	0.00	    $0.00	N	
N	96127	BRIEF EMOTIONAL/BEHAV ASSMT             	     5.87	    $4.81	      ---	       --	007	0	0	0.00	    $0.00	Y	
E	96127	BRIEF EMOTIONAL/BEHAV ASSMT             	     4.81	    $4.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	96130	PSYCL TST EVAL PHYS/QHP 1ST             	   257.63	  $257.63	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	96130	PSYCL TST EVAL PHYS/QHP 1ST             	   121.46	   $99.60	      ---	       --	007	0	0	0.00	    $0.00	Y	
Q	96130	PSYCL TST EVAL PHYS/QHP 1ST             	   121.46	   $99.60	      ---	       --	007	0	0	0.00	    $0.00	N	
X	96130	PSYCL TST EVAL PHYS/QHP 1ST             	   107.69	  $107.69	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	96130	PSYCL TST EVAL PHYS/QHP 1ST             	   107.69	  $107.69	      ---	       --	009	0	0	0.00	    $0.00	N	
Y	96131	PSYCL TST EVAL PHYS/QHP EA              	    77.94	   $77.94	      ---	       --	009	0	0	0.00	    $0.00	N	
X	96131	PSYCL TST EVAL PHYS/QHP EA              	    77.94	   $77.94	      ---	       --	009	0	0	0.00	    $0.00	Y	
Q	96131	PSYCL TST EVAL PHYS/QHP EA              	    92.45	   $75.81	      ---	       --	007	0	0	0.00	    $0.00	N	
N	96131	PSYCL TST EVAL PHYS/QHP EA              	    92.45	   $75.81	      ---	       --	007	0	0	0.00	    $0.00	Y	
E	96131	PSYCL TST EVAL PHYS/QHP EA              	    77.94	   $77.94	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	96132	NRPSYC TST EVAL PHYS/QHP 1ST            	   116.97	  $116.97	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	96132	NRPSYC TST EVAL PHYS/QHP 1ST            	   138.25	  $113.37	      ---	       --	007	0	0	0.00	    $0.00	Y	
Q	96132	NRPSYC TST EVAL PHYS/QHP 1ST            	   138.25	  $113.37	      ---	       --	007	0	0	0.00	    $0.00	N	
X	96132	NRPSYC TST EVAL PHYS/QHP 1ST            	   116.97	  $116.97	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	96132	NRPSYC TST EVAL PHYS/QHP 1ST            	   116.97	  $116.97	      ---	       --	009	0	0	0.00	    $0.00	N	
Y	96133	NRPSYC TST EVAL PHYS/QHP EA             	    89.46	   $89.46	      ---	       --	009	0	0	0.00	    $0.00	N	
X	96133	NRPSYC TST EVAL PHYS/QHP EA             	    89.46	   $89.46	      ---	       --	009	0	0	0.00	    $0.00	Y	
Q	96133	NRPSYC TST EVAL PHYS/QHP EA             	   105.40	   $86.43	      ---	       --	007	0	0	0.00	    $0.00	N	
N	96133	NRPSYC TST EVAL PHYS/QHP EA             	   105.40	   $86.43	      ---	       --	007	0	0	0.00	    $0.00	Y	
E	96133	NRPSYC TST EVAL PHYS/QHP EA             	    89.46	   $89.46	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	96136	PSYCL/NRPSYC TST PHY/QHP 1ST            	    41.88	   $41.88	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	96136	PSYCL/NRPSYC TST PHY/QHP 1ST            	    51.07	   $41.88	      ---	       --	007	0	0	0.00	    $0.00	Y	
Q	96136	PSYCL/NRPSYC TST PHY/QHP 1ST            	    51.07	   $41.88	      ---	       --	007	0	0	0.00	    $0.00	N	
X	96136	PSYCL/NRPSYC TST PHY/QHP 1ST            	    41.88	   $41.88	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	96136	PSYCL/NRPSYC TST PHY/QHP 1ST            	    41.88	   $41.88	      ---	       --	009	0	0	0.00	    $0.00	N	
Y	96137	PSYCL/NRPSYC TST PHY/QHP EA             	    39.01	   $39.01	      ---	       --	009	0	0	0.00	    $0.00	N	
X	96137	PSYCL/NRPSYC TST PHY/QHP EA             	    39.01	   $39.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
Q	96137	PSYCL/NRPSYC TST PHY/QHP EA             	    47.57	   $39.01	      ---	       --	007	0	0	0.00	    $0.00	N	
N	96137	PSYCL/NRPSYC TST PHY/QHP EA             	    47.57	   $39.01	      ---	       --	007	0	0	0.00	    $0.00	Y	
E	96137	PSYCL/NRPSYC TST PHY/QHP EA             	    39.01	   $39.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	96138	PSYCL/NRPSYC TECH 1ST                   	    43.52	   $35.69	      ---	       --	007	0	0	0.00	    $0.00	Y	
Q	96138	PSYCL/NRPSYC TECH 1ST                   	    43.52	   $35.69	      ---	       --	007	0	0	0.00	    $0.00	N	
X	96138	PSYCL/NRPSYC TECH 1ST                   	    35.69	   $35.69	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	96139	PSYCL/NRPSYC TST TECH EA                	    35.69	   $35.69	      ---	       --	009	0	0	0.00	    $0.00	N	
Q	96139	PSYCL/NRPSYC TST TECH EA                	    43.52	   $35.69	      ---	       --	007	0	0	0.00	    $0.00	N	
N	96139	PSYCL/NRPSYC TST TECH EA                	    43.52	   $35.69	      ---	       --	007	0	0	0.00	    $0.00	N	
N	96146	PSYCL/NRPSYC TST AUTO RESULT            	     2.24	    $1.84	      ---	       --	007	0	0	0.00	    $0.00	Y	
Q	96146	PSYCL/NRPSYC TST AUTO RESULT            	     2.24	    $1.84	      ---	       --	007	0	0	0.00	    $0.00	N	
X	96146	PSYCL/NRPSYC TST AUTO RESULT            	     2.09	    $2.09	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	96146	PSYCL/NRPSYC TST AUTO RESULT            	     2.09	    $2.09	      ---	       --	009	0	0	0.00	    $0.00	N	
X	96156	HLTH BHV ASSMT/REASSESSMENT             	    85.40	   $85.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
Q	96156	HLTH BHV ASSMT/REASSESSMENT             	   102.80	   $84.30	      ---	       --	007	0	0	0.00	    $0.00	N	
N	96156	HLTH BHV ASSMT/REASSESSMENT             	   102.80	   $84.30	      ---	       --	007	0	0	0.00	    $0.00	Y	
E	96156	HLTH BHV ASSMT/REASSESSMENT             	    12.94	   $12.94	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	96158	HLTH BHV IVNTJ INDIV 1ST 30             	    47.45	   $47.45	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	96158	HLTH BHV IVNTJ INDIV 1ST 30             	    70.28	   $57.63	      ---	       --	007	0	0	0.00	    $0.00	Y	
Q	96158	HLTH BHV IVNTJ INDIV 1ST 30             	    70.28	   $57.63	      ---	       --	007	0	0	0.00	    $0.00	N	
X	96158	HLTH BHV IVNTJ INDIV 1ST 30             	    58.34	   $58.34	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	96159	HLTH BHV IVNTJ INDIV EA ADDL            	    20.11	   $20.11	      ---	       --	009	0	0	0.00	    $0.00	Y	
Q	96159	HLTH BHV IVNTJ INDIV EA ADDL            	    24.52	   $20.11	      ---	       --	007	0	0	0.00	    $0.00	N	
N	96159	HLTH BHV IVNTJ INDIV EA ADDL            	    24.52	   $20.11	      ---	       --	007	0	0	0.00	    $0.00	Y	
E	96159	HLTH BHV IVNTJ INDIV EA ADDL            	    12.94	   $12.94	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	96160	PT-FOCUSED HLTH RISK ASSMT              	     2.56	    $2.56	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	96161	CAREGIVER HEALTH RISK ASSMT             	     2.56	    $2.56	      ---	       --	009	0	0	0.00	    $0.00	Y	
Q	96164	HLTH BHV IVNTJ GRP 1ST 30               	    10.39	    $8.52	      ---	       --	007	0	0	0.00	    $0.00	N	
X	96164	HLTH BHV IVNTJ GRP 1ST 30               	     8.77	    $8.77	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	96164	HLTH BHV IVNTJ GRP 1ST 30               	    10.38	    $8.51	      ---	       --	007	0	0	0.00	    $0.00	Y	
E	96164	HLTH BHV IVNTJ GRP 1ST 30               	    10.50	   $10.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	96165	HLTH BHV IVNTJ GRP EA ADDL              	     2.16	    $2.16	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	96165	HLTH BHV IVNTJ GRP EA ADDL              	     4.89	    $4.01	      ---	       --	007	0	0	0.00	    $0.00	Y	
X	96165	HLTH BHV IVNTJ GRP EA ADDL              	     4.01	    $4.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
Q	96165	HLTH BHV IVNTJ GRP EA ADDL              	     4.89	    $4.01	      ---	       --	007	0	0	0.00	    $0.00	N	
Q	96167	HLTH BHV IVNTJ FAM 1ST 30               	    75.40	   $61.83	      ---	       --	007	0	0	0.00	    $0.00	N	
X	96167	HLTH BHV IVNTJ FAM 1ST 30               	    62.01	   $62.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	96167	HLTH BHV IVNTJ FAM 1ST 30               	    75.40	   $61.83	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	96168	HLTH BHV IVNTJ FAM EA ADDL              	    26.76	   $21.94	      ---	       --	007	0	0	0.00	    $0.00	Y	
X	96168	HLTH BHV IVNTJ FAM EA ADDL              	    21.95	   $21.95	      ---	       --	009	0	0	0.00	    $0.00	Y	
Q	96168	HLTH BHV IVNTJ FAM EA ADDL              	    26.77	   $21.95	      ---	       --	007	0	0	0.00	    $0.00	N	
Q	96170	HLTH BHV IVNTJ FAM WO PT 1ST            	    85.72	   $70.29	      ---	       --	007	0	0	0.00	    $0.00	N	
X	96170	HLTH BHV IVNTJ FAM WO PT 1ST            	    70.29	   $70.29	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	96170	HLTH BHV IVNTJ FAM WO PT 1ST            	    85.71	   $70.28	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	96171	HLTH BHV IVNTJ FAM W/O PT EA            	    31.15	   $25.54	      ---	       --	007	0	0	0.00	    $0.00	Y	
X	96171	HLTH BHV IVNTJ FAM W/O PT EA            	    25.55	   $25.55	      ---	       --	009	0	0	0.00	    $0.00	Y	
Q	96171	HLTH BHV IVNTJ FAM W/O PT EA            	    31.16	   $25.55	      ---	       --	007	0	0	0.00	    $0.00	N	
Q	96202	MLT FAM GRP BHV TRAIN 1ST 60            	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
X	96202	MLT FAM GRP BHV TRAIN 1ST 60            	    21.06	   $21.06	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	96202	MLT FAM GRP BHV TRAIN 1ST 60            	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	96203	MLT FAM GRP BHV TRAIN EA ADD            	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
X	96203	MLT FAM GRP BHV TRAIN EA ADD            	     5.40	    $5.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
Q	96203	MLT FAM GRP BHV TRAIN EA ADD            	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
X	96360	HYDRATION IV INFUSION INIT              	    51.30	   $51.30	      ---	       --	009	1	0	0.00	    $0.00	Y	
N	96360	HYDRATION IV INFUSION INIT              	     5.13	   $51.30	   $55.97	   $63.71	053	1	0	0.00	    $0.00	Y	
N	96361	HYDRATE IV INFUSION ADD-ON              	     1.46	   $14.60	   $15.93	   $18.13	053	1	0	0.00	    $0.00	Y	
X	96361	HYDRATE IV INFUSION ADD-ON              	    14.60	   $14.60	      ---	       --	009	1	0	0.00	    $0.00	Y	
Y	96365	THER/PROPH/DIAG IV INF INIT             	    62.60	   $62.60	      ---	   $62.60	009	1	0	0.00	    $0.00	Y	
N	96365	THER/PROPH/DIAG IV INF INIT             	    76.34	   $62.60	      ---	   $79.39	007	1	0	0.00	    $0.00	Y	
N	96366	THER/PROPH/DIAG IV INF ADDON            	    23.50	   $19.27	      ---	   $24.44	007	1	0	0.00	    $0.00	Y	
Y	96366	THER/PROPH/DIAG IV INF ADDON            	    19.27	   $19.27	      ---	   $19.27	009	1	0	0.00	    $0.00	Y	
Y	96367	TX/PROPH/DG ADDL SEQ IV INF             	    31.05	   $31.05	      ---	   $31.05	009	1	0	0.00	    $0.00	Y	
N	96367	TX/PROPH/DG ADDL SEQ IV INF             	    37.86	   $31.05	      ---	   $39.37	007	1	0	0.00	    $0.00	Y	
N	96368	THER/DIAG CONCURRENT INF                	    21.90	   $17.96	      ---	   $22.78	007	1	0	0.00	    $0.00	Y	
Y	96368	THER/DIAG CONCURRENT INF                	    17.96	   $17.96	      ---	   $17.96	009	1	0	0.00	    $0.00	Y	
Y	96369	SC THER INFUSION UP TO 1 HR             	   138.41	  $138.41	      ---	  $138.41	009	1	0	0.00	    $0.00	Y	
N	96369	SC THER INFUSION UP TO 1 HR             	   168.79	  $138.41	      ---	  $175.54	007	1	0	0.00	    $0.00	Y	
N	96370	SC THER INFUSION ADDL HR                	    16.50	   $13.53	      ---	   $17.16	007	1	0	0.00	    $0.00	Y	
Y	96370	SC THER INFUSION ADDL HR                	    13.53	   $13.53	      ---	   $13.53	009	1	0	0.00	    $0.00	Y	
Y	96371	SC THER INFUSION RESET PUMP             	    67.73	   $67.73	      ---	   $67.73	009	1	0	0.00	    $0.00	Y	
N	96371	SC THER INFUSION RESET PUMP             	    82.60	   $67.73	      ---	   $85.90	007	1	0	0.00	    $0.00	Y	
N	96372	THER/PROPH/DIAG INJ SC/IM               	    22.86	   $18.75	      ---	   $23.77	007	1	0	0.00	    $0.00	Y	
Y	96372	THER/PROPH/DIAG INJ SC/IM               	    18.75	   $18.75	      ---	   $18.75	009	1	0	0.00	    $0.00	Y	
Y	96373	THER/PROPH/DIAG INJ IA                  	    16.84	   $16.84	      ---	   $16.84	009	1	0	0.00	    $0.00	Y	
X	96373	THER/PROPH/DIAG INJ IA                  	    16.84	   $16.84	      ---	       --	009	1	0	0.00	    $0.00	Y	
N	96373	THER/PROPH/DIAG INJ IA                  	    19.39	   $15.90	      ---	   $20.17	007	1	0	0.00	    $0.00	Y	
N	96374	THER/PROPH/DIAG INJ IV PUSH             	    60.75	   $49.82	      ---	   $63.18	007	1	0	0.00	    $0.00	Y	
X	96374	THER/PROPH/DIAG INJ IV PUSH             	    49.82	   $49.82	      ---	       --	009	1	0	0.00	    $0.00	Y	
Y	96374	THER/PROPH/DIAG INJ IV PUSH             	    49.82	   $49.82	      ---	   $49.82	009	1	0	0.00	    $0.00	Y	
Y	96375	TX/PRO/DX INJ NEW DRUG ADDON            	    21.29	   $21.29	      ---	   $21.29	009	1	0	0.00	    $0.00	Y	
N	96375	TX/PRO/DX INJ NEW DRUG ADDON            	    25.96	   $21.29	      ---	   $27.00	007	1	0	0.00	    $0.00	Y	
N	96377	APPLICATON ON-BODY INJECTOR             	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
Y	96377	APPLICATON ON-BODY INJECTOR             	    15.69	   $15.69	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	96379	UNL THER/PROP/DIAG INJ/INF              	     0.00	    $0.00	      ---	       --	007	1	0	0.00	    $0.00	Y	
N	96401	CHEMO ANTI-NEOPL SQ/IM                  	    13.00	   $10.66	      ---	   $13.52	007	1	0	0.00	    $0.00	Y	
N	96402	CHEMO HORMON ANTINEOPL SQ/IM            	    13.00	   $10.66	      ---	   $13.52	007	1	0	0.00	    $0.00	Y	
N	96405	CHEMO INTRALESIONAL UP TO 7             	    47.94	   $39.31	      ---	   $49.86	007	1	0	0.00	    $0.00	Y	
N	96406	CHEMO INTRALESIONAL OVER 7              	    63.10	   $51.74	      ---	   $65.62	007	1	0	0.00	    $0.00	Y	
N	96409	CHEMO IV PUSH SNGL DRUG                 	    21.90	   $17.96	      ---	   $22.78	007	1	0	0.00	    $0.00	Y	
N	96411	CHEMO IV PUSH ADDL DRUG                 	    21.90	   $17.96	      ---	   $22.78	007	1	0	0.00	    $0.00	Y	
N	96413	CHEMO IV INFUSION 1 HR                  	    34.87	   $28.59	      ---	   $36.26	007	1	0	0.00	    $0.00	Y	
N	96415	CHEMO IV INFUSION ADDL HR               	    26.21	   $21.49	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	96416	CHEMO PROLONG INFUSE W/PUMP             	    56.33	   $46.19	      ---	   $58.58	007	1	0	0.00	    $0.00	Y	
N	96417	CHEMO IV INFUS EACH ADDL SEQ            	    34.87	   $28.59	      ---	   $36.26	007	1	0	0.00	    $0.00	Y	
N	96420	CHEMO IA PUSH TECNIQUE                  	    51.43	   $42.17	      ---	   $53.49	007	1	0	0.00	    $0.00	Y	
N	96422	CHEMO IA INFUSION UP TO 1 HR            	    45.30	   $37.15	      ---	   $47.11	007	1	0	0.00	    $0.00	Y	
N	96423	CHEMO IA INFUSE EACH ADDL HR            	    20.39	   $16.72	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	96425	CHEMOTHERAPY INFUSION METHOD            	   186.63	  $153.04	      ---	  $194.10	007	1	0	0.00	    $0.00	Y	
N	96440	CHMOTX ADMN PLRL CAV THRCNTS            	   202.90	  $166.38	      ---	  $211.02	007	1	0	0.00	    $0.00	Y	
N	96446	CHEMOTX ADMN PERTL CAV IMPL             	   151.54	  $124.26	      ---	  $157.60	007	1	0	0.00	    $0.00	Y	
N	96450	CHEMOTHERAPY INTO CNS                   	   159.32	  $130.64	      ---	  $165.69	007	1	0	0.00	    $0.00	Y	
N	96521	REFILL/MAINT PORTABLE PUMP              	    20.16	   $16.53	      ---	       --	007	0	1	0.00	    $0.00	Y	
N	96522	REFILL/MAINT PUMP/RESVR SYST            	    34.23	   $28.07	      ---	   $35.60	007	1	1	0.00	    $0.00	Y	
N	96523	IRRIG DRUG DELIVERY DEVICE              	     0.00	    $0.00	      ---	       --	007	1	0	0.00	    $0.00	Y	
N	96542	CHEMOTHERAPY INJECTION                  	   104.29	   $85.52	      ---	  $108.46	007	1	0	0.00	    $0.00	Y	
O	96547	INTRAOP HIPEC PX 1ST 60 MIN             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	96547	INTRAOP HIPEC PX 1ST 60 MIN             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	96548	NTRAOP HIPEC PX EA ADD 30MIN            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	96548	NTRAOP HIPEC PX EA ADD 30MIN            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
N	96549	UNLISTED CHEMOTHERAPY PX                	     0.00	    $0.00	      ---	       --	007	1	1	0.00	    $0.00	Y	
N	96567	PDT DSTR PRMLG LES SKN                  	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	96573	PDT DSTR PRMLG LES PHYS/QHP             	   214.62	  $175.99	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	96574	DBRDMT PRMLG LES W/PDT                  	   274.79	  $225.33	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	96900	ACTINOTHERAPY UV LIGHT                  	     9.02	    $7.40	      ---	    $9.38	007	1	1	0.00	    $0.00	Y	
N	96910	PHOTCHMTX TAR&UVB/PTRLTM&UVB            	    30.00	   $24.60	      ---	   $31.20	007	1	1	0.00	    $0.00	Y	
N	96912	PHOTOCHEMOTHERAPY PUVA                  	    19.46	   $15.96	      ---	   $20.24	007	1	1	0.00	    $0.00	Y	
N	96913	PHOTOCHEMOTX SEV DERMATOSES             	    39.79	   $32.63	      ---	   $41.38	007	1	0	0.00	    $0.00	Y	
N	96920	EXCIMER LSR PSRIASIS<250SQCM            	   151.57	  $124.29	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	96921	EXCIMER LSR PSRIASIS 250-500            	   162.40	  $133.17	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	96922	EXCIMER LSR PSRIASIS>500SQCM            	   222.13	  $182.15	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	96999	UNLISTED SPEC DERM SVC/PX               	     0.00	    $0.00	      ---	       --	007	1	1	0.00	    $0.00	Y	
N	97010	HOT OR COLD PACKS THERAPY               	    12.00	    $9.84	      ---	   $12.48	007	1	1	0.00	    $0.00	Y	
P	97010	HOT OR COLD PACKS THERAPY               	    12.00	    $9.84	      ---	       --	019	0	1	0.00	    $0.00	Y	
X	97010	HOT OR COLD PACKS THERAPY               	     9.84	    $9.84	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	97012	MECHANICAL TRACTION THERAPY             	    13.18	   $13.18	      ---	       --	009	1	1	0.00	    $0.00	Y	
P	97012	MECHANICAL TRACTION THERAPY             	    13.59	   $11.14	      ---	       --	019	0	1	0.00	    $0.00	Y	
N	97012	MECHANICAL TRACTION THERAPY             	    13.59	   $11.14	      ---	   $14.13	007	1	1	0.00	    $0.00	Y	
N	97014	ELECTRIC STIMULATION THERAPY            	    13.59	   $11.14	      ---	   $14.13	007	1	1	0.00	    $0.00	Y	
P	97014	ELECTRIC STIMULATION THERAPY            	    13.59	   $11.14	      ---	       --	019	0	1	0.00	    $0.00	Y	
P	97016	VASOPNEUMATIC DEVICE THERAPY            	    13.59	   $11.14	      ---	       --	019	0	1	0.00	    $0.00	Y	
N	97016	VASOPNEUMATIC DEVICE THERAPY            	    13.59	   $11.14	      ---	   $14.13	007	1	1	0.00	    $0.00	Y	
X	97016	VASOPNEUMATIC DEVICE THERAPY            	    11.14	   $11.14	      ---	       --	009	1	1	0.00	    $0.00	Y	
N	97018	PARAFFIN BATH THERAPY                   	    12.00	    $9.84	      ---	   $12.48	007	1	1	0.00	    $0.00	Y	
P	97018	PARAFFIN BATH THERAPY                   	    12.00	    $9.84	      ---	       --	019	0	1	0.00	    $0.00	Y	
P	97022	WHIRLPOOL THERAPY                       	    13.59	   $11.14	      ---	       --	019	0	1	0.00	    $0.00	Y	
N	97022	WHIRLPOOL THERAPY                       	    13.59	   $11.14	      ---	   $14.13	007	1	1	0.00	    $0.00	Y	
N	97024	DIATHERMY EG MICROWAVE                  	    12.00	    $9.84	      ---	   $12.48	007	1	1	0.00	    $0.00	Y	
P	97024	DIATHERMY EG MICROWAVE                  	    12.00	    $9.84	      ---	       --	019	0	1	0.00	    $0.00	Y	
P	97026	INFRARED THERAPY                        	    12.00	    $9.84	      ---	       --	019	0	1	0.00	    $0.00	Y	
N	97026	INFRARED THERAPY                        	    12.00	    $9.84	      ---	   $12.48	007	1	1	0.00	    $0.00	Y	
N	97028	ULTRAVIOLET THERAPY                     	    12.00	    $9.84	      ---	   $12.48	007	1	1	0.00	    $0.00	Y	
P	97028	ULTRAVIOLET THERAPY                     	    12.00	    $9.84	      ---	       --	019	0	1	0.00	    $0.00	Y	
P	97032	APPL MODALITY 1+ESTIM EA 15             	    10.56	    $8.66	      ---	       --	019	0	1	0.00	    $0.00	Y	
N	97032	APPL MODALITY 1+ESTIM EA 15             	    10.56	    $8.66	      ---	   $10.98	007	1	1	0.00	    $0.00	Y	
N	97033	APP MDLTY 1+IONTPHRSIS EA 15            	    11.20	    $9.18	      ---	   $11.65	007	1	1	0.00	    $0.00	Y	
P	97033	APP MDLTY 1+IONTPHRSIS EA 15            	    11.20	    $9.18	      ---	       --	019	0	1	0.00	    $0.00	Y	
P	97034	APP MDLTY 1+CNTRST BTH EA 15            	     9.55	    $7.83	      ---	       --	019	0	1	0.00	    $0.00	Y	
N	97034	APP MDLTY 1+CNTRST BTH EA 15            	     9.55	    $7.83	      ---	    $9.93	007	1	1	0.00	    $0.00	Y	
N	97035	APP MDLTY 1+ULTRASOUND EA 15            	     9.06	    $7.43	      ---	    $9.42	007	1	1	0.00	    $0.00	Y	
P	97035	APP MDLTY 1+ULTRASOUND EA 15            	     9.06	    $7.43	      ---	       --	019	0	1	0.00	    $0.00	Y	
P	97036	APP MDLTY 1+HUBBRD TNK EA 15            	    13.59	   $11.14	      ---	       --	019	1	1	0.00	    $0.00	Y	
N	97036	APP MDLTY 1+HUBBRD TNK EA 15            	    13.59	   $11.14	      ---	   $14.13	007	1	1	0.00	    $0.00	Y	
N	97039	UNLISTED MODALITY                       	    17.40	   $14.27	      ---	   $18.10	007	1	1	0.00	    $0.00	Y	
P	97039	UNLISTED MODALITY                       	    17.40	   $14.27	      ---	       --	007	0	1	0.00	    $0.00	Y	
P	97110	THERAPEUTIC EXERCISES                   	    13.37	   $10.96	      ---	       --	019	0	1	0.00	    $0.00	Y	
N	97110	THERAPEUTIC EXERCISES                   	    13.37	   $10.96	      ---	   $13.90	007	1	1	0.00	    $0.00	Y	
E	97110	THERAPEUTIC EXERCISES                   	     6.37	    $6.37	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	97112	NEUROMUSCULAR REEDUCATION               	    14.90	   $12.22	      ---	   $15.50	007	1	1	0.00	    $0.00	Y	
P	97112	NEUROMUSCULAR REEDUCATION               	    14.90	   $12.22	      ---	       --	019	0	1	0.00	    $0.00	Y	
P	97113	AQUATIC THERAPY/EXERCISES               	    16.99	   $13.93	      ---	       --	019	0	1	0.00	    $0.00	Y	
N	97113	AQUATIC THERAPY/EXERCISES               	    16.99	   $13.93	      ---	   $17.67	007	1	1	0.00	    $0.00	Y	
N	97116	GAIT TRAINING THERAPY                   	    13.76	   $11.28	      ---	   $14.31	007	1	1	0.00	    $0.00	Y	
P	97116	GAIT TRAINING THERAPY                   	    13.76	   $11.28	      ---	       --	019	0	1	0.00	    $0.00	Y	
P	97124	MASSAGE THERAPY                         	    12.55	   $10.29	      ---	       --	019	0	1	0.00	    $0.00	Y	
N	97124	MASSAGE THERAPY                         	    12.55	   $10.29	      ---	   $13.05	007	1	1	0.00	    $0.00	Y	
N	97129	THER IVNTJ 1ST 15 MIN                   	    25.34	   $20.78	      ---	       --	007	0	0	0.00	    $0.00	Y	
Q	97129	THER IVNTJ 1ST 15 MIN                   	    25.34	   $20.78	      ---	       --	007	0	0	0.00	    $0.00	N	
Q	97130	THER IVNTJ EA ADDL 15 MIN               	    24.19	   $19.84	      ---	       --	007	0	0	0.00	    $0.00	N	
N	97130	THER IVNTJ EA ADDL 15 MIN               	    24.19	   $19.84	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	97139	UNLISTED THERAPEUTIC PX                 	     9.33	    $7.65	      ---	    $9.70	007	1	1	0.00	    $0.00	Y	
P	97139	UNLISTED THERAPEUTIC PX                 	     9.33	    $7.65	      ---	       --	019	0	1	0.00	    $0.00	Y	
P	97140	MANUAL THERAPY 1/> REGIONS              	    27.09	   $22.21	      ---	       --	019	1	0	0.00	    $0.00	Y	
N	97140	MANUAL THERAPY 1/> REGIONS              	    27.09	   $22.21	      ---	   $28.17	007	1	0	0.00	    $0.00	Y	
E	97150	GROUP THERAPEUTIC PROCEDURES            	    13.54	   $13.54	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	97151	BHV ID ASSMT BY PHYS/QHP                	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
Q	97151	BHV ID ASSMT BY PHYS/QHP                	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	N	
Q	97152	BHV ID SUPRT ASSMT BY 1 TECH            	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	N	
N	97152	BHV ID SUPRT ASSMT BY 1 TECH            	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	97153	ADAPTIVE BEHAVIOR TX BY TECH            	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
Q	97153	ADAPTIVE BEHAVIOR TX BY TECH            	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	N	
Q	97154	GRP ADAPT BHV TX BY TECH                	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	N	
N	97154	GRP ADAPT BHV TX BY TECH                	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	97155	ADAPT BEHAVIOR TX PHYS/QHP              	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
Q	97155	ADAPT BEHAVIOR TX PHYS/QHP              	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	N	
Q	97156	FAM ADAPT BHV TX GDN PHY/QHP            	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	N	
N	97156	FAM ADAPT BHV TX GDN PHY/QHP            	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	97157	MULT FAM ADAPT BHV TX GDN               	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
Q	97157	MULT FAM ADAPT BHV TX GDN               	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	N	
Q	97158	GRP ADAPT BHV TX BY PHY/QHP             	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	N	
N	97158	GRP ADAPT BHV TX BY PHY/QHP             	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
E	97163	PT EVAL HIGH COMPLEX 45 MIN             	   135.56	  $135.56	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	97164	PT RE-EVAL EST PLAN CARE                	    94.14	   $94.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	97167	OT EVAL HIGH COMPLEX 60 MIN             	   125.74	  $125.74	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	97168	OT RE-EVAL EST PLAN CARE                	    87.32	   $87.32	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	97530	THERAPEUTIC ACTIVITIES                  	    13.59	   $11.14	      ---	   $14.13	007	1	1	0.00	    $0.00	Y	
N	97533	SENSORY INTEGRATION                     	    29.48	   $24.17	      ---	   $30.66	007	1	1	0.00	    $0.00	Y	
E	97533	SENSORY INTEGRATION                     	    12.34	   $12.34	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	97535	SELF CARE MNGMENT TRAINING              	     5.31	    $5.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	97597	DBRDMT OPN WND 1ST 20 CM/<              	    51.35	   $42.11	      ---	   $53.40	007	1	0	0.00	    $0.00	Y	
P	97597	DBRDMT OPN WND 1ST 20 CM/<              	    51.35	   $42.11	      ---	       --	019	1	0	0.00	    $0.00	Y	
X	97597	DBRDMT OPN WND 1ST 20 CM/<              	    94.09	   $94.09	      ---	       --	009	1	0	0.00	    $0.00	Y	
X	97598	DBRDMT OPN WND ADDL 20CM/<              	    53.47	   $53.47	      ---	       --	009	1	0	0.00	    $0.00	Y	
P	97598	DBRDMT OPN WND ADDL 20CM/<              	    65.21	   $53.47	      ---	       --	019	1	0	0.00	    $0.00	Y	
N	97598	DBRDMT OPN WND ADDL 20CM/<              	    65.21	   $53.47	      ---	   $67.82	007	1	0	0.00	    $0.00	Y	
N	97750	PHYSICAL PERFORMANCE TEST               	    14.02	   $11.50	      ---	   $14.58	007	1	0	0.00	    $0.00	Y	
N	97799	UNLISTED PHYSCL MED/REHAB PX            	     0.00	    $0.00	      ---	       --	007	1	1	0.00	    $0.00	Y	
N	97802	MEDICAL NUTRITION INDIV IN              	    30.35	   $30.35	      ---	   $30.35	009	1	1	0.00	    $0.00	Y	
X	97802	MEDICAL NUTRITION INDIV IN              	    33.81	   $33.81	      ---	       --	009	1	1	0.00	    $0.00	Y	
T	97802	MEDICAL NUTRITION INDIV IN              	    30.35	   $30.35	      ---	       --	009	0	0	0.00	    $0.00	Y	
T	97803	MED NUTRITION INDIV SUBSEQ              	    26.11	   $26.11	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	97803	MED NUTRITION INDIV SUBSEQ              	    29.47	   $29.47	      ---	       --	009	1	1	0.00	    $0.00	Y	
N	97803	MED NUTRITION INDIV SUBSEQ              	    26.11	   $26.11	      ---	   $26.11	009	1	1	0.00	    $0.00	Y	
N	97804	MEDICAL NUTRITION GROUP                 	    13.91	   $13.91	      ---	   $13.91	009	1	1	0.00	    $0.00	Y	
X	97804	MEDICAL NUTRITION GROUP                 	    15.42	   $15.42	      ---	       --	009	1	1	0.00	    $0.00	Y	
T	97804	MEDICAL NUTRITION GROUP                 	    13.91	   $13.91	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	97810	ACUP 1/> WO ESTIM 1ST 15 MIN            	    24.39	   $20.00	      ---	   $25.37	007	1	1	0.00	    $0.00	Y	
P	97810	ACUP 1/> WO ESTIM 1ST 15 MIN            	    24.39	   $20.00	      ---	       --	019	1	1	0.00	    $0.00	Y	
P	97811	ACUP 1/> W/O ESTIM EA ADD 15            	    24.39	   $20.00	      ---	       --	019	1	1	0.00	    $0.00	Y	
N	97811	ACUP 1/> W/O ESTIM EA ADD 15            	    24.39	   $20.00	      ---	   $25.37	007	1	1	0.00	    $0.00	Y	
N	97813	ACUP 1/> W/ESTIM 1ST 15 MIN             	    24.39	   $20.00	      ---	   $25.37	007	1	1	0.00	    $0.00	Y	
P	97813	ACUP 1/> W/ESTIM 1ST 15 MIN             	    24.39	   $20.00	      ---	       --	019	1	1	0.00	    $0.00	Y	
P	97814	ACUP 1/> W/ESTIM EA ADDL 15             	    24.39	   $20.00	      ---	       --	019	1	1	0.00	    $0.00	Y	
N	97814	ACUP 1/> W/ESTIM EA ADDL 15             	    24.39	   $20.00	      ---	   $25.37	007	1	1	0.00	    $0.00	Y	
N	98016	BRIEF COMUNICAJ TECH-BSD SVC            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	98925	OSTEOPATH MANJ 1-2 REGIONS              	    27.57	   $27.57	      ---	       --	009	0	0	0.00	    $0.00	N	
X	98925	OSTEOPATH MANJ 1-2 REGIONS              	    28.37	   $28.37	      ---	       --	009	0	0	0.00	    $0.00	N	
X	98926	OSTEOPATH MANJ 3-4 REGIONS              	    40.74	   $40.74	      ---	       --	009	0	0	0.00	    $0.00	N	
N	98926	OSTEOPATH MANJ 3-4 REGIONS              	    39.54	   $39.54	      ---	       --	009	0	0	0.00	    $0.00	N	
1	98940	CHIROPRACT MANJ 1-2 REGIONS             	    16.72	   $16.72	      ---	       --	009	0	0	0.00	    $0.00	N	
1	98941	CHIROPRACT MANJ 3-4 REGIONS             	    16.72	   $16.72	      ---	       --	009	0	0	0.00	    $0.00	N	
1	98942	CHIROPRACTIC MANJ 5 REGIONS             	    16.72	   $16.72	      ---	       --	009	0	0	0.00	    $0.00	N	
X	98960	EDU&TRN PT SELF-MGMT NQHP 1             	    27.54	   $27.54	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	98960	EDU&TRN PT SELF-MGMT NQHP 1             	    32.51	   $26.66	      ---	       --	007	0	0	0.00	    $0.00	Y	
E	98960	EDU&TRN PT SELF-MGMT NQHP 1             	    26.66	   $26.66	      ---	       --	009	0	0	0.00	    $0.00	N	
E	98961	EDU&TRN PT SLF-MGMT NQHP 2-4            	    12.66	   $12.66	      ---	       --	009	0	0	0.00	    $0.00	N	
N	98961	EDU&TRN PT SLF-MGMT NQHP 2-4            	    15.44	   $12.66	      ---	       --	007	0	0	0.00	    $0.00	Y	
X	98961	EDU&TRN PT SLF-MGMT NQHP 2-4            	    13.29	   $13.29	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	98962	EDU&TRN PT SLF-MGMT NQHP 5-8            	     9.77	    $9.77	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	98962	EDU&TRN PT SLF-MGMT NQHP 5-8            	    11.54	    $9.46	      ---	       --	007	0	0	0.00	    $0.00	Y	
E	98962	EDU&TRN PT SLF-MGMT NQHP 5-8            	     9.46	    $9.46	      ---	       --	009	0	0	0.00	    $0.00	N	
Y	98966	PH1 ASSMT&MGMT NQHP 5-10                	    11.90	   $11.90	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	98967	PH1 ASSMT&MGMT NQHP 11-20               	    21.56	   $21.56	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	98968	PH1 ASSMT&MGMT NQHP 21-30               	    30.09	   $30.09	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	98978	REM THER MNTR DEV SPLY CBT              	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	99000	SPECIMEN HANDLING OFFICE-LAB            	     4.43	    $3.63	      ---	       --	007	0	0	0.00	    $0.00	Y	
1	99056	MED SERVICE OUT OF OFFICE               	     7.50	    $7.50	      ---	       --	009	0	1	0.00	    $0.00	N	
N	99070	SPECIAL SUPPLIES PHYS/QHP               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	99070	SPECIAL SUPPLIES PHYS/QHP               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	99082	UNUSUAL PHYSICIAN TRAVEL                	    50.40	   $50.40	      ---	       --	009	0	0	0.00	    $0.00	N	
N	99091	COLLJ & INTERPJ DATA EA 30 D            	    48.32	   $48.32	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	99091	COLLJ & INTERPJ DATA EA 30 D            	    48.32	   $48.32	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	99151	MOD SED SAME PHYS/QHP <5 YRS            	     4.97	   $69.63	      ---	       --	002	0	0	0.00	    $0.00	Y	
N	99152	MOD SED SAME PHYS/QHP 5/>YRS            	     3.33	   $46.65	      ---	       --	002	0	0	0.00	    $0.00	Y	
N	99153	MOD SED SAME PHYS/QHP EA                	     0.72	   $10.09	      ---	       --	002	0	0	0.00	    $0.00	Y	
N	99155	MOD SED OTH PHYS/QHP <5 YRS             	     5.59	   $78.32	      ---	       --	002	0	0	0.00	    $0.00	Y	
N	99156	MOD SED OTH PHYS/QHP 5/>YRS             	     4.54	   $63.61	      ---	       --	002	0	0	0.00	    $0.00	Y	
N	99157	MOD SED OTHER PHYS/QHP EA               	     3.44	   $48.19	      ---	       --	002	0	0	0.00	    $0.00	Y	
N	99170	ANOGENITAL EXAM CHILD W IMAG            	    10.88	  $108.80	  $118.70	  $135.13	001	1	0	0.00	    $0.00	Y	
X	99170	ANOGENITAL EXAM CHILD W IMAG            	   150.06	  $150.06	      ---	       --	009	1	0	0.00	    $0.00	Y	
E	99173	VISUAL ACUITY SCREEN                    	     4.03	    $4.03	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	99183	HYPERBARIC OXYGEN THERAPY               	   113.29	   $92.90	      ---	  $117.82	007	1	0	0.00	    $0.00	Y	
N	99184	HYPOTHERMIA ILL NEONATE                 	   242.80	  $199.10	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	99188	APP TOPICAL FLUORIDE VARNISH            	    18.00	   $18.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	99188	APP TOPICAL FLUORIDE VARNISH            	    18.00	   $18.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	99195	PHLEBOTOMY                              	    91.89	   $91.89	      ---	       --	009	1	0	0.00	    $0.00	Y	
N	99195	PHLEBOTOMY                              	    20.00	   $16.40	      ---	   $20.80	007	1	0	0.00	    $0.00	Y	
N	99199	UNLISTED SPECIAL SVC PX/RPRT            	     0.00	    $0.00	      ---	       --	007	1	0	0.00	    $0.00	Y	
N	99202	OFFICE O/P NEW SF 15 MIN                	     3.43	   $34.30	   $37.42	   $42.60	001	1	1	0.00	    $0.00	Y	
P	99202	OFFICE O/P NEW SF 15 MIN                	     3.43	   $34.30	   $37.42	       --	052	0	1	0.00	    $0.00	Y	
X	99202	OFFICE O/P NEW SF 15 MIN                	    69.30	   $69.30	      ---	       --	009	1	1	0.00	    $0.00	Y	
1	99202	OFFICE O/P NEW SF 15 MIN                	    34.30	   $34.30	      ---	   $34.30	009	1	0	0.00	    $0.00	Y	
Y	99202	OFFICE O/P NEW SF 15 MIN                	    69.30	   $69.30	      ---	   $69.30	009	1	1	0.00	    $0.00	Y	
Y	99203	OFFICE O/P NEW LOW 30 MIN               	   101.27	  $101.27	      ---	  $101.27	009	1	1	0.00	    $0.00	Y	
1	99203	OFFICE O/P NEW LOW 30 MIN               	    57.20	   $57.20	      ---	   $57.20	009	1	0	0.00	    $0.00	Y	
X	99203	OFFICE O/P NEW LOW 30 MIN               	   101.27	  $101.27	      ---	       --	009	1	1	0.00	    $0.00	Y	
P	99203	OFFICE O/P NEW LOW 30 MIN               	     5.72	   $57.20	   $62.41	       --	052	0	1	0.00	    $0.00	Y	
N	99203	OFFICE O/P NEW LOW 30 MIN               	     5.72	   $57.20	   $62.41	   $71.04	001	1	1	0.00	    $0.00	Y	
N	99204	OFFICE O/P NEW MOD 45 MIN               	     6.89	   $68.90	   $75.17	   $85.57	001	1	1	0.00	    $0.00	Y	
P	99204	OFFICE O/P NEW MOD 45 MIN               	     6.89	   $68.90	   $75.17	       --	052	1	1	0.00	    $0.00	Y	
X	99204	OFFICE O/P NEW MOD 45 MIN               	   151.90	  $151.90	      ---	       --	009	1	1	0.00	    $0.00	Y	
1	99204	OFFICE O/P NEW MOD 45 MIN               	    68.90	   $68.90	      ---	   $68.90	009	1	0	0.00	    $0.00	Y	
Y	99204	OFFICE O/P NEW MOD 45 MIN               	   151.90	  $151.90	      ---	  $151.90	009	1	1	0.00	    $0.00	Y	
Y	99205	OFFICE O/P NEW HI 60 MIN                	   197.98	  $197.98	      ---	  $197.98	009	1	1	0.00	    $0.00	Y	
1	99205	OFFICE O/P NEW HI 60 MIN                	    82.70	   $82.70	      ---	   $82.70	009	1	0	0.00	    $0.00	Y	
X	99205	OFFICE O/P NEW HI 60 MIN                	   197.98	  $197.98	      ---	       --	009	1	1	0.00	    $0.00	Y	
P	99205	OFFICE O/P NEW HI 60 MIN                	     8.27	   $82.70	   $90.23	       --	052	1	1	0.00	    $0.00	Y	
N	99205	OFFICE O/P NEW HI 60 MIN                	     8.27	   $82.70	   $90.23	  $102.71	001	1	1	0.00	    $0.00	Y	
N	99211	OFF/OP EST MAY X REQ PHY/QHP            	     1.20	   $12.00	   $13.09	   $14.90	001	1	1	0.00	    $0.00	Y	
P	99211	OFF/OP EST MAY X REQ PHY/QHP            	     1.20	   $12.00	   $13.09	       --	052	0	1	0.00	    $0.00	Y	
X	99211	OFF/OP EST MAY X REQ PHY/QHP            	    22.00	   $22.00	      ---	       --	009	1	1	0.00	    $0.00	Y	
1	99211	OFF/OP EST MAY X REQ PHY/QHP            	    12.00	   $12.00	      ---	   $12.00	009	1	0	0.00	    $0.00	Y	
1	99212	OFFICE O/P EST SF 10 MIN                	    11.41	   $11.41	      ---	   $11.41	009	1	0	0.00	    $0.00	Y	
Y	99212	OFFICE O/P EST SF 10 MIN                	    51.66	   $51.66	      ---	   $51.66	009	1	1	0.00	    $0.00	Y	
X	99212	OFFICE O/P EST SF 10 MIN                	    51.66	   $51.66	      ---	       --	009	1	1	0.00	    $0.00	Y	
P	99212	OFFICE O/P EST SF 10 MIN                	     1.81	   $18.10	   $19.75	       --	052	0	1	0.00	    $0.00	Y	
N	99212	OFFICE O/P EST SF 10 MIN                	     1.81	   $18.10	   $19.75	   $22.48	001	1	1	0.00	    $0.00	Y	
N	99213	OFFICE O/P EST LOW 20 MIN               	     2.40	   $24.00	   $26.18	   $29.81	001	1	1	0.00	    $0.00	Y	
P	99213	OFFICE O/P EST LOW 20 MIN               	     2.40	   $24.00	   $26.18	       --	052	0	1	0.00	    $0.00	Y	
X	99213	OFFICE O/P EST LOW 20 MIN               	    82.02	   $82.02	      ---	       --	009	1	1	0.00	    $0.00	Y	
Y	99213	OFFICE O/P EST LOW 20 MIN               	    82.02	   $82.02	      ---	   $82.02	009	1	1	0.00	    $0.00	Y	
1	99213	OFFICE O/P EST LOW 20 MIN               	    24.00	   $24.00	      ---	   $24.00	009	1	0	0.00	    $0.00	Y	
1	99214	OFFICE O/P EST MOD 30 MIN               	    37.50	   $37.50	      ---	   $37.50	009	1	0	0.00	    $0.00	Y	
Y	99214	OFFICE O/P EST MOD 30 MIN               	   115.88	  $115.88	      ---	  $115.88	009	1	1	0.00	    $0.00	Y	
X	99214	OFFICE O/P EST MOD 30 MIN               	   115.88	  $115.88	      ---	       --	009	1	1	0.00	    $0.00	Y	
P	99214	OFFICE O/P EST MOD 30 MIN               	     3.75	   $37.50	   $40.91	       --	052	1	1	0.00	    $0.00	Y	
N	99214	OFFICE O/P EST MOD 30 MIN               	     3.75	   $37.50	   $40.91	   $46.58	001	1	1	0.00	    $0.00	Y	
N	99215	OFFICE O/P EST HI 40 MIN                	     5.72	   $57.20	   $62.41	   $71.04	001	1	1	0.00	    $0.00	Y	
P	99215	OFFICE O/P EST HI 40 MIN                	     5.72	   $57.20	   $62.41	       --	052	1	1	0.00	    $0.00	Y	
X	99215	OFFICE O/P EST HI 40 MIN                	   162.11	  $162.11	      ---	       --	009	1	1	0.00	    $0.00	Y	
Y	99215	OFFICE O/P EST HI 40 MIN                	   162.11	  $162.11	      ---	  $162.11	009	1	1	0.00	    $0.00	Y	
1	99215	OFFICE O/P EST HI 40 MIN                	    57.20	   $57.20	      ---	   $57.20	009	1	0	0.00	    $0.00	Y	
Y	99221	1ST HOSP IP/OBS SF/LOW 40               	    34.30	   $34.30	      ---	   $34.30	009	1	0	0.00	    $0.00	Y	
P	99221	1ST HOSP IP/OBS SF/LOW 40               	     3.43	   $34.30	   $37.42	       --	052	0	0	0.00	    $0.00	Y	
N	99221	1ST HOSP IP/OBS SF/LOW 40               	     3.43	   $34.30	   $37.42	   $42.60	001	1	0	0.00	    $0.00	Y	
N	99222	1ST HOSP IP/OBS MODERATE 55             	     7.32	   $73.20	   $79.86	   $90.91	001	1	0	0.00	    $0.00	Y	
P	99222	1ST HOSP IP/OBS MODERATE 55             	     7.32	   $73.20	   $79.86	       --	052	0	0	0.00	    $0.00	Y	
Y	99222	1ST HOSP IP/OBS MODERATE 55             	    73.20	   $73.20	      ---	   $73.20	009	1	0	0.00	    $0.00	Y	
Y	99223	1ST HOSP IP/OBS HIGH 75                 	    80.10	   $80.10	      ---	   $80.10	009	1	0	0.00	    $0.00	Y	
P	99223	1ST HOSP IP/OBS HIGH 75                 	     8.01	   $80.10	   $87.39	       --	052	0	0	0.00	    $0.00	Y	
N	99223	1ST HOSP IP/OBS HIGH 75                 	     8.01	   $80.10	   $87.39	   $99.48	001	1	0	0.00	    $0.00	Y	
N	99231	SBSQ HOSP IP/OBS SF/LOW 25              	     2.75	   $27.50	   $30.00	   $34.16	001	1	0	0.00	    $0.00	Y	
P	99231	SBSQ HOSP IP/OBS SF/LOW 25              	     2.75	   $27.50	   $30.00	       --	052	0	0	0.00	    $0.00	Y	
Y	99231	SBSQ HOSP IP/OBS SF/LOW 25              	    27.50	   $27.50	      ---	   $27.50	009	1	0	0.00	    $0.00	Y	
Y	99232	SBSQ HOSP IP/OBS MODERATE 35            	    37.80	   $37.80	      ---	   $37.80	009	1	0	0.00	    $0.00	Y	
P	99232	SBSQ HOSP IP/OBS MODERATE 35            	     3.78	   $37.80	   $41.24	       --	052	0	0	0.00	    $0.00	Y	
N	99232	SBSQ HOSP IP/OBS MODERATE 35            	     3.78	   $37.80	   $41.24	   $46.95	001	1	0	0.00	    $0.00	Y	
N	99233	SBSQ HOSP IP/OBS HIGH 50                	     4.58	   $45.80	   $49.97	   $56.88	001	1	0	0.00	    $0.00	Y	
P	99233	SBSQ HOSP IP/OBS HIGH 50                	     4.58	   $45.80	   $49.97	       --	052	1	0	0.00	    $0.00	Y	
Y	99233	SBSQ HOSP IP/OBS HIGH 50                	    45.80	   $45.80	      ---	   $45.80	009	1	0	0.00	    $0.00	Y	
Y	99234	HOSP IP/OBS SM DT SF/LOW 45             	    74.70	   $74.70	      ---	   $74.70	009	1	0	0.00	    $0.00	Y	
N	99234	HOSP IP/OBS SM DT SF/LOW 45             	     7.47	   $74.70	   $81.50	   $92.78	001	1	0	0.00	    $0.00	Y	
N	99235	HOSP IP/OBS SAME DATE MOD 70            	    10.35	  $103.50	  $112.92	  $128.55	001	1	0	0.00	    $0.00	Y	
Y	99235	HOSP IP/OBS SAME DATE MOD 70            	   103.50	  $103.50	      ---	  $103.50	009	1	0	0.00	    $0.00	Y	
Y	99236	HOSP IP/OBS SAME DATE HI 85             	   124.60	  $124.60	      ---	  $124.60	009	1	0	0.00	    $0.00	Y	
N	99236	HOSP IP/OBS SAME DATE HI 85             	    12.46	  $124.60	  $135.94	  $154.75	001	1	0	0.00	    $0.00	Y	
N	99238	HOSP IP/OBS DSCHRG MGMT 30/<            	     3.76	   $37.60	   $41.02	   $46.70	001	1	0	0.00	    $0.00	Y	
P	99238	HOSP IP/OBS DSCHRG MGMT 30/<            	     3.76	   $37.60	   $41.02	       --	052	1	0	0.00	    $0.00	Y	
V	99238	HOSP IP/OBS DSCHRG MGMT 30/<            	     3.76	   $37.60	   $41.02	   $46.70	001	1	0	0.00	    $0.00	Y	
V	99239	HOSP IP/OBS DSCHRG MGMT >30             	     5.34	   $53.40	   $58.26	   $66.32	001	1	0	0.00	    $0.00	Y	
P	99239	HOSP IP/OBS DSCHRG MGMT >30             	     5.34	   $53.40	   $58.26	       --	052	1	0	0.00	    $0.00	Y	
N	99239	HOSP IP/OBS DSCHRG MGMT >30             	     5.34	   $53.40	   $58.26	   $66.32	001	1	0	0.00	    $0.00	Y	
N	99242	OFF/OP CONSLTJ NEW/EST SF 20            	     4.72	   $47.20	   $51.50	   $58.62	053	1	1	0.00	    $0.00	Y	
P	99242	OFF/OP CONSLTJ NEW/EST SF 20            	     4.72	   $47.20	   $51.50	       --	052	0	1	0.00	    $0.00	Y	
X	99242	OFF/OP CONSLTJ NEW/EST SF 20            	    69.09	   $69.09	      ---	       --	009	1	1	0.00	    $0.00	Y	
Y	99242	OFF/OP CONSLTJ NEW/EST SF 20            	    69.09	   $69.09	      ---	   $69.09	009	1	1	0.00	    $0.00	Y	
1	99242	OFF/OP CONSLTJ NEW/EST SF 20            	    47.20	   $47.20	      ---	   $47.20	009	1	0	0.00	    $0.00	Y	
1	99243	OFF/OP CNSLTJ NEW/EST LOW 30            	    59.50	   $59.50	      ---	   $59.50	009	1	0	0.00	    $0.00	Y	
Y	99243	OFF/OP CNSLTJ NEW/EST LOW 30            	   103.09	  $103.09	      ---	  $103.09	009	1	1	0.00	    $0.00	Y	
X	99243	OFF/OP CNSLTJ NEW/EST LOW 30            	   103.09	  $103.09	      ---	       --	009	1	1	0.00	    $0.00	Y	
P	99243	OFF/OP CNSLTJ NEW/EST LOW 30            	     5.95	   $59.50	   $64.91	       --	052	0	1	0.00	    $0.00	Y	
N	99243	OFF/OP CNSLTJ NEW/EST LOW 30            	     5.95	   $59.50	   $64.91	   $73.90	053	1	1	0.00	    $0.00	Y	
N	99244	OFF/OP CNSLTJ NEW/EST MOD 40            	     8.14	   $81.40	   $88.81	  $101.10	053	1	1	0.00	    $0.00	Y	
P	99244	OFF/OP CNSLTJ NEW/EST MOD 40            	     8.14	   $81.40	   $88.81	       --	052	1	1	0.00	    $0.00	Y	
X	99244	OFF/OP CNSLTJ NEW/EST MOD 40            	   147.06	  $147.06	      ---	       --	009	1	1	0.00	    $0.00	Y	
Y	99244	OFF/OP CNSLTJ NEW/EST MOD 40            	   147.06	  $147.06	      ---	  $147.06	009	1	1	0.00	    $0.00	Y	
Y	99245	OFF/OP CONSLTJ NEW/EST HI 55            	   190.89	  $190.89	      ---	  $190.89	009	1	1	0.00	    $0.00	Y	
X	99245	OFF/OP CONSLTJ NEW/EST HI 55            	   190.89	  $190.89	      ---	       --	009	1	1	0.00	    $0.00	Y	
P	99245	OFF/OP CONSLTJ NEW/EST HI 55            	    10.22	  $102.20	  $111.50	       --	052	1	1	0.00	    $0.00	Y	
N	99245	OFF/OP CONSLTJ NEW/EST HI 55            	    10.22	  $102.20	  $111.50	  $126.93	053	1	1	0.00	    $0.00	Y	
V	99251	INPATIENT CONSULTATION                  	    33.98	   $27.86	      ---	       --	007	0	1	0.00	    $0.00	Y	
V	99252	IP/OBS CONSLTJ NEW/EST SF 35            	    39.59	   $32.46	      ---	       --	007	0	1	0.00	    $0.00	Y	
Y	99252	IP/OBS CONSLTJ NEW/EST SF 35            	    32.46	   $32.46	      ---	       --	009	0	1	0.00	    $0.00	Y	
N	99252	IP/OBS CONSLTJ NEW/EST SF 35            	    39.59	   $32.46	      ---	       --	007	0	1	0.00	    $0.00	Y	
P	99252	IP/OBS CONSLTJ NEW/EST SF 35            	    39.59	   $32.46	      ---	       --	019	0	1	0.00	    $0.00	Y	
P	99253	IP/OBS CNSLTJ NEW/EST LOW 45            	    56.63	   $46.44	      ---	       --	019	0	1	0.00	    $0.00	Y	
N	99253	IP/OBS CNSLTJ NEW/EST LOW 45            	    56.63	   $46.44	      ---	       --	007	0	1	0.00	    $0.00	Y	
Y	99253	IP/OBS CNSLTJ NEW/EST LOW 45            	    46.44	   $46.44	      ---	       --	009	0	1	0.00	    $0.00	Y	
V	99253	IP/OBS CNSLTJ NEW/EST LOW 45            	    56.63	   $46.44	      ---	       --	007	0	1	0.00	    $0.00	Y	
V	99254	IP/OBS CNSLTJ NEW/EST MOD 60            	    79.28	   $65.01	      ---	       --	007	0	1	0.00	    $0.00	Y	
Y	99254	IP/OBS CNSLTJ NEW/EST MOD 60            	    65.01	   $65.01	      ---	       --	009	0	1	0.00	    $0.00	Y	
N	99254	IP/OBS CNSLTJ NEW/EST MOD 60            	    79.28	   $65.01	      ---	       --	007	0	1	0.00	    $0.00	Y	
P	99254	IP/OBS CNSLTJ NEW/EST MOD 60            	    79.28	   $65.01	      ---	       --	019	0	1	0.00	    $0.00	Y	
P	99255	IP/OBS CONSLTJ NEW/EST HI 80            	   105.18	   $86.25	      ---	       --	019	0	1	0.00	    $0.00	Y	
N	99255	IP/OBS CONSLTJ NEW/EST HI 80            	   105.18	   $86.25	      ---	       --	007	0	1	0.00	    $0.00	Y	
Y	99255	IP/OBS CONSLTJ NEW/EST HI 80            	    86.25	   $86.25	      ---	       --	009	0	1	0.00	    $0.00	Y	
V	99255	IP/OBS CONSLTJ NEW/EST HI 80            	   105.18	   $86.25	      ---	       --	007	0	1	0.00	    $0.00	Y	
N	99281	EMR DPT VST MAYX REQ PHY/QHP            	    14.60	   $15.18	      ---	   $15.18	017	1	0	0.00	    $0.00	Y	
P	99281	EMR DPT VST MAYX REQ PHY/QHP            	    12.61	   $10.34	      ---	       --	019	0	0	0.00	    $0.00	Y	
P	99282	EMERGENCY DEPT VISIT SF MDM             	    23.42	   $19.20	      ---	       --	019	0	0	0.00	    $0.00	Y	
N	99282	EMERGENCY DEPT VISIT SF MDM             	    23.44	   $24.38	      ---	   $24.38	017	1	0	0.00	    $0.00	Y	
N	99283	EMERGENCY DEPT VISIT LOW MDM            	    42.88	   $44.60	      ---	   $44.60	017	1	0	0.00	    $0.00	Y	
P	99283	EMERGENCY DEPT VISIT LOW MDM            	    42.83	   $35.12	      ---	       --	019	0	0	0.00	    $0.00	Y	
P	99284	EMERGENCY DEPT VISIT MOD MDM            	    65.65	   $53.83	      ---	       --	019	0	0	0.00	    $0.00	Y	
N	99284	EMERGENCY DEPT VISIT MOD MDM            	    65.72	   $68.35	      ---	   $68.35	017	1	0	0.00	    $0.00	Y	
N	99285	EMERGENCY DEPT VISIT HI MDM             	   103.92	  $108.08	      ---	  $108.08	017	1	0	0.00	    $0.00	Y	
P	99285	EMERGENCY DEPT VISIT HI MDM             	   131.81	  $108.08	      ---	       --	019	1	0	0.00	    $0.00	Y	
N	99291	CRITICAL CARE FIRST HOUR                	    12.16	  $121.60	  $132.67	  $151.03	001	1	0	0.00	    $0.00	Y	
N	99292	CRITICAL CARE ADDL 30 MIN               	     5.89	   $58.90	   $64.26	   $73.15	001	1	0	0.00	    $0.00	Y	
N	99304	1ST NF CARE SF/LOW MDM 25               	     3.78	   $37.80	   $41.24	       --	001	0	0	0.00	    $0.00	Y	
P	99304	1ST NF CARE SF/LOW MDM 25               	     3.78	   $37.80	   $41.24	       --	052	0	0	0.00	    $0.00	Y	
X	99304	1ST NF CARE SF/LOW MDM 25               	    71.93	   $71.93	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	99304	1ST NF CARE SF/LOW MDM 25               	    71.93	   $71.93	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	99305	1ST NF CARE MODERATE MDM 35             	   119.09	  $119.09	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	99305	1ST NF CARE MODERATE MDM 35             	   119.09	  $119.09	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	99305	1ST NF CARE MODERATE MDM 35             	     4.69	   $46.90	   $51.17	       --	052	0	0	0.00	    $0.00	Y	
N	99305	1ST NF CARE MODERATE MDM 35             	     4.69	   $46.90	   $51.17	       --	001	0	0	0.00	    $0.00	Y	
N	99306	1ST NF CARE HIGH MDM 50                 	     7.21	   $72.10	   $78.66	       --	001	0	0	0.00	    $0.00	Y	
P	99306	1ST NF CARE HIGH MDM 50                 	     7.21	   $72.10	   $78.66	       --	052	0	0	0.00	    $0.00	Y	
X	99306	1ST NF CARE HIGH MDM 50                 	   162.85	  $162.85	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	99306	1ST NF CARE HIGH MDM 50                 	   162.85	  $162.85	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	99307	SBSQ NF CARE SF MDM 10                  	    35.64	   $35.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	99307	SBSQ NF CARE SF MDM 10                  	    35.64	   $35.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	99307	SBSQ NF CARE SF MDM 10                  	     1.37	   $13.70	   $14.95	       --	052	0	0	0.00	    $0.00	Y	
N	99307	SBSQ NF CARE SF MDM 10                  	     1.37	   $13.70	   $14.95	       --	001	0	0	0.00	    $0.00	Y	
N	99308	SBSQ NF CARE LOW MDM 20                 	     2.75	   $27.50	   $30.00	       --	001	0	0	0.00	    $0.00	Y	
P	99308	SBSQ NF CARE LOW MDM 20                 	     2.75	   $27.50	   $30.00	       --	052	0	0	0.00	    $0.00	Y	
X	99308	SBSQ NF CARE LOW MDM 20                 	    66.67	   $66.67	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	99308	SBSQ NF CARE LOW MDM 20                 	    66.67	   $66.67	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	99309	SBSQ NF CARE MODERATE MDM 30            	    95.70	   $95.70	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	99309	SBSQ NF CARE MODERATE MDM 30            	    95.70	   $95.70	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	99309	SBSQ NF CARE MODERATE MDM 30            	     4.00	   $40.00	   $43.64	       --	052	0	0	0.00	    $0.00	Y	
N	99309	SBSQ NF CARE MODERATE MDM 30            	     4.00	   $40.00	   $43.64	       --	001	0	0	0.00	    $0.00	Y	
N	99310	SBSQ NF CARE HIGH MDM 45                	     5.20	   $52.00	   $56.73	       --	001	0	0	0.00	    $0.00	Y	
P	99310	SBSQ NF CARE HIGH MDM 45                	     5.20	   $52.00	   $56.73	       --	052	0	0	0.00	    $0.00	Y	
X	99310	SBSQ NF CARE HIGH MDM 45                	   137.30	  $137.30	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	99310	SBSQ NF CARE HIGH MDM 45                	   137.30	  $137.30	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	99315	NF DSCHRG MGMT 30 MIN/LESS              	    73.04	   $73.04	      ---	       --	009	1	0	0.00	    $0.00	Y	
P	99315	NF DSCHRG MGMT 30 MIN/LESS              	     3.84	   $38.40	   $41.89	       --	052	1	0	0.00	    $0.00	Y	
N	99315	NF DSCHRG MGMT 30 MIN/LESS              	     3.84	   $38.40	   $41.89	   $47.69	001	1	0	0.00	    $0.00	Y	
N	99316	NF DSCHRG MGMT 30 MIN+                  	     4.66	   $46.60	   $50.84	   $57.88	001	1	0	0.00	    $0.00	Y	
P	99316	NF DSCHRG MGMT 30 MIN+                  	     4.66	   $46.60	   $50.84	       --	052	1	0	0.00	    $0.00	Y	
X	99316	NF DSCHRG MGMT 30 MIN+                  	   117.17	  $117.17	      ---	       --	009	1	0	0.00	    $0.00	Y	
X	99341	HOME/RES VST NEW SF MDM 15              	    43.76	   $43.76	      ---	       --	009	1	0	0.00	    $0.00	Y	
V	99341	HOME/RES VST NEW SF MDM 15              	     4.12	   $41.20	   $44.95	   $51.17	001	1	0	0.00	    $0.00	Y	
Y	99341	HOME/RES VST NEW SF MDM 15              	    43.76	   $43.76	      ---	   $43.76	009	1	0	0.00	    $0.00	Y	
P	99341	HOME/RES VST NEW SF MDM 15              	     3.67	   $36.70	   $40.04	       --	052	0	0	0.00	    $0.00	Y	
N	99341	HOME/RES VST NEW SF MDM 15              	     4.12	   $41.20	   $44.95	   $51.17	001	1	0	0.00	    $0.00	Y	
N	99342	HOME/RES VST NEW LOW MDM 30             	     4.92	   $49.20	   $53.68	   $61.11	001	1	0	0.00	    $0.00	Y	
P	99342	HOME/RES VST NEW LOW MDM 30             	     4.38	   $43.80	   $47.79	       --	052	0	0	0.00	    $0.00	Y	
Y	99342	HOME/RES VST NEW LOW MDM 30             	    69.56	   $69.56	      ---	   $69.56	009	1	0	0.00	    $0.00	Y	
V	99342	HOME/RES VST NEW LOW MDM 30             	     4.92	   $49.20	   $53.68	   $61.11	001	1	0	0.00	    $0.00	Y	
X	99342	HOME/RES VST NEW LOW MDM 30             	    69.56	   $69.56	      ---	       --	009	1	0	0.00	    $0.00	Y	
V	99343	HOME VISIT NEW PATIENT                  	     6.29	   $62.90	   $68.62	   $78.12	001	1	0	0.00	    $0.00	Y	
V	99344	HOME/RES VST NEW MOD MDM 60             	     7.70	   $77.00	   $84.01	   $95.63	001	1	0	0.00	    $0.00	Y	
X	99344	HOME/RES VST NEW MOD MDM 60             	   128.37	  $128.37	      ---	       --	009	1	0	0.00	    $0.00	Y	
Y	99344	HOME/RES VST NEW MOD MDM 60             	   128.37	  $128.37	      ---	  $128.37	009	1	0	0.00	    $0.00	Y	
P	99344	HOME/RES VST NEW MOD MDM 60             	     6.86	   $68.60	   $74.84	       --	052	0	0	0.00	    $0.00	Y	
N	99344	HOME/RES VST NEW MOD MDM 60             	     7.70	   $77.00	   $84.01	   $95.63	001	1	0	0.00	    $0.00	Y	
N	99345	HOME/RES VST NEW HIGH MDM 75            	     9.43	   $94.30	  $102.88	  $117.12	001	1	0	0.00	    $0.00	Y	
P	99345	HOME/RES VST NEW HIGH MDM 75            	     8.40	   $84.00	   $91.64	       --	052	0	0	0.00	    $0.00	Y	
Y	99345	HOME/RES VST NEW HIGH MDM 75            	   180.94	  $180.94	      ---	  $180.94	009	1	0	0.00	    $0.00	Y	
X	99345	HOME/RES VST NEW HIGH MDM 75            	   180.94	  $180.94	      ---	       --	009	1	0	0.00	    $0.00	Y	
V	99345	HOME/RES VST NEW HIGH MDM 75            	     9.43	   $94.30	  $102.88	  $117.12	001	1	0	0.00	    $0.00	Y	
V	99347	HOME/RES VST EST SF MDM 20              	     2.52	   $25.20	   $27.49	   $31.30	001	1	0	0.00	    $0.00	Y	
X	99347	HOME/RES VST EST SF MDM 20              	    40.09	   $40.09	      ---	       --	009	1	0	0.00	    $0.00	Y	
Y	99347	HOME/RES VST EST SF MDM 20              	    40.09	   $40.09	      ---	   $40.09	009	1	0	0.00	    $0.00	Y	
P	99347	HOME/RES VST EST SF MDM 20              	     2.24	   $22.40	   $24.44	       --	052	0	0	0.00	    $0.00	Y	
N	99347	HOME/RES VST EST SF MDM 20              	     2.52	   $25.20	   $27.49	   $31.30	001	1	0	0.00	    $0.00	Y	
N	99348	HOME/RES VST EST LOW MDM 30             	     3.43	   $34.30	   $37.42	   $42.60	001	1	0	0.00	    $0.00	Y	
P	99348	HOME/RES VST EST LOW MDM 30             	     3.06	   $30.60	   $33.38	       --	052	0	0	0.00	    $0.00	Y	
Y	99348	HOME/RES VST EST LOW MDM 30             	    68.22	   $68.22	      ---	   $68.22	009	1	0	0.00	    $0.00	Y	
X	99348	HOME/RES VST EST LOW MDM 30             	    68.22	   $68.22	      ---	       --	009	1	0	0.00	    $0.00	Y	
V	99348	HOME/RES VST EST LOW MDM 30             	     3.43	   $34.30	   $37.42	   $42.60	001	1	0	0.00	    $0.00	Y	
V	99349	HOME/RES VST EST MOD MDM 40             	     5.16	   $51.60	   $56.30	   $64.09	001	1	0	0.00	    $0.00	Y	
X	99349	HOME/RES VST EST MOD MDM 40             	   113.90	  $113.90	      ---	       --	009	1	0	0.00	    $0.00	Y	
Y	99349	HOME/RES VST EST MOD MDM 40             	   113.90	  $113.90	      ---	  $113.90	009	1	0	0.00	    $0.00	Y	
P	99349	HOME/RES VST EST MOD MDM 40             	     4.60	   $46.00	   $50.19	       --	052	0	0	0.00	    $0.00	Y	
N	99349	HOME/RES VST EST MOD MDM 40             	     5.16	   $51.60	   $56.30	   $64.09	001	1	0	0.00	    $0.00	Y	
N	99350	HOME/RES VST EST HIGH MDM 60            	     8.01	   $80.10	   $87.39	   $99.48	001	1	0	0.00	    $0.00	Y	
P	99350	HOME/RES VST EST HIGH MDM 60            	     7.14	   $71.40	   $77.90	       --	052	0	0	0.00	    $0.00	Y	
Y	99350	HOME/RES VST EST HIGH MDM 60            	   166.07	  $166.07	      ---	  $166.07	009	1	0	0.00	    $0.00	Y	
X	99350	HOME/RES VST EST HIGH MDM 60            	   166.07	  $166.07	      ---	       --	009	1	0	0.00	    $0.00	Y	
V	99350	HOME/RES VST EST HIGH MDM 60            	     8.01	   $80.10	   $87.39	   $99.48	001	1	0	0.00	    $0.00	Y	
X	99358	PROLONG SERVICE W/O CONTACT             	    81.58	   $81.58	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	99358	PROLONG SERVICE W/O CONTACT             	    42.20	   $42.20	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	99359	PROLONG SERV W/O CONTACT ADD            	    21.10	   $21.10	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	99359	PROLONG SERV W/O CONTACT ADD            	    38.30	   $38.30	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	99360	PHYSICIAN STANDBY SERVICES              	     2.55	   $25.50	   $27.82	   $31.67	053	1	0	0.00	    $0.00	Y	
N	99366	TEAM CONF W/PAT BY HC PROF              	    37.24	   $30.54	      ---	       --	007	0	0	0.00	    $0.00	Y	
X	99366	TEAM CONF W/PAT BY HC PROF              	    36.71	   $36.71	      ---	       --	009	0	0	0.00	    $0.00	Y	
V	99366	TEAM CONF W/PAT BY HC PROF              	    37.24	   $30.54	      ---	       --	007	0	0	0.00	    $0.00	Y	
Q	99366	TEAM CONF W/PAT BY HC PROF              	    18.98	   $18.98	      ---	       --	009	0	0	0.00	    $0.00	N	
Y	99366	TEAM CONF W/PAT BY HC PROF              	    36.71	   $36.71	      ---	       --	009	0	0	0.00	    $0.00	N	
E	99366	TEAM CONF W/PAT BY HC PROF              	    36.71	   $36.71	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	99367	TEAM CONF W/O PAT BY PHYS               	    48.26	   $48.26	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	99368	TEAM CONF W/O PAT BY HC PRO             	    31.44	   $31.44	      ---	       --	009	0	0	0.00	    $0.00	N	
Q	99368	TEAM CONF W/O PAT BY HC PRO             	    18.98	   $18.98	      ---	       --	009	0	0	0.00	    $0.00	N	
V	99368	TEAM CONF W/O PAT BY HC PRO             	    34.54	   $28.32	      ---	       --	007	0	0	0.00	    $0.00	Y	
X	99368	TEAM CONF W/O PAT BY HC PRO             	    31.44	   $31.44	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	99368	TEAM CONF W/O PAT BY HC PRO             	    34.54	   $28.32	      ---	       --	007	0	0	0.00	    $0.00	Y	
E	99368	TEAM CONF W/O PAT BY HC PRO             	    31.44	   $31.44	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	99381	INIT PM E/M NEW PAT INFANT              	    37.46	   $45.33	   $45.33	       --	031	0	0	0.00	    $0.00	Y	
X	99381	INIT PM E/M NEW PAT INFANT              	   122.33	  $122.33	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	99382	INIT PM E/M NEW PAT 1-4 YRS             	   127.13	  $127.13	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	99382	INIT PM E/M NEW PAT 1-4 YRS             	    38.95	   $47.13	   $47.13	       --	031	0	0	0.00	    $0.00	Y	
N	99383	PREV VISIT NEW AGE 5-11                 	    45.31	   $54.83	   $54.83	       --	031	0	0	0.00	    $0.00	Y	
X	99383	PREV VISIT NEW AGE 5-11                 	   131.83	  $131.83	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	99384	PREV VISIT NEW AGE 12-17                	   148.78	  $148.78	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	99384	PREV VISIT NEW AGE 12-17                	    54.36	   $65.78	   $65.78	       --	031	0	0	0.00	    $0.00	Y	
N	99385	PREV VISIT NEW AGE 18-39                	    11.41	  $114.10	      ---	       --	001	0	0	0.00	    $0.00	Y	
X	99385	PREV VISIT NEW AGE 18-39                	   144.10	  $144.10	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	99386	PREV VISIT NEW AGE 40-64                	   135.01	  $135.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	99386	PREV VISIT NEW AGE 40-64                	    13.22	  $132.20	      ---	       --	001	0	0	0.00	    $0.00	Y	
N	99387	INIT PM E/M NEW PAT 65+ YRS             	    14.30	  $143.00	      ---	  $177.61	001	1	1	0.00	    $0.00	Y	
X	99387	INIT PM E/M NEW PAT 65+ YRS             	   146.75	  $146.75	      ---	       --	009	1	1	0.00	    $0.00	Y	
X	99391	PER PM REEVAL EST PAT INFANT            	   109.69	  $109.69	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	99391	PER PM REEVAL EST PAT INFANT            	    28.67	   $34.69	   $34.69	       --	031	0	0	0.00	    $0.00	Y	
N	99392	PREV VISIT EST AGE 1-4                  	    30.90	   $37.39	   $37.39	       --	031	0	0	0.00	    $0.00	Y	
X	99392	PREV VISIT EST AGE 1-4                  	   116.39	  $116.39	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	99393	PREV VISIT EST AGE 5-11                 	   115.85	  $115.85	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	99393	PREV VISIT EST AGE 5-11                 	    36.24	   $43.85	   $43.85	       --	031	0	0	0.00	    $0.00	Y	
N	99394	PREV VISIT EST AGE 12-17                	    45.31	   $54.83	   $54.83	       --	031	0	0	0.00	    $0.00	Y	
X	99394	PREV VISIT EST AGE 12-17                	   126.83	  $126.83	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	99395	PREV VISIT EST AGE 18-39                	   129.90	  $129.90	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	99395	PREV VISIT EST AGE 18-39                	    10.29	  $102.90	      ---	       --	001	0	0	0.00	    $0.00	Y	
N	99396	PREV VISIT EST AGE 40-64                	    10.99	  $109.90	      ---	       --	001	0	0	0.00	    $0.00	Y	
X	99396	PREV VISIT EST AGE 40-64                	   112.20	  $112.20	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	99397	PER PM REEVAL EST PAT 65+ YR            	   121.16	  $121.16	      ---	       --	009	1	1	0.00	    $0.00	Y	
N	99397	PER PM REEVAL EST PAT 65+ YR            	    11.84	  $118.40	      ---	  $147.05	001	1	1	0.00	    $0.00	Y	
E	99401	PREV MED CNSL INDIV APPRX 15            	    12.94	   $12.94	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	99402	PREV MED CNSL INDIV APPRX 30            	    25.58	   $25.58	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	99403	PREV MED CNSL INDIV APPRX 45            	    38.37	   $38.37	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	99404	PREV MED CNSL INDIV APPRX 60            	    51.16	   $51.16	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	99406	BEHAV CHNG SMOKING 3-10 MIN             	    12.70	   $10.41	      ---	       --	007	0	0	0.00	    $0.00	Y	
X	99406	BEHAV CHNG SMOKING 3-10 MIN             	    13.37	   $13.37	      ---	       --	009	0	0	0.00	    $0.00	Y	
Q	99406	BEHAV CHNG SMOKING 3-10 MIN             	    12.70	   $10.41	      ---	       --	007	0	0	0.00	    $0.00	N	
Q	99407	BEHAV CHNG SMOKING > 10 MIN             	    24.30	   $19.93	      ---	       --	007	0	0	0.00	    $0.00	N	
X	99407	BEHAV CHNG SMOKING > 10 MIN             	    24.78	   $24.78	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	99407	BEHAV CHNG SMOKING > 10 MIN             	    24.30	   $19.93	      ---	       --	007	0	0	0.00	    $0.00	Y	
Y	99408	AUDIT/DAST 15-30 MIN                    	    31.24	   $31.24	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	99408	AUDIT/DAST 15-30 MIN                    	    31.24	   $31.24	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	99409	AUDIT/DAST OVER 30 MIN                  	    59.61	   $59.61	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	99409	AUDIT/DAST OVER 30 MIN                  	    59.61	   $59.61	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	99411	PREVENTIVE COUNSELING GROUP             	    18.79	   $18.79	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	99412	PREVENTIVE COUNSELING GROUP             	    23.27	   $23.27	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	99415	PROLNG CLIN STAFF SVC 1ST HR            	    17.77	   $17.77	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	99415	PROLNG CLIN STAFF SVC 1ST HR            	     8.11	    $8.11	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	99416	PROLNG CLIN STAFF SVC EA ADD            	     4.49	    $4.49	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	99416	PROLNG CLIN STAFF SVC EA ADD            	     8.17	    $8.17	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	99417	PROLNG OP E/M EACH 15 MIN               	    28.38	   $28.38	      ---	       --	009	0	1	0.00	    $0.00	Y	
1	99417	PROLNG OP E/M EACH 15 MIN               	    28.38	   $28.38	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	99417	PROLNG OP E/M EACH 15 MIN               	    28.38	   $28.38	      ---	       --	009	0	1	0.00	    $0.00	Y	
N	99418	PROLNG IP/OBS E/M EA 15 MIN             	    40.26	   $33.01	      ---	       --	007	0	0	0.00	    $0.00	Y	
P	99418	PROLNG IP/OBS E/M EA 15 MIN             	     0.00	    $0.00	      ---	       --	019	0	0	0.00	    $0.00	Y	
P	99424	PRIN CARE MGMT PHYS 1ST 30              	     7.13	   $71.30	   $77.79	       --	052	0	0	0.00	    $0.00	Y	
N	99424	PRIN CARE MGMT PHYS 1ST 30              	    71.31	   $71.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	99424	PRIN CARE MGMT PHYS 1ST 30              	    72.81	   $72.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	99425	PRIN CARE MGMT PHYS EA ADDL             	    52.27	   $52.27	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	99425	PRIN CARE MGMT PHYS EA ADDL             	    51.53	   $51.53	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	99425	PRIN CARE MGMT PHYS EA ADDL             	     5.15	   $51.50	   $56.19	       --	052	0	0	0.00	    $0.00	Y	
P	99426	PRIN CARE MGMT STAFF 1ST 30             	     5.44	   $54.40	   $59.35	       --	052	0	0	0.00	    $0.00	Y	
N	99426	PRIN CARE MGMT STAFF 1ST 30             	    54.41	   $54.41	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	99426	PRIN CARE MGMT STAFF 1ST 30             	    55.00	   $55.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	99427	PRIN CARE MGMT STAFF EA ADDL            	    42.68	   $42.68	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	99427	PRIN CARE MGMT STAFF EA ADDL            	    41.93	   $41.93	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	99427	PRIN CARE MGMT STAFF EA ADDL            	     4.19	   $41.90	   $45.71	       --	052	0	0	0.00	    $0.00	Y	
N	99429	UNLISTED PREVENTIVE SERVICE             	     0.00	    $0.00	      ---	       --	001	0	1	0.00	    $0.00	Y	
N	99437	CHRNC CARE MGMT PHYS EA ADDL            	    52.49	   $52.49	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	99437	CHRNC CARE MGMT PHYS EA ADDL            	     5.24	   $52.40	   $57.17	       --	052	0	0	0.00	    $0.00	Y	
X	99437	CHRNC CARE MGMT PHYS EA ADDL            	    53.87	   $53.87	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	99439	CHRNC CARE MGMT STAF EA ADDL            	    42.99	   $42.99	      ---	       --	009	0	1	0.00	    $0.00	Y	
N	99439	CHRNC CARE MGMT STAF EA ADDL            	    32.58	   $32.58	      ---	       --	009	0	1	0.00	    $0.00	Y	
N	99451	NTRPROF PH1/NTRNET/EHR 5/>              	    31.45	   $31.45	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	99451	NTRPROF PH1/NTRNET/EHR 5/>              	    31.80	   $31.80	      ---	       --	009	0	0	0.00	    $0.00	N	
Y	99451	NTRPROF PH1/NTRNET/EHR 5/>              	    31.80	   $31.80	      ---	       --	009	0	0	0.00	    $0.00	N	
N	99452	NTRPROF PH1/NTRNET/EHR RFRL             	    31.45	   $31.45	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	99453	REM MNTR PHYSIOL PARAM SETUP            	    17.77	   $17.77	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	99453	REM MNTR PHYSIOL PARAM SETUP            	    17.94	   $17.94	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	99454	REM MNTR PHYSIOL PARAM DEV              	    58.92	   $58.92	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	99454	REM MNTR PHYSIOL PARAM DEV              	    58.92	   $58.92	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	99457	REM PHYSIOL MNTR 1ST 20 MIN             	    44.84	   $44.84	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	99457	REM PHYSIOL MNTR 1ST 20 MIN             	    44.84	   $44.84	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	99458	REM PHYSIOL MNTR EA ADDL 20             	    35.79	   $35.79	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	99458	REM PHYSIOL MNTR EA ADDL 20             	    35.59	   $35.59	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	99460	INIT NB EM PER DAY HOSP                 	     4.72	   $47.20	   $51.50	       --	001	0	0	0.00	    $0.00	Y	
N	99461	INIT NB EM PER DAY NON-FAC              	     7.28	   $72.80	   $79.42	       --	001	0	0	0.00	    $0.00	Y	
X	99461	INIT NB EM PER DAY NON-FAC              	    83.37	   $83.37	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	99462	SBSQ NB EM PER DAY HOSP                 	     2.52	   $25.20	   $27.49	       --	001	0	0	0.00	    $0.00	Y	
N	99463	SAME DAY NB DISCHARGE                   	   113.75	   $93.28	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	99464	ATTENDANCE AT DELIVERY                  	     5.92	   $59.20	   $64.59	   $73.53	001	1	0	0.00	    $0.00	Y	
X	99464	ATTENDANCE AT DELIVERY                  	    64.72	   $64.72	      ---	       --	009	1	0	0.00	    $0.00	Y	
N	99465	NB RESUSCITATION                        	    12.20	  $122.00	  $133.10	       --	001	0	0	0.00	    $0.00	Y	
N	99466	PED CRIT CARE TRANSPORT                 	   236.54	  $193.96	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	99467	PED CRIT CARE TRANSPORT ADDL            	   118.04	   $96.79	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	99468	NEONATE CRIT CARE INITIAL               	   364.64	  $299.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	99469	NEONATE CRIT CARE SUBSQ                 	   175.02	  $143.52	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	99471	PED CRITICAL CARE INITIAL               	   364.64	  $299.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	99472	PED CRITICAL CARE SUBSQ                 	   175.02	  $143.52	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	99475	PED CRIT CARE AGE 2-5 INIT              	   364.64	  $299.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	99476	PED CRIT CARE AGE 2-5 SUBSQ             	   175.02	  $143.52	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	99477	INIT DAY HOSP NEONATE CARE              	   323.76	  $265.48	      ---	  $336.71	007	1	0	0.00	    $0.00	Y	
N	99478	IC LBW INF < 1500 GM SUBSQ              	   148.18	  $121.51	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	99479	IC LBW INF 1500-2500 G SUBSQ            	   127.33	  $104.41	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	99480	IC INF PBW 2501-5000 G SUBSQ            	   120.28	   $98.63	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	99483	ASSMT & CARE PLN PT COG IMP             	   300.80	  $246.66	      ---	       --	007	0	0	0.00	    $0.00	Y	
X	99483	ASSMT & CARE PLN PT COG IMP             	   247.09	  $247.09	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	99484	CARE MGMT SVC BHVL HLTH COND            	    38.99	   $38.99	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	99485	SUPRV INTERFACILTY TRANSPORT            	    76.31	   $62.57	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	99486	SUPRV INTERFAC TRNSPORT ADDL            	    66.40	   $54.45	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	99490	CHRNC CARE MGMT STAFF 1ST 20            	    45.11	   $45.11	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	99490	CHRNC CARE MGMT STAFF 1ST 20            	    56.43	   $56.43	      ---	       --	009	0	0	0.00	    $0.00	Y	
V	99490	CHRNC CARE MGMT STAFF 1ST 20            	    45.11	   $45.11	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	99491	CHRNC CARE MGMT PHYS 1ST 30             	    76.24	   $76.24	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	99491	CHRNC CARE MGMT PHYS 1ST 30             	    71.19	   $71.19	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	99492	1ST PSYC COLLAB CARE MGMT               	   141.26	  $141.26	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	99492	1ST PSYC COLLAB CARE MGMT               	   141.26	  $141.26	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	99493	SBSQ PSYC COLLAB CARE MGMT              	   129.39	  $129.39	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	99493	SBSQ PSYC COLLAB CARE MGMT              	   112.14	  $112.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	99494	1ST/SBSQ PSYC COLLAB CARE               	    57.88	   $57.88	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	99494	1ST/SBSQ PSYC COLLAB CARE               	    57.88	   $57.88	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	99495	TRANSJ CARE MGMT MOD F2F 14D            	   186.43	  $186.43	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	99496	TRANSJ CARE MGMT HIGH F2F 7D            	   252.44	  $252.44	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	99497	ADVNCD CARE PLAN 30 MIN                 	    74.32	   $74.32	      ---	       --	009	0	0	0.00	    $0.00	Y	
V	99497	ADVNCD CARE PLAN 30 MIN                 	    69.59	   $69.59	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	99497	ADVNCD CARE PLAN 30 MIN                 	    69.59	   $69.59	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	99498	ADVNCD CARE PLAN ADDL 30 MIN            	    62.64	   $62.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
V	99498	ADVNCD CARE PLAN ADDL 30 MIN            	    62.64	   $62.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	99498	ADVNCD CARE PLAN ADDL 30 MIN            	    63.94	   $63.94	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	99499	UNLISTED E&M SERVICE                    	     0.00	    $0.00	      ---	       --	007	1	1	0.00	    $0.00	Y	
N	99501	HOME VISIT POSTNATAL                    	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	99502	HOME VISIT NB CARE                      	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	99600	UNLISTED HOME VISIT SVC/PX              	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	N	
N	99605	MTMS BY PHARM NP 15 MIN                 	    43.00	   $43.00	      ---	       --	009	0	0	0.00	    $0.00	N	
N	99606	MTMS BY PHARM EST 15 MIN                	    43.00	   $43.00	      ---	       --	009	0	0	0.00	    $0.00	N	
N	99607	MTMS BY PHARM ADDL 15 MIN               	    32.00	   $32.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A0120	NONER TRANSPORT MINI-BUS                	    17.65	   $17.65	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A0130	NONER TRANSPORT WHEELCH VAN             	    20.30	   $20.30	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A0225	NEONATAL EMERGENCY TRANSPORT            	   179.92	  $179.92	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A0380	BASIC LIFE SUPPORT MILEAGE              	     1.50	    $1.50	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A0390	ADVANCED LIFE SUPPORT MILEAG            	     1.30	    $1.30	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A0420	AMBULANCE WAITING 1/2 HR                	    19.76	   $19.76	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A0422	AMBULANCE 02 LIFE SUSTAINING            	     9.98	    $9.98	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A0424	EXTRA AMBULANCE ATTENDANT               	    16.44	   $16.44	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A0425	GROUND MILEAGE                          	     3.55	    $3.55	      ---	       --	009	0	0	0.00	    $0.00	N	
E	A0425	GROUND MILEAGE                          	     0.65	    $0.65	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A0426	ALS 1                                   	   107.16	  $107.16	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A0427	ALS1-EMERGENCY                          	   118.20	  $118.20	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A0428	BLS                                     	   107.16	  $107.16	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A0429	BLS-EMERGENCY                           	   118.20	  $118.20	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A0430	FIXED WING AIR TRANSPORT                	  1275.00	 $1275.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A0431	ROTARY WING AIR TRANSPORT               	  1800.00	 $1800.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A0433	ALS 2                                   	   118.20	  $118.20	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A0434	SPECIALTY CARE TRANSPORT                	   118.20	  $118.20	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A0435	FIXED WING AIR MILEAGE                  	    14.25	   $14.25	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A0436	ROTARY WING AIR MILEAGE                 	    22.10	   $22.10	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A0999	UNLISTED AMBULANCE SERVICE              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A2001	INNOVAMATRIX AC, PER SQ CM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A2001	INNOVAMATRIX AC, PER SQ CM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A2002	MIRRAGEN ADV WND MAT PER SQ             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A2002	MIRRAGEN ADV WND MAT PER SQ             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A2004	XCELLISTEM, 1 MG                        	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A2004	XCELLISTEM, 1 MG                        	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A2005	MICROLYTE MATRIX, PER SQ CM             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A2005	MICROLYTE MATRIX, PER SQ CM             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A2006	NOVOSORB SYNPATH PER SQ CM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A2006	NOVOSORB SYNPATH PER SQ CM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A2007	RESTRATA, PER SQ CM                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A2007	RESTRATA, PER SQ CM                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A2008	THERAGENESIS, PER SQ CM                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A2008	THERAGENESIS, PER SQ CM                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A2009	SYMPHONY, PER SQ CM                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A2009	SYMPHONY, PER SQ CM                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A2010	APIS, PER SQUARE CENTIMETER             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A2010	APIS, PER SQUARE CENTIMETER             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A2011	SUPRA SDRM, PER SQ CM                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A2011	SUPRA SDRM, PER SQ CM                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A2012	SUPRATHEL, PER SQ CM                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A2012	SUPRATHEL, PER SQ CM                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A2013	INNOVAMATRIX FS, PER SQ CM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A2013	INNOVAMATRIX FS, PER SQ CM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A2014	OMEZA COLLAG PER 100 MG                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A2014	OMEZA COLLAG PER 100 MG                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A2015	PHOENIX WND MTRX, PER SQ CM             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A2015	PHOENIX WND MTRX, PER SQ CM             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A2016	PERMEADERM B, PER SQ CM                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A2016	PERMEADERM B, PER SQ CM                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A2017	PERMEADERM GLOVE, EACH                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A2018	PERMEADERM C, PER SQ CM                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A2018	PERMEADERM C, PER SQ CM                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A2019	KERECIS MARIGEN SHLD SQ CM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A2019	KERECIS MARIGEN SHLD SQ CM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A2020	AC5 WOUND SYSTEM                        	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A2020	AC5 WOUND SYSTEM                        	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A2021	NEOMATRIX PER SQ CM                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A2021	NEOMATRIX PER SQ CM                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A2022	INNOVABRN/INNOVAMATX XL SQCM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A2022	INNOVABRN/INNOVAMATX XL SQCM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A2023	INNOVAMATRIX PD, 1 MG                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A2023	INNOVAMATRIX PD, 1 MG                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A2024	RESOLVE OR XENOPATCH SQ CM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A2024	RESOLVE OR XENOPATCH SQ CM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A2025	MIRO3D PER CUBIC CM                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A2025	MIRO3D PER CUBIC CM                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A2026	RESTRATA MINIMATRIX, 5 MG               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A2026	RESTRATA MINIMATRIX, 5 MG               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A2027	MATRIDERM PER SQ CM                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A2027	MATRIDERM PER SQ CM                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A2028	MICROMATRIX FLEX PER MG                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A2028	MICROMATRIX FLEX PER MG                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A2029	MIROTRACT MATRIX SHEET                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A2029	MIROTRACT MATRIX SHEET                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A2030	MIRO3D FIBERS, PER MG                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A2030	MIRO3D FIBERS, PER MG                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A2031	MIRODRY, PER SQ CM                      	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A2031	MIRODRY, PER SQ CM                      	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A2032	MYRIAD MATRIX, PER SQ CM                	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A2032	MYRIAD MATRIX, PER SQ CM                	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A2033	MYRIAD MORCELLS, 4 MG                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A2033	MYRIAD MORCELLS, 4 MG                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A2034	FOUND DRS SOLO, PER SQ CM               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A2034	FOUND DRS SOLO, PER SQ CM               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A2035	CORPL P THERAC P ALLAC P MG             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A2035	CORPL P THERAC P ALLAC P MG             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A4100	SKIN SUB FDA CLRD AS DEV NOS            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A4100	SKIN SUB FDA CLRD AS DEV NOS            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A4217	STERILE WATER/SALINE, 500 ML            	     6.00	    $6.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A4217	STERILE WATER/SALINE, 500 ML            	     6.00	    $6.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A4226	WEEKLY SUPPLY MAINT CGS PUMP            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A4261	CERVICAL CAP CONTRACEPTIVE              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	A4264	INTRATUBAL OCCLUSION DEVICE             	  1299.00	 $1299.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A4266	DIAPHRAGM                               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A4267	MALE CONDOM                             	    14.99	   $14.99	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A4268	FEMALE CONDOM                           	    10.83	   $10.83	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A4269	SPERMICIDE                              	    14.99	   $14.99	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A4271	HOME LANCING/TEST CARTRIDGES            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A4280	BRST PRSTHS ADHSV ATTCHMNT              	     3.00	    $3.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A4281	REPLACEMENT BREASTPUMP TUBE             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A4282	REPLACEMENT BREASTPUMP ADPT             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A4283	REPLACEMENT BREASTPUMP CAP              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A4284	REPLCMNT BREAST PUMP SHIELD             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A4285	REPLCMNT BREAST PUMP BOTTLE             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A4286	REPLCMNT BREASTPUMP LOK RING            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A4287	DISP COL STO BAG BREAST MILK            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A4556	ELECTRODES, PAIR                        	    12.02	   $12.02	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A4557	LEAD WIRES, PAIR                        	    16.05	   $16.05	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A4561	PESSARY REUSABLE RUB ANYTYPE            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A4562	PESSARY REUSABLE NONRUBBER              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A4564	PESSARY, DISPOSABLE ANY TYPE            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A4566	SHOULD SLING/VEST/ABRESTRAIN            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A4595	TENS SUPPL 2 LEAD PER MONTH             	    17.44	   $17.44	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A4602	REPLACE LITHIUM BATTERY 1.5V            	     3.97	    $3.97	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A4604	TUBING WITH HEATING ELEMENT             	    55.57	   $55.57	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A4606	OXYGEN PROBE USED W OXIMETER            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A4615	CANNULA NASAL                           	     0.85	    $0.85	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A4619	FACE TENT                               	     2.10	    $2.10	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A4620	VARIABLE CONCENTRATION MASK             	     0.74	    $0.74	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A4635	UNDERARM CRUTCH PAD                     	     4.10	    $4.10	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A4636	HANDGRIP FOR CANE ETC                   	     2.91	    $2.91	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A4637	REPL TIP CANE/CRUTCH/WALKER             	     1.54	    $1.54	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A4640	ALTERNATING PRESSURE PAD                	    45.18	   $45.18	      ---	       --	009	0	0	0.00	    $4.38	Y	
L	A4641	RADIOPHARM DX AGENT NOC                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A4642	IN111 SATUMOMAB                         	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A4648	IMPLANTABLE TISSUE MARKER               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A4649	SURGICAL SUPPLIES                       	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A4650	IMPLANT RADIATION DOSIMETER             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A4660	SPHYG/BP APP W CUFF AND STET            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A4663	DIALYSIS BLOOD PRESSURE CUFF            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A4670	AUTOMATIC BP MONITOR, DIAL              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A5500	DIAB SHOE FOR DENSITY INSERT            	    47.49	   $47.49	      ---	       --	009	0	0	0.00	    $0.00	N	
P	A5500	DIAB SHOE FOR DENSITY INSERT            	    47.49	   $47.49	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A5501	DIABETIC CUSTOM MOLDED SHOE             	   142.43	  $142.43	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A5501	DIABETIC CUSTOM MOLDED SHOE             	   142.43	  $142.43	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A5503	DIABETIC SHOE W/ROLLER/ROCKR            	    21.12	   $21.12	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A5504	DIABETIC SHOE WITH WEDGE                	    21.12	   $21.12	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A5505	DIAB SHOE W/METATARSAL BAR              	    21.12	   $21.12	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A5506	DIABETIC SHOE W/OFF SET HEEL            	    21.12	   $21.12	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A5507	MODIFICATION DIABETIC SHOE              	    21.12	   $21.12	      ---	       --	009	0	0	0.00	    $0.00	N	
P	A5507	MODIFICATION DIABETIC SHOE              	    21.12	   $21.12	      ---	       --	009	0	0	0.00	    $0.00	N	
P	A5512	MULTI DEN INSERT DIRECT FORM            	    19.38	   $19.38	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A5512	MULTI DEN INSERT DIRECT FORM            	    19.38	   $19.38	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A5513	MULTI DEN INSERT CUSTOM MOLD            	    28.91	   $28.91	      ---	       --	009	0	0	0.00	    $0.00	N	
P	A5513	MULTI DEN INSERT CUSTOM MOLD            	    28.91	   $28.91	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A6501	COMPRES BURNGARMENT BODYSUIT            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A6502	COMPRES BURNGARMENT CHINSTRP            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A6503	COMPRES BURNGARMENT FACEHOOD            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A6504	CMPRSBURNGARMENT GLOVE-WRIST            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A6505	CMPRSBURNGARMENT GLOVE-ELBOW            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A6506	CMPRSBURNGRMNT GLOVE-AXILLA             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A6507	CMPRS BURNGARMENT FOOT-KNEE             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A6508	CMPRS BURNGARMENT FOOT-THIGH            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A6509	COMPRES BURN GARMENT JACKET             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A6510	COMPRES BURN GARMENT LEOTARD            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A6511	COMPRES BURN GARMENT PANTY              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A6512	COMPRES BURN GARMENT, NOC               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A6513	COMPRESS BURN MASK FACE/NECK            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A6521	G COM GARMNT GLOVE NGHT CUST            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A6523	G COM GARMENT ARM NGHT CUSTM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A6525	G COM GARM LWRLEG/FT NGT CUS            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
P	A6525	G COM GARM LWRLEG/FT NGT CUS            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
P	A6527	G GARMT FULL LEG/FT NGHT CUS            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A6527	G GARMT FULL LEG/FT NGHT CUS            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A6529	G COM GARMT BRA NIGHT CUSTM             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A6544	GC STOCKING GARTER BELT                 	    11.50	   $11.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A6544	GC STOCKING GARTER BELT                 	    11.50	   $11.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A6545	GRAD COM NON-ELASTIC BK SURG            	    71.56	   $71.56	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A6545	GRAD COM NON-ELASTIC BK SURG            	    71.56	   $71.56	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A6549	GRAD COM GARM NOC DAY USE               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	A6549	GRAD COM GARM NOC DAY USE               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A6550	NEG PRES WOUND THER DRSG SET            	    21.00	   $21.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A6553	G COM STCKING BK 30-40 CUSTM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
P	A6553	G COM STCKING BK 30-40 CUSTM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
P	A6555	G COM STCKING BK 40+ CUSTM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A6555	G COM STCKING BK 40+ CUSTM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A6556	G COM STCKING THGH18-30 CUST            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A6557	G COM STCKING THGH30-40 CUST            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A6558	G COM STCKING THGH 40+ CUST             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A6559	G STCKNG FULL/CHAP18-30 CUST            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A6560	G STCKNG FULL/CHAP30-40 CUST            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A6561	G STOCKNG FULL/CHAP 40+ CUST            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A6562	G COM STCKNG WAIST18-30 CUST            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A6563	G COM STCKNG WAIST30-40 CUST            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A6564	G COM STCKNG WAIST 40+ CUST             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A6565	GRAD COMP GAUNTLET CUSTOM               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A6567	G COM GARMENT NECK/HEAD CUST            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A6569	G COM GARMNT TORSO/SHDR CUST            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A6571	G COM GARMENT GENITAL CUSTM             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A6573	GRAD COM GARMNT TOE CAP CUST            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
P	A6573	GRAD COM GARMNT TOE CAP CUST            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A6574	CUSTOM GRADIENT SLEEV/GLOV              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A6576	CUSTOM GRAD COM SLEEVE MED              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A6577	CUSTOM GRAD CM SLEEVE HEAVY             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A6579	CUSTOM GRAD COM GLOVE MED               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A6580	CUSTOM GRAD COM GLOVE HEAVY             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A6610	G COM STCKING BK 18-30 CUSTM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
P	A6610	G COM STCKING BK 18-30 CUSTM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A7000	DISPOSABLE CANISTER FOR PUMP            	     9.35	    $9.35	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A7001	NONDISPOSABLE PUMP CANISTER             	    38.51	   $38.51	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A7005	NONDISPOSABLE NEBULIZER SET             	    24.46	   $24.46	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A7015	AEROSOL MASK USED W NEBULIZE            	     1.79	    $1.79	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A7020	INTERFACE, COUGH STIM DEVICE            	    16.85	   $16.85	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A7021	SUPPL AND ACCESS LUNG EXPAN             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A7027	COMBINATION ORAL/NASAL MASK             	   174.73	  $174.73	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A7028	REPL ORAL CUSHION COMBO MASK            	    47.41	   $47.41	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A7029	REPL NASAL PILLOW COMB MASK             	    20.29	   $20.29	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A7030	CPAP FULL FACE MASK                     	   143.93	  $143.93	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A7031	REPLACEMENT FACEMASK INTERFA            	    53.74	   $53.74	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A7032	REPLACEMENT NASAL CUSHION               	    30.81	   $30.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A7033	REPLACEMENT NASAL PILLOWS               	    22.85	   $22.85	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A7034	NASAL APPLICATION DEVICE                	    89.85	   $89.85	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A7035	POS AIRWAY PRESS HEADGEAR               	    30.13	   $30.13	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A7036	POS AIRWAY PRESS CHINSTRAP              	    14.98	   $14.98	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A7037	POS AIRWAY PRESSURE TUBING              	    27.18	   $27.18	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A7038	POS AIRWAY PRESSURE FILTER              	     3.87	    $3.87	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A7039	FILTER, NON DISPOSABLE W PAP            	    11.05	   $11.05	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A7044	PAP ORAL INTERFACE                      	   106.57	  $106.57	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A7045	REPL EXHALATION PORT FOR PAP            	    16.44	   $16.44	      ---	       --	009	0	0	0.00	    $1.64	Y	
1	A7046	REPL WATER CHAMBER, PAP DEV             	    17.15	   $17.15	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A7048	VACUUM DRAIN BOTTLE/TUBE KIT            	    36.66	   $36.66	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A7049	EPAP NASAL VALVE                        	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A8000	SOFT PROTECT HELMET PREFAB              	   122.68	  $122.68	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A8001	HARD PROTECT HELMET PREFAB              	   122.68	  $122.68	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A8002	SOFT PROTECT HELMET CUSTOM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A8003	HARD PROTECT HELMET CUSTOM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A8004	REPL SOFT INTERFACE, HELMET             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
U	A9279	MONITORING FEATURE/DEVICENOC            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
U	A9280	ALERT DEVICE, NOC                       	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	A9281	REACHING/GRABBING DEVICE                	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A9284	NON-ELECTRONIC SPIROMETER               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
U	A9300	EXERCISE EQUIPMENT                      	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
L	A9500	TC99M SESTAMIBI                         	    97.36	   $97.36	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9501	TECHNETIUM TC-99M TEBOROXIME            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9502	TC99M TETROFOSMIN                       	    96.84	   $96.84	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9503	TC99M MEDRONATE                         	    18.87	   $18.87	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9504	TC99M APCITIDE                          	   380.00	  $380.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9505	TL201 THALLIUM                          	    26.58	   $26.58	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A9506	TC-99M GRAPHITE CRUCIBLE                	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9507	IN111 CAPROMAB                          	  2252.27	 $2252.27	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9508	I131 IODOBENGUATE, DX                   	   460.96	  $460.96	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9509	IODINE I-123 SOD IODIDE MIL             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9510	TC99M DISOFENIN                         	    34.83	   $34.83	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9512	TC99M PERTECHNETATE                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	A9513	LUTETIUM LU 177 DOTATAT THER            	   299.04	  $299.04	      ---	       --	009	0	0	0.00	    $0.00	N	
L	A9515	CHOLINE C-11                            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	A9516	IODINE I-123 SOD IODIDE MIC             	    89.33	   $89.33	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9517	I131 IODIDE CAP, RX                     	   152.28	  $152.28	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9520	TC99 TILMANOCEPT DIAG 0.5MCI            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	A9521	TC99M EXAMETAZIME                       	   454.09	  $454.09	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9524	I131 SERUM ALBUMIN, DX                  	    45.45	   $45.45	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9526	NITROGEN N-13 AMMONIA                   	   659.00	  $659.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9527	IODINE I-125 SODIUM IODIDE              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9528	IODINE I-131 IODIDE CAP, DX             	    30.46	   $30.46	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9529	I131 IODIDE SOL, DX                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9530	I131 IODIDE SOL, RX                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9531	I131 MAX 100UCI                         	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9532	I125 SERUM ALBUMIN, DX                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9536	TC99M DEPREOTIDE                        	   608.00	  $608.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9537	TC99M MEBROFENIN                        	    45.36	   $45.36	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9538	TC99M PYROPHOSPHATE                     	    64.05	   $64.05	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9539	TC99M PENTETATE                         	    13.00	   $13.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9540	TC99M MAA                               	    30.00	   $30.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9541	TC99M SULFUR COLLOID                    	    42.56	   $42.56	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	A9542	IN111 IBRITUMOMAB, DX                   	  3490.46	 $3490.46	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	A9543	Y90 IBRITUMOMAB, RX                     	 66804.65	$66804.65	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9546	CO57/58                                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9547	IN111 OXYQUINOLINE                      	   233.29	  $233.29	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9548	IN111 PENTETATE                         	   780.87	  $780.87	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9550	TC99M GLUCEPTATE                        	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9551	TC99M SUCCIMER                          	   101.30	  $101.30	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9552	F18 FDG                                 	   360.00	  $360.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9553	CR51 CHROMATE                           	   168.04	  $168.04	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9554	I125 IOTHALAMATE, DX                    	   467.05	  $467.05	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9556	GA67 GALLIUM                            	   135.02	  $135.02	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9557	TC99M BICISATE                          	   339.34	  $339.34	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9558	XE133 XENON 10MCI                       	   235.61	  $235.61	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9559	CO57 CYANO                              	   129.94	  $129.94	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9560	TC99M LABELED RBC                       	    51.80	   $51.80	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9561	TC99M OXIDRONATE                        	    22.43	   $22.43	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9562	TC99M MERTIATIDE                        	   306.98	  $306.98	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9563	P32 NA PHOSPHATE                        	    98.18	   $98.18	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9564	P32 CHROMIC PHOSPHATE                   	   525.62	  $525.62	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9566	TC99M FANOLESOMAB                       	   794.81	  $794.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9567	TECHNETIUM TC-99M AEROSOL               	    61.74	   $61.74	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9569	TECHNETIUM TC-99M AUTO WBC              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9570	INDIUM IN-111 AUTO WBC                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9571	INDIUM IN-111 AUTO PLATELET             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9572	INDIUM IN-111 PENTETREOTIDE             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	A9573	INJ, GADOPICLENOL, 1 ML                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A9574	AIR POLY INTRAUTERINE FOAM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
L	A9575	INJ GADOTERATE MEGLUMI 0.1ML            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	A9576	INJ PROHANCE MULTIPACK                  	     1.42	    $1.42	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9577	INJ MULTIHANCE                          	     1.84	    $1.84	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9578	INJ MULTIHANCE MULTIPACK                	     1.81	    $1.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9579	GAD-BASE MR CONTRAST NOS,1ML            	     1.58	    $1.58	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9580	SODIUM FLUORIDE F-18                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9581	GADOXETATE DISODIUM INJ                 	    14.75	   $14.75	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9582	IODINE I-123 IOBENGUANE                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9583	GADOFOSVESET TRISODIUM INJ              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9584	IODINE I-123 IOFLUPANE                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9585	GADOBUTROL INJECTION                    	     0.33	    $0.33	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9587	GALLIUM GA-68                           	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	A9588	FLUCICLOVINE F-18                       	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	A9589	INSTI HEXAMINOLEVULINATE HCL            	  1088.20	 $4156.92	      ---	       --	005	0	0	0.00	    $0.00	Y	
I	A9590	IODINE I-131 IOBENGUANE 1MCI            	   324.85	  $324.85	      ---	       --	030	0	0	0.00	    $0.00	Y	
L	A9591	FLUOROESTRADIOL F 18                    	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
I	A9592	COPPER CU 64 DOTATATE DIAG              	   929.46	  $929.46	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	A9593	GALLIUM GA-68 PSMA-11 UCSF              	     0.00	    $0.00	      ---	       --	030	0	0	0.00	    $0.00	N	
I	A9594	GALLIUM GA-68 PSMA-11, UCLA             	     0.00	    $0.00	      ---	       --	030	0	0	0.00	    $0.00	N	
I	A9595	PIFLU F-18, DIA 1 MILLICURIE            	   551.96	  $551.96	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	A9596	GALLIUM ILLUCCIX 1 MILLICURE            	   968.20	  $968.20	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9597	PET, DX, FOR TUMOR ID, NOC              	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	A9598	PET DX FOR NON-TUMOR ID, NOC            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	A9600	SR89 STRONTIUM                          	   706.23	  $706.23	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	A9601	FLORTAUCIPIR INJ 1 MILLICURI            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	A9602	FLUORODOPA F-18 DIAG PER MCI            	   498.87	  $498.87	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	A9603	INJ, PAFOLACIANINE, 0.1 MG              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	A9604	SM 153 LEXIDRONAM                       	 16287.34	$16287.34	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	A9606	RADIUM RA223 DICHLORIDE THER            	   169.02	  $169.02	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	A9607	LUTETIUM LU 177 VIPIVOTIDE              	   243.52	  $243.52	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9608	FLOTUFOLASTAT F18 DIAG 1 MCI            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	A9609	F18 FDG, 15 MILLICURIES                 	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	A9610	XE129 XENON, DIAGNOSTIC                 	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
I	A9611	FLURPIRIDAZ F18, DIAG, 1 MCI            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	A9615	INJ, PEGULICIANINE, 1 MG                	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	A9697	INJ, MAGTRACE PER STUDY DOSE            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9698	NON-RAD CONTRAST MATERIALNOC            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	A9699	RADIOPHARM RX AGENT NOC                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	A9699	RADIOPHARM RX AGENT NOC                 	     0.00	    $0.00	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	A9800	GALLIUM LOCAMETZ 1 MILLICURI            	   800.00	  $800.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A9900	SUPPLY/ACCESSORY/SERVICE                	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	A9999	DME SUPPLY OR ACCESSORY, NOS            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	B4164	PARENTERAL 50% DEXTROSE SOLU            	    16.25	   $16.25	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	B4168	PARENTERAL SOL AMINO ACID 3.            	    23.70	   $23.70	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	B4172	PARENTERAL SOL AMINO ACID 5.            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	B4176	PARENTERAL SOL AMINO ACID 7-            	    45.85	   $45.85	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	B4178	PARENTERAL SOL AMINO ACID >             	    55.03	   $55.03	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	B4180	PARENTERAL SOL CARB > 50%               	    23.33	   $23.33	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	B4185	PN SOLN NOS 10 GRAMS LIPIDS             	    10.74	   $10.74	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	B4187	OMEGAVEN, 10 GRAMS LIPIDS               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	B4216	PARENTERAL NUTRITION ADDITIV            	     7.38	    $7.38	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	B9002	ENTER NUTR INF PUMP ANY TYPE            	   907.45	  $907.45	      ---	       --	009	0	0	0.00	   $87.89	Y	
1	C1052	HEMOSTATIC AGENT, GI, TOPIC             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	C1062	INTRAVERTEBRAL FX AUG IMPL              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	C1204	TC 99M TILMANOCEPT                      	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	C1721	AICD, DUAL CHAMBER                      	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	N	
1	C1722	AICD, SINGLE CHAMBER                    	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	N	
1	C1734	ORTH/DEVIC/DRUG BN/BN,TIS/BN            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	C1748	ENDOSCOPE, SINGLE, UGI                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	C1767	GENERATOR, NEURO NON-RECHARG            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	C1771	REP DEV, URINARY, W/SLING               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	C1777	LEAD, AICD, ENDO SINGLE COIL            	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	N	
1	C1785	PMKR, DUAL, RATE-RESP                   	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	N	
1	C1786	PMKR, SINGLE, RATE-RESP                 	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	N	
1	C1820	GENERATOR NEURO RECHG BAT SY            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	C1822	GEN, NEURO, HF, RECHG BAT               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	C1823	GEN, NEURO, TRANS SEN/STIM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	C1824	GENERATOR, CCM, IMPLANT                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	C1825	GEN, NEURO, CAROT SINUS BARO            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	C1830	POWER BONE MARROW BX NEEDLE             	     0.00	    $0.00	      ---	       --	009	1	0	0.00	    $0.00	Y	
1	C1831	PERSONALIZED INTERBODY CAGE             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	C1839	IRIS PROSTHESIS                         	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	C1840	TELESCOPIC INTRAOCULAR LENS             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	C1874	STENT, COATED/COV W/DEL SYS             	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	N	
1	C1875	STENT, COATED/COV W/O DEL SY            	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	N	
1	C1882	AICD, OTHER THAN SING/DUAL              	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	N	
1	C1886	CATHETER, ABLATION                      	     0.00	    $0.00	      ---	       --	009	1	0	0.00	    $0.00	N	
1	C1895	LEAD, AICD, ENDO DUAL COIL              	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	N	
1	C1896	LEAD, AICD, NON SING/DUAL               	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	N	
1	C1982	CATH, PRESSURE,VALVE-OCCLU              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	C2596	PROBE, ROBOTIC, WATER-JET               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	C2616	BRACHYTX, NON-STR,YTTRIUM-90            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	C2619	PMKR, DUAL, NON RATE-RESP               	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	N	
1	C2620	PMKR, SINGLE, NON RATE-RESP             	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	N	
1	C2621	PMKR, OTHER THAN SING/DUAL              	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	N	
1	C2624	WIRELESS PRESSURE SENSOR                	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	C2634	BRACHYTX, NON-STR, HA, I-125            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	C2635	BRACHYTX, NON-STR, HA, P-103            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	C2637	BRACHY,NON-STR,YTTERBIUM-169            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	C2638	BRACHYTX, STRANDED, I-125               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	C2639	BRACHYTX, NON-STRANDED,I-125            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	C2640	BRACHYTX, STRANDED, P-103               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	C2641	BRACHYTX, NON-STRANDED,P-103            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	C2644	BRACHYTX CESIUM-131 CHLORIDE            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	C2645	BRACHYTX PLANAR, P-103                  	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	C2698	BRACHYTX, STRANDED, NOS                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	C2699	BRACHYTX, NON-STRANDED, NOS             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	C7563	TRLUML BALLO ANGIOP ALL ART             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	C7564	VEIN MECH THROM W/INTRVAS US            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	C7565	RPR AA HRN < 3 RDC W/ RMVL              	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
L	C8001	3D ANAT SEG IMAGING PREOP               	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
K	C8002	PREP SKIN CELL SUSP, AUTOMTD            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	C8003	IMP EXTAR KNEE SHCK ABSRB               	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	C8003	IMP EXTAR KNEE SHCK ABSRB               	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
L	C8004	SIM ANG W/PRS CATH RAD EMB              	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
I	C9047	INJECTION, CAPLACIZUMAB-YHDP            	   783.70	  $783.70	      ---	       --	030	0	0	0.00	    $0.00	Y	
L	C9067	GALLIUM GA-68 DOTATOC                   	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
1	C9088	INSTILL, BUPIVAC AND MELOXIC            	     0.77	    $0.77	      ---	       --	009	0	0	0.00	    $0.00	N	
I	C9101	INJ, OLICERIDINE 0.1 MG                 	     5.59	    $5.59	      ---	       --	030	0	0	0.00	    $0.00	Y	
1	C9143	COCAINE HCL NASAL (NUMBRINO)            	     2.36	    $2.36	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	C9144	INJ, BUPIVACAINE (POSIMIR)              	     4.94	    $4.94	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	C9145	INJ, APONVIE, 1 MG                      	     1.86	    $1.86	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	C9174	DATOPOTAMAB DERUXTECAN, 1 MG            	    48.91	   $48.91	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	C9175	INJ, TREOSULFAN, 50 MG                  	    30.50	   $30.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	C9250	ARTISS FIBRIN SEALANT                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	C9250	ARTISS FIBRIN SEALANT                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	C9254	INJECTION, LACOSAMIDE                   	     0.32	    $0.32	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	C9285	PATCH, LIDOCAINE/TETRACAINE             	    16.95	   $16.95	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	C9293	INJECTION, GLUCARPIDASE                 	   411.74	  $411.74	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	C9360	SURGIMEND, NEONATAL                     	     9.00	    $9.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	C9361	NEUROMEND NERVE WRAP                    	   212.09	  $212.09	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	C9362	IMPLNT,BON VOID FILLER-STRIP            	    40.70	   $40.70	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	C9363	INTEGRA MESHED BIL WOUND MAT            	    14.30	   $14.30	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	C9363	INTEGRA MESHED BIL WOUND MAT            	    14.30	   $14.30	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	C9364	PORCINE IMPLANT, PERMACOL               	    14.14	   $14.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	C9460	INJECTION, CANGRELOR                    	    20.02	   $20.02	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	C9462	INJECTION, DELAFLOXACIN                 	     4.93	    $4.93	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	C9488	CONIVAPTAN HCL                          	    49.03	   $49.03	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	C9507	COVID-19 CONVALESCENT PLASMA            	   754.96	  $754.96	      ---	       --	030	0	0	0.00	    $0.00	Y	
K	C9725	PLACE ENDORECTAL APP                    	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
N	C9728	PLACE DEVICE/MARKER, NON PRO            	   155.26	  $127.31	      ---	       --	007	0	0	0.00	    $0.00	Y	
L	C9738	BLUE LIGHT CYSTO IMAG AGENT             	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
K	C9751	MICROWAVE BRONCH, 3D, EBUS              	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	C9756	FLUORESCENCE LYMPH MAP W/ICG            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	C9756	FLUORESCENCE LYMPH MAP W/ICG            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	C9757	SPINE DEVICE IMPLANT SURGERY            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	C9757	SPINE DEVICE IMPLANT SURGERY            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	C9759	TRANSCATH INTRAOP MICROINF              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	C9761	CYSTO, LITHO, VACUUM KIDNEY             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	C9764	REVASC INTRAVASC LITHOTRIPSY            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	C9764	REVASC INTRAVASC LITHOTRIPSY            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
O	C9765	REVASC INTRA LITHOTRIP-STENT            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	C9765	REVASC INTRA LITHOTRIP-STENT            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	C9766	REVASC INTRA LITHOTRIP-ATHER            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	C9766	REVASC INTRA LITHOTRIP-ATHER            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
O	C9767	REVASC LITHOTRIP-STENT-ATHER            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	C9767	REVASC LITHOTRIP-STENT-ATHER            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	C9768	ENDO US-GUIDE HEP PORTO GRAD            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	C9772	REVASC LITHOTRIP TIBI/PERONE            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	C9772	REVASC LITHOTRIP TIBI/PERONE            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	C9773	REVASC LITHOTR-STENT TIB/PER            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	C9773	REVASC LITHOTR-STENT TIB/PER            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	C9774	REVASC LITHOTR-ATHER TIB/PER            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	C9774	REVASC LITHOTR-ATHER TIB/PER            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	C9775	REVASC LITH-STEN-ATH TIB/PER            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	C9775	REVASC LITH-STEN-ATH TIB/PER            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	C9779	ESD ENDOSCOPY OR COLONOSCOPY            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	C9780	INSERT CV CATH INF & SUP APP            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	C9781	ARTHRO/SHOUL SURG; W/SPACER             	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
L	C9789	INSTILL PHARM RENAL PELVIS              	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	C9791	MRI HYPERPOLARIZED XENON129             	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
K	C9796	RPR INTST EXCL ANRECT FIST              	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	C9796	RPR INTST EXCL ANRECT FIST              	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	C9797	VASC EMB/OCC W/PRS CATH                 	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	C9797	VASC EMB/OCC W/PRS CATH                 	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
1	E0100	CANE ADJUST/FIXED WITH TIP              	    15.99	   $15.99	      ---	       --	009	0	0	0.00	    $4.75	Y	
1	E0105	CANE ADJUST/FIXED QUAD/3 PRO            	    37.50	   $37.50	      ---	       --	009	0	0	0.00	    $7.09	Y	
1	E0110	CRUTCH FOREARM PAIR                     	    62.07	   $62.07	      ---	       --	009	0	0	0.00	   $12.79	Y	
1	E0112	CRUTCH UNDERARM PAIR WOOD               	    29.60	   $29.60	      ---	       --	009	0	0	0.00	    $7.94	Y	
1	E0114	CRUTCH UNDERARM PAIR NO WOOD            	    37.75	   $37.75	      ---	       --	009	0	0	0.00	    $6.86	Y	
1	E0117	UNDERARM SPRINGASSIST CRUTCH            	   154.17	  $154.17	      ---	       --	009	0	0	0.00	   $15.41	Y	
1	E0130	WALKER RIGID ADJUST/FIXED HT            	    47.27	   $47.27	      ---	       --	009	0	0	0.00	    $8.61	Y	
1	E0135	WALKER FOLDING ADJUST/FIXED             	    52.71	   $52.71	      ---	       --	009	0	0	0.00	    $8.79	Y	
1	E0140	WALKER W TRUNK SUPPORT                  	   210.56	  $210.56	      ---	       --	009	0	0	0.00	   $21.06	Y	
1	E0141	RIGID WHEELED WALKER ADJ/FIX            	    66.02	   $66.02	      ---	       --	009	0	0	0.00	   $10.91	Y	
1	E0143	WALKER FOLDING WHEELED W/O S            	    64.69	   $64.69	      ---	       --	009	0	0	0.00	   $10.60	Y	
1	E0144	ENCLOSED WALKER W REAR SEAT             	   254.76	  $254.76	      ---	       --	009	0	0	0.00	   $23.38	Y	
1	E0147	WALKER VARIABLE WHEEL RESIST            	   279.69	  $279.69	      ---	       --	009	0	0	0.00	   $28.41	Y	
1	E0148	HEAVYDUTY WALKER NO WHEELS              	    85.71	   $85.71	      ---	       --	009	0	0	0.00	    $8.58	Y	
1	E0149	HEAVY DUTY WHEELED WALKER               	    95.28	   $95.28	      ---	       --	009	0	0	0.00	    $9.53	Y	
1	E0153	FOREARM CRUTCH PLATFORM ATTA            	    55.50	   $55.50	      ---	       --	009	0	0	0.00	    $6.27	Y	
1	E0154	WALKER PLATFORM ATTACHMENT              	    48.88	   $48.88	      ---	       --	009	0	0	0.00	    $5.49	Y	
1	E0155	WALKER WHEEL ATTACHMENT,PAIR            	    21.43	   $21.43	      ---	       --	009	0	0	0.00	    $2.42	Y	
1	E0156	WALKER SEAT ATTACHMENT                  	    17.20	   $17.20	      ---	       --	009	0	0	0.00	    $1.82	Y	
1	E0157	WALKER CRUTCH ATTACHMENT                	    51.56	   $51.56	      ---	       --	009	0	0	0.00	    $5.43	Y	
1	E0158	WALKER LEG EXTENDERS SET OF4            	    21.99	   $21.99	      ---	       --	009	0	0	0.00	    $2.34	Y	
1	E0159	BRAKE FOR WHEELED WALKER                	    13.35	   $13.35	      ---	       --	009	0	0	0.00	    $1.34	Y	
1	E0163	COMMODE CHAIR WITH FIXED ARM            	    73.31	   $73.31	      ---	       --	009	0	0	0.00	   $13.50	Y	
1	E0165	COMMODE CHAIR WITH DETACHARM            	   162.36	  $162.36	      ---	       --	009	0	0	0.00	   $13.02	Y	
1	E0167	COMMODE CHAIR PAIL OR PAN               	     9.60	    $9.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0168	HEAVYDUTY/WIDE COMMODE CHAIR            	   119.45	  $119.45	      ---	       --	009	0	0	0.00	   $11.94	Y	
1	E0170	COMMODE CHAIR ELECTRIC                  	  1542.91	 $1542.91	      ---	       --	009	0	0	0.00	  $128.58	Y	
1	E0171	COMMODE CHAIR NON-ELECTRIC              	   277.63	  $277.63	      ---	       --	009	0	0	0.00	   $23.14	Y	
1	E0181	PRESS PAD ALTERNATING W/ PUM            	   250.20	  $250.20	      ---	       --	009	0	0	0.00	   $18.63	Y	
1	E0182	REPLACE PUMP, ALT PRESS PAD             	   251.33	  $251.33	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0184	DRY PRESSURE MATTRESS                   	   132.40	  $132.40	      ---	       --	009	0	0	0.00	   $18.18	Y	
1	E0185	GEL PRESSURE MATTRESS PAD               	   219.62	  $219.62	      ---	       --	009	0	0	0.00	   $27.94	Y	
1	E0186	AIR PRESSURE MATTRESS                   	   194.88	  $194.88	      ---	       --	009	0	0	0.00	   $16.24	Y	
1	E0187	WATER PRESSURE MATTRESS                 	   222.82	  $222.82	      ---	       --	009	0	0	0.00	   $18.57	Y	
1	E0188	SYNTHETIC SHEEPSKIN PAD                 	    21.14	   $21.14	      ---	       --	009	0	0	0.00	    $2.47	Y	
1	E0189	LAMBSWOOL SHEEPSKIN PAD                 	    41.57	   $41.57	      ---	       --	009	0	0	0.00	    $4.50	Y	
1	E0193	POWERED AIR FLOTATION BED               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	   $24.09	Y	
1	E0194	AIR FLUIDIZED BED                       	     0.00	    $0.00	      ---	       --	009	0	0	0.00	   $55.00	Y	
1	E0196	GEL PRESSURE MATTRESS                   	   311.90	  $311.90	      ---	       --	009	0	0	0.00	   $25.99	Y	
1	E0197	AIR PRESSURE PAD FOR MATTRES            	   134.96	  $134.96	      ---	       --	009	0	0	0.00	   $13.50	Y	
1	E0198	WATER PRESSURE PAD FOR MATTR            	   179.65	  $179.65	      ---	       --	009	0	0	0.00	   $18.61	Y	
1	E0199	DRY PRESSURE PAD FOR MATTRES            	    25.64	   $25.64	      ---	       --	009	0	0	0.00	    $2.55	Y	
1	E0201	PENILE CONTRACTUR DEVIC MANU            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E0202	PHOTOTHERAPY LIGHT W/ PHOTOM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0210	ELECTRIC HEAT PAD STANDARD              	    26.11	   $26.11	      ---	       --	009	0	0	0.00	    $2.46	Y	
1	E0240	BATH/SHOWER CHAIR                       	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0241	BATH TUB WALL RAIL                      	    14.62	   $14.62	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0242	BATH TUB RAIL FLOOR                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0243	TOILET RAIL                             	    42.76	   $42.76	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0244	TOILET SEAT RAISED                      	    46.04	   $46.04	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0245	TUB STOOL OR BENCH                      	    55.07	   $55.07	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0246	TRANSFER TUB RAIL ATTACHMENT            	    37.08	   $37.08	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0247	TRANS BENCH W/WO COMM OPEN              	    81.42	   $81.42	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0248	HDTRANS BENCH W/WO COMM OPEN            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0271	MATTRESS INNERSPRING                    	   128.57	  $128.57	      ---	       --	009	0	0	0.00	   $14.43	Y	
1	E0272	MATTRESS FOAM RUBBER                    	   140.19	  $140.19	      ---	       --	009	0	0	0.00	   $14.38	Y	
1	E0273	BED BOARD                               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0277	POWERED PRES-REDU AIR MATTRS            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	   $18.76	Y	
1	E0291	HOSP BED FX HT W/O RAIL W/O             	   443.14	  $443.14	      ---	       --	009	0	0	0.00	   $35.33	Y	
1	E0293	HOSP BED VAR HT NO SR NO MAT            	   583.49	  $583.49	      ---	       --	009	0	0	0.00	   $46.53	Y	
1	E0295	HOSP BED SEMI-ELECT W/O MATT            	  1222.56	 $1222.56	      ---	       --	009	0	0	0.00	   $76.68	Y	
1	E0297	HOSP BED TOTAL ELECT W/O MAT            	  1302.24	 $1302.24	      ---	       --	009	0	0	0.00	   $93.42	Y	
1	E0300	ENCLOSED PED CRIB HOSP GRADE            	  2270.90	 $2270.90	      ---	       --	009	0	0	0.00	  $212.60	Y	
1	E0303	HOSP BED HVY DTY XTRA WIDE              	  2785.63	 $2785.63	      ---	       --	009	0	0	0.00	  $184.80	Y	
1	E0304	HOSP BED XTRA HVY DTY X WIDE            	  7398.43	 $7398.43	      ---	       --	009	0	0	0.00	  $512.23	Y	
1	E0305	RAILS BED SIDE HALF LENGTH              	   170.78	  $170.78	      ---	       --	009	0	0	0.00	   $11.66	Y	
1	E0310	RAILS BED SIDE FULL LENGTH              	   123.34	  $123.34	      ---	       --	009	0	0	0.00	   $13.81	Y	
1	E0316	BED SAFETY ENCLOSURE                    	  1950.43	 $1950.43	      ---	       --	009	0	0	0.00	  $155.50	Y	
1	E0328	PED HOSPITAL BED, MANUAL                	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0329	PED HOSPITAL BED SEMI/ELECT             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0350	CONTROL UNIT BOWEL SYSTEM               	  5442.80	 $5442.80	      ---	       --	009	0	0	0.00	  $544.28	Y	
1	E0352	DISPOSABLE PACK W/BOWEL SYST            	    36.43	   $36.43	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0371	NONPOWER MATTRESS OVERLAY               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	   $10.62	Y	
1	E0372	POWERED AIR MATTRESS OVERLAY            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	   $13.70	Y	
1	E0373	NONPOWERED PRESSURE MATTRESS            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	   $14.76	Y	
1	E0424	STATIONARY COMPRESSED GAS 02            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	  $136.87	Y	
1	E0425	GAS SYSTEM STATIONARY COMPRE            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0430	OXYGEN SYSTEM GAS PORTABLE              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0431	PORTABLE GASEOUS 02                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	   $24.42	Y	
1	E0433	PORTABLE LIQUID OXYGEN SYS              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	   $45.01	Y	
1	E0434	PORTABLE LIQUID 02                      	     0.00	    $0.00	      ---	       --	009	0	0	0.00	   $45.01	Y	
1	E0435	OXYGEN SYSTEM LIQUID PORTABL            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0439	STATIONARY LIQUID 02                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	  $136.87	Y	
1	E0440	OXYGEN SYSTEM LIQUID STATION            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0441	STATIONARY O2 CONTENTS, GAS             	    65.24	   $65.24	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0442	STATIONARY O2 CONTENTS, LIQ             	    65.24	   $65.24	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0443	PORTABLE 02 CONTENTS, GAS               	    62.64	   $62.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0444	PORTABLE 02 CONTENTS, LIQUID            	    62.64	   $62.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0445	OXIMETER NON-INVASIVE                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0465	HOME VENT INVASIVE INTERFACE            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	  $944.46	Y	
1	E0466	HOME VENT NON-INVASIVE INTER            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	  $944.46	Y	
1	E0467	HOME VENT MULTI-FUNCTION                	     0.00	    $0.00	      ---	       --	009	0	0	0.00	 $1153.70	Y	
1	E0469	LUNG EXPANS HIGH OSCIL NEB              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E0470	RAD W/O BACKUP NON-INV INTFC            	  2364.67	 $2364.67	      ---	       --	009	0	0	0.00	  $182.77	Y	
1	E0471	RAD W/BACKUP NON INV INTRFC             	  6164.88	 $6164.88	      ---	       --	009	0	0	0.00	  $469.44	Y	
1	E0472	RAD W BACKUP INVASIVE INTRFC            	  6164.88	 $6164.88	      ---	       --	009	0	0	0.00	  $542.85	Y	
1	E0480	PERCUSSOR ELECT/PNEUM HOME M            	   414.62	  $414.62	      ---	       --	009	0	0	0.00	   $50.28	Y	
1	E0481	INTRPULMNRY PERCUSS VENT SYS            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0482	COUGH STIMULATING DEVICE                	  3932.74	 $3932.74	      ---	       --	009	0	0	0.00	  $476.87	Y	
1	E0483	HI FREQ CHEST WALL OSCIL SYS            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	 $1237.56	Y	
1	E0484	NON-ELEC OSCILLATORY PEP DVC            	    43.00	   $43.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0486	ORAL DEVICE/APPLIANCE CUSFAB            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0487	ELECTRONIC SPIROMETER                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0555	HUMIDIFIER FOR USE W/ REGULA            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $8.72	Y	
1	E0561	HUMIDIFIER NONHEATED W PAP              	    93.39	   $93.39	      ---	       --	009	0	0	0.00	    $9.33	Y	
1	E0562	HUMIDIFIER HEATED USED W PAP            	   226.88	  $226.88	      ---	       --	009	0	0	0.00	   $22.68	Y	
1	E0565	COMPRESSOR AIR POWER SOURCE             	   585.70	  $585.70	      ---	       --	009	0	0	0.00	   $58.56	Y	
1	E0570	NEBULIZER WITH COMPRESSION              	   154.56	  $154.56	      ---	       --	009	0	0	0.00	   $12.53	Y	
1	E0600	SUCTION PUMP PORTAB HOM MODL            	   439.58	  $439.58	      ---	       --	009	0	0	0.00	   $53.30	Y	
1	E0601	CONT AIRWAY PRESSURE DEVICE             	   609.55	  $609.55	      ---	       --	009	0	0	0.00	   $75.37	Y	
1	E0602	MANUAL BREAST PUMP                      	    23.62	   $23.62	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0603	ELECTRIC BREAST PUMP                    	    93.15	   $93.15	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0604	HOSP GRADE ELEC BREAST PUMP             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $2.72	Y	
1	E0605	VAPORIZER ROOM TYPE                     	    30.75	   $30.75	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0607	BLOOD GLUCOSE MONITOR HOME              	    53.46	   $53.46	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0616	CARDIAC EVENT RECORDER                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0618	APNEA MONITOR                           	     0.00	    $0.00	      ---	       --	009	0	0	0.00	  $303.83	Y	
1	E0619	APNEA MONITOR W RECORDER                	     0.00	    $0.00	      ---	       --	009	0	0	0.00	  $208.80	Y	
1	E0621	PATIENT LIFT SLING OR SEAT              	    71.86	   $71.86	      ---	       --	009	0	0	0.00	    $7.19	Y	
1	E0625	PATIENT LIFT BATHROOM OR TOI            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0630	PATIENT LIFT HYDRAULIC                  	   852.38	  $852.38	      ---	       --	009	0	0	0.00	   $65.99	Y	
1	E0635	PATIENT LIFT ELECTRIC                   	  1174.66	 $1174.66	      ---	       --	009	0	0	0.00	   $97.89	Y	
1	E0637	COMBINATION SIT TO STAND SYS            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0638	STANDING FRAME SYS                      	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0639	MOVEABLE PATIENT LIFT SYSTEM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E0641	MULTI-POSITION STND FRAM SYS            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0642	DYNAMIC STANDING FRAME                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0650	PNEUMA COMPRESOR NON-SEGMENT            	   576.18	  $576.18	      ---	       --	009	0	0	0.00	   $71.10	Y	
1	E0651	PNEUM COMPRESSOR SEGMENTAL              	   624.53	  $624.53	      ---	       --	009	0	0	0.00	   $63.80	Y	
1	E0655	PNEUMATIC APPLIANCE HALF ARM            	    86.34	   $86.34	      ---	       --	009	0	0	0.00	    $8.66	Y	
1	E0656	SEGMENTAL PNEUMATIC TRUNK               	   505.39	  $505.39	      ---	       --	009	0	0	0.00	   $51.31	Y	
1	E0657	SEGMENTAL PNEUMATIC CHEST               	   474.81	  $474.81	      ---	       --	009	0	0	0.00	   $48.20	Y	
1	E0660	PNEUMATIC APPLIANCE FULL LEG            	   108.63	  $108.63	      ---	       --	009	0	0	0.00	   $11.31	Y	
1	E0665	PNEUMATIC APPLIANCE FULL ARM            	    98.23	   $98.23	      ---	       --	009	0	0	0.00	    $9.81	Y	
1	E0666	PNEUMATIC APPLIANCE HALF LEG            	    93.90	   $93.90	      ---	       --	009	0	0	0.00	    $9.68	Y	
1	E0667	SEG PNEUMATIC APPL FULL LEG             	   259.02	  $259.02	      ---	       --	009	0	0	0.00	   $29.25	Y	
1	E0668	SEG PNEUMATIC APPL FULL ARM             	   353.50	  $353.50	      ---	       --	009	0	0	0.00	   $34.89	Y	
1	E0669	SEG PNEUMATIC APPLI HALF LEG            	   146.65	  $146.65	      ---	       --	009	0	0	0.00	   $14.67	Y	
1	E0670	SEG PNEUM INT LEGS/TRUNK                	  1088.82	 $1088.82	      ---	       --	009	0	0	0.00	  $108.88	Y	
1	E0671	PRESSURE PNEUM APPL FULL LEG            	   332.28	  $332.28	      ---	       --	009	0	0	0.00	   $33.23	Y	
1	E0672	PRESSURE PNEUM APPL FULL ARM            	   258.18	  $258.18	      ---	       --	009	0	0	0.00	   $25.82	Y	
1	E0673	PRESSURE PNEUM APPL HALF LEG            	   214.54	  $214.54	      ---	       --	009	0	0	0.00	   $21.46	Y	
1	E0678	NON PNEUM SEQ COMP FULL LEG             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E0679	NON PNEUM SEQ COMP HALF LEG             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E0680	NON PNEUM COMP CONTROL CAL              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E0681	NON PNEU COMP CONTROL W/O CA            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E0682	NON PNEUM COMPRESS FULL ARM             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E0691	UVL PNL 2 SQ FT OR LESS                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E0694	UVL MD CABINET SYS 6 FT                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
U	E0700	SAFETY EQUIPMENT                        	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E0705	TRANSFER DEVICE                         	    40.54	   $40.54	      ---	       --	009	0	0	0.00	    $4.06	Y	
1	E0710	RESTRAINTS ANY TYPE                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0720	TENS TWO LEAD                           	   172.44	  $172.44	      ---	       --	009	0	0	0.00	   $24.99	Y	
1	E0730	TENS FOUR LEAD                          	   173.90	  $173.90	      ---	       --	009	0	0	0.00	   $25.20	Y	
1	E0747	ELEC OSTEOGEN STIM NOT SPINE            	  2398.50	 $2398.50	      ---	       --	009	0	0	0.00	  $238.34	Y	
1	E0748	ELEC OSTEOGEN STIM SPINAL               	  3030.73	 $3030.73	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0760	OSTEOGEN ULTRASOUND STIMLTOR            	  2329.64	 $2329.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0766	ELEC STIM CANCER TREATMENT              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0767	INTRABUC AM RF EMF CANCER TX            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E0770	FUNCTIONAL ELECTRIC STIM NOS            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0776	IV POLE                                 	    75.46	   $75.46	      ---	       --	009	0	0	0.00	   $14.34	Y	
1	E0779	AMB INFUSION PUMP MECHANICAL            	   153.88	  $153.88	      ---	       --	009	0	0	0.00	   $12.82	Y	
1	E0780	MECH AMB INFUSION PUMP <8HRS            	     8.30	    $8.30	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0781	EXTERNAL AMBULATORY INFUS PU            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $7.06	Y	
1	E0783	PROGRAMMABLE INFUSION PUMP              	  7269.63	 $7269.63	      ---	       --	009	0	0	0.00	  $726.98	Y	
1	E0784	EXT AMB INFUSN PUMP INSULIN             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	  $265.90	Y	
1	E0785	REPLACEMENT IMPL PUMP CATHET            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0786	IMPLANTABLE PUMP REPLACEMENT            	  6835.16	 $6835.16	      ---	       --	009	0	0	0.00	  $683.51	Y	
1	E0787	CGS DOSE ADJ INSULIN INF PMP            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0791	PARENTERAL INFUSION PUMP STA            	  2529.60	 $2529.60	      ---	       --	009	0	0	0.00	  $252.96	Y	
1	E0840	TRACT FRAME ATTACH HEADBOARD            	    58.62	   $58.62	      ---	       --	009	0	0	0.00	   $13.06	Y	
1	E0849	CERVICAL PNEUM TRAC EQUIP               	   412.25	  $412.25	      ---	       --	009	0	0	0.00	   $41.22	N	
1	E0850	TRACTION STAND FREE STANDING            	    78.22	   $78.22	      ---	       --	009	0	0	0.00	   $11.54	Y	
1	E0860	TRACT EQUIP CERVICAL TRACT              	    30.82	   $30.82	      ---	       --	009	0	0	0.00	    $5.21	Y	
1	E0870	TRACT FRAME ATTACH FOOTBOARD            	    58.62	   $58.62	      ---	       --	009	0	0	0.00	   $11.91	Y	
1	E0880	TRAC STAND FREE STAND EXTREM            	    78.22	   $78.22	      ---	       --	009	0	0	0.00	   $11.54	Y	
1	E0890	TRACTION FRAME ATTACH PELVIC            	    58.62	   $58.62	      ---	       --	009	0	0	0.00	   $13.06	Y	
1	E0900	TRAC STAND FREE STAND PELVIC            	    78.22	   $78.22	      ---	       --	009	0	0	0.00	   $11.54	Y	
1	E0910	TRAPEZE BAR ATTACHED TO BED             	   169.25	  $169.25	      ---	       --	009	0	0	0.00	   $11.73	Y	
1	E0911	HD TRAPEZE BAR ATTACH TO BED            	   478.56	  $478.56	      ---	       --	009	0	0	0.00	   $37.74	Y	
1	E0912	HD TRAPEZE BAR FREE STANDING            	  1098.91	 $1098.91	      ---	       --	009	0	0	0.00	   $80.30	Y	
1	E0920	FRACTURE FRAME ATTACHED TO B            	   376.51	  $376.51	      ---	       --	009	0	0	0.00	   $31.38	Y	
1	E0930	FRACTURE FRAME FREE STANDING            	   395.52	  $395.52	      ---	       --	009	0	0	0.00	   $32.96	Y	
1	E0935	CONT PAS MOTION EXERCISE DEV            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	   $15.97	Y	
1	E0936	CPM DEVICE, OTHER THAN KNEE             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0940	TRAPEZE BAR FREE STANDING               	   325.25	  $325.25	      ---	       --	009	0	0	0.00	   $22.42	Y	
1	E0942	CERVICAL HEAD HARNESS/HALTER            	    15.88	   $15.88	      ---	       --	009	0	0	0.00	    $1.87	Y	
1	E0944	PELVIC BELT/HARNESS/BOOT                	    31.20	   $31.20	      ---	       --	009	0	0	0.00	    $3.13	Y	
1	E0945	BELT/HARNESS EXTREMITY                  	    35.46	   $35.46	      ---	       --	009	0	0	0.00	    $3.55	Y	
1	E0947	FRACTURE FRAME ATTACHMNTS PE            	   485.17	  $485.17	      ---	       --	009	0	0	0.00	   $50.31	Y	
1	E0948	FRACTURE FRAME ATTACHMNTS CE            	   469.27	  $469.27	      ---	       --	009	0	0	0.00	   $46.91	Y	
1	E0950	TRAY                                    	    86.16	   $86.16	      ---	       --	009	0	0	0.00	    $8.61	Y	
1	E0951	LOOP HEEL                               	    16.31	   $16.31	      ---	       --	009	0	0	0.00	    $1.66	Y	
1	E0952	TOE LOOP/HOLDER, EACH                   	    15.32	   $15.32	      ---	       --	009	0	0	0.00	    $1.59	Y	
1	E0953	W/C LATERAL THIGH/KNEE SUP              	   103.69	  $103.69	      ---	       --	009	0	0	0.00	   $10.37	Y	
1	E0954	FOOT BOX, ANY TYPE EACH FOOT            	    64.54	   $64.54	      ---	       --	009	0	0	0.00	    $6.46	Y	
1	E0955	CUSHIONED HEADREST                      	   133.70	  $133.70	      ---	       --	009	0	0	0.00	   $17.66	Y	
1	E0956	W/C LATERAL TRUNK/HIP SUPPOR            	    89.07	   $89.07	      ---	       --	009	0	0	0.00	    $8.91	Y	
1	E0957	W/C MEDIAL THIGH SUPPORT                	   131.62	  $131.62	      ---	       --	009	0	0	0.00	   $13.16	Y	
1	E0958	WHLCHR ATT- CONV 1 ARM DRIVE            	   392.19	  $392.19	      ---	       --	009	0	0	0.00	   $45.03	Y	
1	E0959	AMPUTEE ADAPTER                         	    44.21	   $44.21	      ---	       --	009	0	0	0.00	    $4.45	Y	
1	E0960	W/C SHOULDER HARNESS/STRAPS             	    83.22	   $83.22	      ---	       --	009	0	0	0.00	    $8.33	Y	
1	E0961	WHEELCHAIR BRAKE EXTENSION              	    24.11	   $24.11	      ---	       --	009	0	0	0.00	    $2.52	Y	
1	E0966	WHEELCHAIR HEAD REST EXTENSI            	    71.37	   $71.37	      ---	       --	009	0	0	0.00	    $7.04	Y	
1	E0967	MAN WC RIM/PROJECTION REP EA            	    65.23	   $65.23	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0970	WHEELCHAIR NO. 2 FOOTPLATES             	    39.63	   $39.63	      ---	       --	009	0	0	0.00	    $4.10	Y	
1	E0971	WHEELCHAIR ANTI-TIPPING DEVI            	    40.85	   $40.85	      ---	       --	009	0	0	0.00	    $4.09	Y	
1	E0973	W/CH ACCESS DET ADJ ARMREST             	    76.54	   $76.54	      ---	       --	009	0	0	0.00	    $7.49	Y	
1	E0974	W/CH ACCESS ANTI-ROLLBACK               	    75.36	   $75.36	      ---	       --	009	0	0	0.00	    $7.93	Y	
1	E0978	W/C ACC,SAF BELT PELV STRAP             	    30.86	   $30.86	      ---	       --	009	0	0	0.00	    $3.09	Y	
1	E0981	SEAT UPHOLSTERY, REPLACEMENT            	    35.89	   $35.89	      ---	       --	009	0	0	0.00	    $3.58	Y	
1	E0982	BACK UPHOLSTERY, REPLACEMENT            	    41.90	   $41.90	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E0983	ADD PWR JOYSTICK                        	  2862.96	 $2862.96	      ---	       --	009	0	0	0.00	  $238.58	Y	
1	E0984	ADD PWR TILLER                          	  1623.99	 $1623.99	      ---	       --	009	0	0	0.00	  $144.19	Y	
1	E0985	W/C SEAT LIFT MECHANISM                 	   194.40	  $194.40	      ---	       --	009	0	0	0.00	   $23.00	Y	
1	E0986	MAN W/C PUSH-RIM POWR SYSTEM            	  4864.24	 $4864.24	      ---	       --	009	0	0	0.00	  $486.43	Y	
1	E0988	LEVER-ACTIVATED WHEEL DRIVE             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	  $321.54	Y	
1	E0990	WHEELCHAIR ELEVATING LEG RES            	    91.17	   $91.17	      ---	       --	009	0	0	0.00	   $10.25	Y	
1	E0992	WHEELCHAIR SOLID SEAT INSERT            	    77.14	   $77.14	      ---	       --	009	0	0	0.00	    $7.50	Y	
1	E0995	WC CALF REST, PAD REPLACEMNT            	    24.94	   $24.94	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E1002	PWR SEAT TILT                           	  4053.21	 $4053.21	      ---	       --	009	0	0	0.00	  $382.06	Y	
1	E1003	PWR SEAT RECLINE                        	  4391.30	 $4391.30	      ---	       --	009	0	0	0.00	  $429.69	Y	
1	E1004	PWR SEAT RECLINE MECH                   	  4869.05	 $4869.05	      ---	       --	009	0	0	0.00	  $474.38	Y	
1	E1005	PWR SEAT RECLINE PWR                    	  5270.36	 $5270.36	      ---	       --	009	0	0	0.00	  $516.17	Y	
1	E1006	PWR SEAT COMBO W/O SHEAR                	  6455.70	 $6455.70	      ---	       --	009	0	0	0.00	  $634.30	Y	
1	E1007	PWR SEAT COMBO W/SHEAR                  	  8741.27	 $8741.27	      ---	       --	009	0	0	0.00	  $823.49	Y	
1	E1008	PWR SEAT COMBO PWR SHEAR                	  8742.05	 $8742.05	      ---	       --	009	0	0	0.00	  $833.55	Y	
1	E1009	ADD MECH LEG ELEVATION                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E1010	ADD PWR LEG ELEVATION                   	  1143.79	 $1143.79	      ---	       --	009	0	0	0.00	  $111.09	Y	
1	E1011	PED WC MODIFY WIDTH ADJUSTM             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E1012	CTR MOUNT PWR ELEV LEG REST             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E1014	RECLINING BACK ADD PED W/C              	   365.14	  $365.14	      ---	       --	009	0	0	0.00	   $36.52	Y	
1	E1015	SHOCK ABSORBER FOR MAN W/C              	   114.70	  $114.70	      ---	       --	009	0	0	0.00	   $11.46	Y	
1	E1016	SHOCK ABSORBER FOR POWER W/C            	   123.87	  $123.87	      ---	       --	009	0	0	0.00	   $12.40	Y	
1	E1017	HD SHCK ABSRBR FOR HD MAN WC            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E1018	HD SHCK ABSRBER FOR HD POWWC            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E1020	RESIDUAL LIMB SUPPORT SYSTEM            	   168.60	  $168.60	      ---	       --	009	0	0	0.00	   $21.50	Y	
1	E1022	WHEELCHR TRANSPORT SECUR                	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E1023	WHEELCHR TRANSIT SECUREMENT             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E1028	W/C MANUAL SWINGAWAY                    	   127.10	  $127.10	      ---	       --	009	0	0	0.00	   $17.31	Y	
1	E1029	W/C VENT TRAY FIXED                     	   369.54	  $369.54	      ---	       --	009	0	0	0.00	   $36.63	Y	
1	E1030	W/C VENT TRAY GIMBALED                  	  1165.27	 $1165.27	      ---	       --	009	0	0	0.00	  $114.99	Y	
1	E1031	ROLLABOUT CHAIR WITH CASTERS            	   604.56	  $604.56	      ---	       --	009	0	0	0.00	   $51.49	Y	
1	E1032	WHEELCHAIR JOYSTICK DRIVE               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E1033	WHEELCHAIR HARDWARE HEADREST            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E1034	WHEELCHAIR TRUNK HIP SUPPORT            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E1035	PATIENT TRANSFER SYSTEM <300            	  7726.32	 $7726.32	      ---	       --	009	0	0	0.00	  $663.00	Y	
1	E1036	PATIENT TRANSFER SYSTEM >300            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	  $763.34	Y	
1	E1037	TRANSPORT CHAIR, PED SIZE               	  1084.90	 $1084.90	      ---	       --	009	0	0	0.00	  $118.80	Y	
1	E1038	TRANSPORT CHAIR PT WT<=300LB            	   216.36	  $216.36	      ---	       --	009	0	0	0.00	   $18.09	Y	
1	E1039	TRANSPORT CHAIR PT WT >300LB            	   410.40	  $410.40	      ---	       --	009	0	0	0.00	   $37.01	N	
1	E1161	MANUAL ADULT WC W TILTINSPAC            	  2366.09	 $2366.09	      ---	       --	009	0	0	0.00	  $236.61	Y	
1	E1220	WHLCHR SPECIAL SIZE/CONSTRC             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E1225	MANUAL SEMI-RECLINING BACK              	   373.73	  $373.73	      ---	       --	009	0	0	0.00	   $41.94	Y	
1	E1226	MANUAL FULLY RECLINING BACK             	   376.02	  $376.02	      ---	       --	009	0	0	0.00	   $38.70	Y	
1	E1228	WHEELCHAIR SPEC SZ SPEC HT B            	   233.27	  $233.27	      ---	       --	009	0	0	0.00	   $19.44	Y	
1	E1229	PEDIATRIC WHEELCHAIR NOS                	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E1230	POWER OPERATED VEHICLE                  	  1707.13	 $1707.13	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E1231	RIGID PED W/C TILT-IN-SPACE             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E1232	FOLDING PED WC TILT-IN-SPACE            	  2138.41	 $2138.41	      ---	       --	009	0	0	0.00	  $213.85	Y	
1	E1233	RIG PED WC TLTNSPC W/O SEAT             	  2215.73	 $2215.73	      ---	       --	009	0	0	0.00	  $221.57	Y	
1	E1234	FLD PED WC TLTNSPC W/O SEAT             	  1928.95	 $1928.95	      ---	       --	009	0	0	0.00	  $192.91	Y	
1	E1235	RIGID PED WC ADJUSTABLE                 	  1857.43	 $1857.43	      ---	       --	009	0	0	0.00	  $185.75	Y	
1	E1236	FOLDING PED WC ADJUSTABLE               	  1638.73	 $1638.73	      ---	       --	009	0	0	0.00	  $163.87	Y	
1	E1237	RGD PED WC ADJSTABL W/O SEAT            	  1653.05	 $1653.05	      ---	       --	009	0	0	0.00	  $165.30	Y	
1	E1238	FLD PED WC ADJSTABL W/O SEAT            	  1638.73	 $1638.73	      ---	       --	009	0	0	0.00	  $163.87	Y	
1	E1239	PED POWER WHEELCHAIR NOS                	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E1296	WHEELCHAIR SPECIAL SEAT HEIG            	   374.93	  $374.93	      ---	       --	009	0	0	0.00	   $37.50	Y	
1	E1297	WHEELCHAIR SPECIAL SEAT DEPT            	    72.09	   $72.09	      ---	       --	009	0	0	0.00	    $9.42	Y	
1	E1298	WHEELCHAIR SPEC SEAT DEPTH/W            	   325.53	  $325.53	      ---	       --	009	0	0	0.00	   $32.56	Y	
1	E1353	OXYGEN SUPPLIES REGULATOR               	    32.97	   $32.97	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E1354	WHEELED CART, PORT CYL/CONC             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E1355	OXYGEN SUPPLIES STAND/RACK              	    24.84	   $24.84	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E1356	BATT PACK/CART, PORT CONC               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E1357	BATTERY CHARGER, PORT CONC              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E1358	DC POWER ADAPTER, PORT CONC             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E1390	OXYGEN CONCENTRATOR                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	  $136.87	Y	
1	E1391	OXYGEN CONCENTRATOR, DUAL               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	  $136.87	Y	
1	E1392	PORTABLE OXYGEN CONCENTRATOR            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	   $45.01	Y	
1	E1399	DURABLE MEDICAL EQUIPMENT MI            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E1639	SCALE, EACH                             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E1810	ADJUST KNEE EXT & FLEX DEV              	  1195.97	 $1195.97	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E1902	AAC NON-ELECTRONIC BOARD                	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E2000	GASTRIC SUCTION PUMP HME MDL            	   473.86	  $473.86	      ---	       --	009	0	0	0.00	   $39.49	Y	
1	E2100	BLD GLUCOSE MONITOR W VOICE             	   437.37	  $437.37	      ---	       --	009	0	0	0.00	   $43.74	Y	
1	E2101	BLD GLUCOSE MONITOR W LANCE             	   150.85	  $150.85	      ---	       --	009	0	0	0.00	   $15.09	Y	
1	E2102	ADJU CGM RECEIVER/MONITOR               	   178.58	  $178.58	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E2104	GLUCOSE MONITOR W CARTRIDGE             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E2201	MAN W/CH ACC SEAT W>=20"<24"            	   373.10	  $373.10	      ---	       --	009	0	0	0.00	   $37.31	Y	
1	E2202	SEAT WIDTH 24-27 IN                     	   473.98	  $473.98	      ---	       --	009	0	0	0.00	   $47.40	Y	
1	E2203	FRAME DEPTH LESS THAN 22 IN             	   479.05	  $479.05	      ---	       --	009	0	0	0.00	   $47.89	Y	
1	E2204	FRAME DEPTH 22 TO 25 IN                 	   813.40	  $813.40	      ---	       --	009	0	0	0.00	   $81.35	Y	
1	E2205	MANUAL WC ACCESSORY, HANDRIM            	    32.10	   $32.10	      ---	       --	009	0	0	0.00	    $3.19	N	
1	E2206	MAN WC WHL LOCK COMP REPL EA            	    35.26	   $35.26	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E2207	CRUTCH AND CANE HOLDER                  	    42.62	   $42.62	      ---	       --	009	0	0	0.00	    $4.27	Y	
1	E2208	CYLINDER TANK CARRIER                   	    97.90	   $97.90	      ---	       --	009	0	0	0.00	    $9.79	Y	
1	E2209	ARM TROUGH EACH                         	    95.89	   $95.89	      ---	       --	009	0	0	0.00	    $9.58	Y	
1	E2210	WHEELCHAIR BEARINGS                     	     6.03	    $6.03	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E2211	PNEUMATIC PROPULSION TIRE               	    40.91	   $40.91	      ---	       --	009	0	0	0.00	    $4.01	Y	
1	E2212	PNEUMATIC PROP TIRE TUBE                	     5.78	    $5.78	      ---	       --	009	0	0	0.00	    $0.61	Y	
1	E2213	PNEUMATIC PROP TIRE INSERT              	    29.91	   $29.91	      ---	       --	009	0	0	0.00	    $3.01	Y	
1	E2214	PNEUMATIC CASTER TIRE EACH              	    36.00	   $36.00	      ---	       --	009	0	0	0.00	    $3.96	Y	
1	E2215	PNEUMATIC CASTER TIRE TUBE              	     9.45	    $9.45	      ---	       --	009	0	0	0.00	    $0.94	Y	
1	E2218	FOAM PROPULSION TIRE EACH               	    59.48	   $59.48	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E2219	FOAM CASTER TIRE ANY SIZE EA            	    41.85	   $41.85	      ---	       --	009	0	0	0.00	    $4.72	Y	
1	E2220	SOLID PROPULS TIRE, REPL, EA            	    26.61	   $26.61	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E2221	SOLID CASTER TIRE REPL, EACH            	    23.84	   $23.84	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E2222	SOLID CASTER INTEG WHL, REPL            	    19.86	   $19.86	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E2224	PROPULSION WHL EXCL TIRE REP            	    81.48	   $81.48	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E2225	CASTER WHEEL EXCLUDES TIRE              	    17.40	   $17.40	      ---	       --	009	0	0	0.00	    $1.74	Y	
1	E2226	CASTER FORK REPLACEMENT ONLY            	    37.94	   $37.94	      ---	       --	009	0	0	0.00	    $3.79	Y	
1	E2227	GEAR REDUCTION DRIVE WHEEL              	  1569.13	 $1569.13	      ---	       --	009	0	0	0.00	  $156.93	Y	
1	E2228	MWC ACC, WHEELCHAIR BRAKE               	   865.90	  $865.90	      ---	       --	009	0	0	0.00	  $103.48	Y	
1	E2231	SOLID SEAT SUPPORT BASE                 	   160.91	  $160.91	      ---	       --	009	0	0	0.00	   $16.09	Y	
1	E2291	PLANAR BACK FOR PED SIZE WC             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E2292	PLANAR SEAT FOR PED SIZE WC             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E2293	CONTOUR BACK FOR PED SIZE WC            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E2294	CONTOUR SEAT FOR PED SIZE WC            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E2295	PED DYNAMIC SEATING FRAME               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E2298	PWR SEAT ELEV SYS FOR CRT               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E2301	PWR STANDING                            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E2310	ELECTRO CONNECT BTW CONTROL             	  1170.24	 $1170.24	      ---	       --	009	0	0	0.00	  $111.04	Y	
1	E2311	ELECTRO CONNECT BTW 2 SYS               	  2369.20	 $2369.20	      ---	       --	009	0	0	0.00	  $224.48	Y	
1	E2312	MINI-PROP REMOTE JOYSTICK               	  1764.30	 $1764.30	      ---	       --	009	0	0	0.00	  $223.84	Y	
1	E2313	PWC HARNESS, EXPAND CONTROL             	   320.26	  $320.26	      ---	       --	009	0	0	0.00	   $32.03	Y	
1	E2321	HAND INTERFACE JOYSTICK                 	  1198.22	 $1198.22	      ---	       --	009	0	0	0.00	  $150.85	Y	
1	E2322	MULT MECH SWITCHES                      	  1063.45	 $1063.45	      ---	       --	009	0	0	0.00	  $137.99	Y	
1	E2323	SPECIAL JOYSTICK HANDLE                 	    66.17	   $66.17	      ---	       --	009	0	0	0.00	    $6.61	Y	
1	E2324	CHIN CUP INTERFACE                      	    41.92	   $41.92	      ---	       --	009	0	0	0.00	    $4.17	Y	
1	E2325	SIP AND PUFF INTERFACE                  	  1346.83	 $1346.83	      ---	       --	009	0	0	0.00	  $131.84	Y	
1	E2326	BREATH TUBE KIT                         	   347.14	  $347.14	      ---	       --	009	0	0	0.00	   $34.28	Y	
1	E2327	HEAD CONTROL INTERFACE MECH             	  1969.80	 $1969.80	      ---	       --	009	0	0	0.00	  $256.78	Y	
1	E2328	HEAD/EXTREMITY CONTROL INTER            	  4955.32	 $4955.32	      ---	       --	009	0	0	0.00	  $485.88	Y	
1	E2329	HEAD CONTROL NONPROPORTIONAL            	  1766.13	 $1766.13	      ---	       --	009	0	0	0.00	  $174.31	Y	
1	E2330	HEAD CONTROL PROXIMITY SWITC            	  3422.09	 $3422.09	      ---	       --	009	0	0	0.00	  $336.20	Y	
1	E2331	ATTENDANT CONTROL                       	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E2340	W/C WDTH 20-23 IN SEAT FRAME            	   358.36	  $358.36	      ---	       --	009	0	0	0.00	   $35.85	Y	
1	E2341	W/C WDTH 24-27 IN SEAT FRAME            	   537.58	  $537.58	      ---	       --	009	0	0	0.00	   $53.76	Y	
1	E2342	W/C DPTH 20-21 IN SEAT FRAME            	   447.98	  $447.98	      ---	       --	009	0	0	0.00	   $44.80	Y	
1	E2343	W/C DPTH 22-25 IN SEAT FRAME            	   716.78	  $716.78	      ---	       --	009	0	0	0.00	   $71.67	Y	
1	E2351	ELECTRONIC SGD INTERFACE                	   691.51	  $691.51	      ---	       --	009	0	0	0.00	   $69.15	Y	
1	E2358	GR 34 NONSEALED LEADACID                	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E2359	GR34 SEALED LEADACID BATTERY            	   187.04	  $187.04	      ---	       --	009	0	0	0.00	   $18.71	Y	
1	E2360	22NF NONSEALED LEADACID                 	   106.53	  $106.53	      ---	       --	009	0	0	0.00	   $10.65	Y	
1	E2361	22NF SEALED LEADACID BATTERY            	   128.24	  $128.24	      ---	       --	009	0	0	0.00	   $12.83	Y	
1	E2362	GR24 NONSEALED LEADACID                 	    90.44	   $90.44	      ---	       --	009	0	0	0.00	    $9.04	Y	
1	E2363	GR24 SEALED LEADACID BATTERY            	   166.83	  $166.83	      ---	       --	009	0	0	0.00	   $16.69	Y	
1	E2364	U1NONSEALED LEADACID BATTERY            	   106.53	  $106.53	      ---	       --	009	0	0	0.00	   $10.65	Y	
1	E2365	U1 SEALED LEADACID BATTERY              	    94.85	   $94.85	      ---	       --	009	0	0	0.00	    $9.48	Y	
1	E2366	BATTERY CHARGER, SINGLE MODE            	   212.64	  $212.64	      ---	       --	009	0	0	0.00	   $21.30	Y	
1	E2367	BATTERY CHARGER, DUAL MODE              	   263.62	  $263.62	      ---	       --	009	0	0	0.00	   $26.43	Y	
1	E2368	PWR WC DRIVEWHEEL MOTOR REPL            	   379.50	  $379.50	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E2369	PWR WC DRIVEWHEEL GEAR REPL             	   358.60	  $358.60	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E2370	PWR WC DR WH MOTOR/GEAR COMB            	   493.20	  $493.20	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E2371	GR27 SEALED LEADACID BATTERY            	   144.21	  $144.21	      ---	       --	009	0	0	0.00	   $14.43	Y	
1	E2372	GR27 NON-SEALED LEADACID                	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E2373	HAND/CHIN CTRL SPEC JOYSTICK            	   614.99	  $614.99	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E2374	HAND/CHIN CTRL STD JOYSTICK             	   534.02	  $534.02	      ---	       --	009	0	0	0.00	   $50.92	Y	
1	E2375	NON-EXPANDABLE CONTROLLER               	   602.20	  $602.20	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E2376	EXPANDABLE CONTROLLER, REPL             	  1342.27	 $1342.27	      ---	       --	009	0	0	0.00	  $127.26	Y	
1	E2377	EXPANDABLE CONTROLLER, INITL            	   485.71	  $485.71	      ---	       --	009	0	0	0.00	   $46.57	Y	
1	E2378	PW ACTUATOR REPLACEMENT                 	   447.62	  $447.62	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E2381	PNEUM DRIVE WHEEL TIRE                  	    57.32	   $57.32	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E2382	TUBE, PNEUM WHEEL DRIVE TIRE            	    19.02	   $19.02	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E2383	INSERT, PNEUM WHEEL DRIVE               	   140.87	  $140.87	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E2384	PNEUMATIC CASTER TIRE                   	    71.58	   $71.58	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E2385	TUBE, PNEUMATIC CASTER TIRE             	    45.51	   $45.51	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E2386	FOAM FILLED DRIVE WHEEL TIRE            	   126.97	  $126.97	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E2387	FOAM FILLED CASTER TIRE                 	    57.37	   $57.37	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E2388	FOAM DRIVE WHEEL TIRE                   	    48.19	   $48.19	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E2389	FOAM CASTER TIRE                        	    26.18	   $26.18	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E2390	SOLID DRIVE WHEEL TIRE                  	    40.93	   $40.93	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E2391	SOLID CASTER TIRE                       	    19.39	   $19.39	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E2392	SOLID CASTER TIRE, INTEGRATE            	    48.78	   $48.78	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E2394	DRIVE WHEEL EXCLUDES TIRE               	    68.50	   $68.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E2395	CASTER WHEEL EXCLUDES TIRE              	    49.83	   $49.83	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E2396	CASTER FORK                             	    60.38	   $60.38	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E2397	PWC ACC, LITH-BASED BATTERY             	   414.13	  $414.13	      ---	       --	009	0	0	0.00	   $41.41	Y	
1	E2398	WC DYNAMIC POS BACK HARDWARE            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	E2402	NEG PRESS WOUND THERAPY PUMP            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	   $45.77	N	
1	E2500	SGD DIGITIZED PRE-REC <=8MIN            	   391.06	  $391.06	      ---	       --	009	0	0	0.00	   $34.73	N	
1	E2502	SGD PREREC MSG >8MIN <=20MIN            	  1195.80	 $1195.80	      ---	       --	009	0	0	0.00	  $106.18	N	
1	E2504	SGD PREREC MSG>20MIN <=40MIN            	  1577.42	 $1577.42	      ---	       --	009	0	0	0.00	  $140.09	N	
1	E2506	SGD PREREC MSG > 40 MIN                 	  2312.96	 $2312.96	      ---	       --	009	0	0	0.00	  $205.37	N	
1	E2508	SGD SPELLING PHYS CONTACT               	  3576.61	 $3576.61	      ---	       --	009	0	0	0.00	  $317.58	N	
1	E2510	SGD W MULTI METHODS MSG/ACCS            	  6768.25	 $6768.25	      ---	       --	009	0	0	0.00	  $600.99	N	
1	E2511	SGD SFTWRE PRGRM FOR PC/PDA             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E2512	SGD ACCESSORY, MOUNTING SYS             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E2513	SGD ACCESSORY, EMG SENSOR               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E2599	SGD ACCESSORY NOC                       	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E2601	GEN W/C CUSHION WDTH < 22 IN            	    50.70	   $50.70	      ---	       --	009	0	0	0.00	    $5.08	N	
1	E2602	GEN W/C CUSHION WDTH >=22 IN            	   103.14	  $103.14	      ---	       --	009	0	0	0.00	   $10.32	N	
1	E2603	SKIN PROTECT WC CUS WD <22IN            	   129.02	  $129.02	      ---	       --	009	0	0	0.00	   $12.91	N	
1	E2604	SKIN PROTECT WC CUS WD>=22IN            	   169.68	  $169.68	      ---	       --	009	0	0	0.00	   $16.97	N	
1	E2605	POSITION WC CUSH WDTH <22 IN            	   243.36	  $243.36	      ---	       --	009	0	0	0.00	   $24.34	N	
1	E2606	POSITION WC CUSH WDTH>=22 IN            	   384.42	  $384.42	      ---	       --	009	0	0	0.00	   $38.45	N	
1	E2607	SKIN PRO/POS WC CUS WD <22IN            	   250.12	  $250.12	      ---	       --	009	0	0	0.00	   $25.01	N	
1	E2608	SKIN PRO/POS WC CUS WD>=22IN            	   306.64	  $306.64	      ---	       --	009	0	0	0.00	   $30.66	N	
1	E2609	CUSTOM FABRICATE W/C CUSHION            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E2610	POWERED W/C CUSHION                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E2611	GEN USE BACK CUSH WDTH <22IN            	   236.80	  $236.80	      ---	       --	009	0	0	0.00	   $23.67	N	
1	E2612	GEN USE BACK CUSH WDTH>=22IN            	   369.34	  $369.34	      ---	       --	009	0	0	0.00	   $36.93	N	
1	E2613	POSITION BACK CUSH WD <22IN             	   356.61	  $356.61	      ---	       --	009	0	0	0.00	   $35.67	N	
1	E2614	POSITION BACK CUSH WD>=22IN             	   508.32	  $508.32	      ---	       --	009	0	0	0.00	   $50.83	N	
1	E2615	POS BACK POST/LAT WDTH <22IN            	   408.76	  $408.76	      ---	       --	009	0	0	0.00	   $40.88	N	
1	E2616	POS BACK POST/LAT WDTH>=22IN            	   550.23	  $550.23	      ---	       --	009	0	0	0.00	   $55.02	N	
1	E2617	CUSTOM FAB W/C BACK CUSHION             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E2619	REPLACE COVER W/C SEAT CUSH             	    49.09	   $49.09	      ---	       --	009	0	0	0.00	    $4.91	N	
1	E2620	WC PLANAR BACK CUSH WD <22IN            	   469.33	  $469.33	      ---	       --	009	0	0	0.00	   $46.94	N	
1	E2621	WC PLANAR BACK CUSH WD>=22IN            	   519.21	  $519.21	      ---	       --	009	0	0	0.00	   $51.92	N	
1	E2622	ADJ SKIN PRO W/C CUS WD<22IN            	   299.68	  $299.68	      ---	       --	009	0	0	0.00	   $29.97	N	
1	E2623	ADJ SKIN PRO WC CUS WD>=22IN            	   381.33	  $381.33	      ---	       --	009	0	0	0.00	   $38.14	N	
1	E2624	ADJ SKIN PRO/POS CUS<22IN               	   302.14	  $302.14	      ---	       --	009	0	0	0.00	   $30.22	N	
1	E2625	ADJ SKIN PRO/POS WC CUS>=22             	   382.49	  $382.49	      ---	       --	009	0	0	0.00	   $38.24	N	
1	E2626	SEO MOBILE ARM SUP ATT TO WC            	   667.16	  $667.16	      ---	       --	009	0	0	0.00	   $66.70	Y	
1	E2627	ARM SUPP ATT TO WC RANCHO TY            	  1064.58	 $1064.58	      ---	       --	009	0	0	0.00	  $106.49	Y	
1	E2628	MOBILE ARM SUPPORTS RECLININ            	   801.99	  $801.99	      ---	       --	009	0	0	0.00	   $80.20	Y	
1	E2629	FRICTION DAMPENING ARM SUPP             	  1014.90	 $1014.90	      ---	       --	009	0	0	0.00	  $101.48	Y	
1	E2630	MONOSUSPENSION ARM/HAND SUPP            	   709.72	  $709.72	      ---	       --	009	0	0	0.00	   $70.97	Y	
1	E2631	ELEVAT PROXIMAL ARM SUPPORT             	   283.90	  $283.90	      ---	       --	009	0	0	0.00	   $28.39	Y	
1	E2632	OFFSET/LAT ROCKER ARM W/ELA             	   180.52	  $180.52	      ---	       --	009	0	0	0.00	   $18.05	Y	
1	E2633	MOBILE ARM SUPPORT SUPINATOR            	   152.60	  $152.60	      ---	       --	009	0	0	0.00	   $15.24	Y	
1	E3200	GAIT MOD SYSTM RHYM AUDITORY            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E8000	POSTERIOR GAIT TRAINER                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E8001	UPRIGHT GAIT TRAINER                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	E8002	ANTERIOR GAIT TRAINER                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
N	G0011	HIV PREP COUNSEL, MD 15-30M             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	G0088	ADM IV DRUG 1ST HOME VISIT              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	G0089	ADM SUBQ DRUG 1ST HOME VISIT            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	G0108	DIAB MANAGE TRN PER INDIV               	    45.74	   $45.74	      ---	       --	009	0	0	0.00	    $0.00	N	
X	G0108	DIAB MANAGE TRN PER INDIV               	    49.69	   $49.69	      ---	       --	009	0	0	0.00	    $0.00	N	
X	G0109	DIAB MANAGE TRN IND/GROUP               	    14.14	   $14.14	      ---	       --	009	0	0	0.00	    $0.00	N	
1	G0109	DIAB MANAGE TRN IND/GROUP               	    12.26	   $12.26	      ---	       --	009	0	0	0.00	    $0.00	N	
1	G0151	HHCP-SERV OF PT,EA 15 MIN               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
V	G0151	HHCP-SERV OF PT,EA 15 MIN               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
V	G0152	HHCP-SERV OF OT,EA 15 MIN               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	G0152	HHCP-SERV OF OT,EA 15 MIN               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	G0153	HHCP-SVS OF S/L PATH,EA 15MN            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	G0155	HHCP-SVS OF CSW,EA 15 MIN               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
V	G0155	HHCP-SVS OF CSW,EA 15 MIN               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
U	G0155	HHCP-SVS OF CSW,EA 15 MIN               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
T	G0156	HHCP-SVS OF AIDE,EA 15 MIN              	     7.09	    $7.09	      ---	       --	009	0	0	0.00	    $0.00	Y	
V	G0156	HHCP-SVS OF AIDE,EA 15 MIN              	     7.09	    $7.09	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	G0156	HHCP-SVS OF AIDE,EA 15 MIN              	     7.09	    $7.09	      ---	       --	009	0	0	0.00	    $0.00	Y	
G	G0156	HHCP-SVS OF AIDE,EA 15 MIN              	     5.01	    $5.01	      ---	       --	009	0	0	0.00	    $0.00	N	
V	G0159	HHC PT MAINT EA 15 MIN                  	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
U	G0159	HHC PT MAINT EA 15 MIN                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
T	G0162	HHC RN E&M PLAN SVS, 15 MIN             	    17.04	   $17.04	      ---	       --	009	0	0	0.00	    $0.00	Y	
V	G0162	HHC RN E&M PLAN SVS, 15 MIN             	    17.04	   $17.04	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	G0162	HHC RN E&M PLAN SVS, 15 MIN             	    17.04	   $17.04	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	G0176	OPPS/PHP/IOP; ACTIVITY THRPY            	    35.00	   $35.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	G0183	SOFTWARE MEAS OF CARDIAC VOL            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
E	G0237	THERAPEUTIC PROCD STRG ENDUR            	    12.08	   $12.08	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	G0279	TOMOSYNTHESIS, MAMMO                    	    12.44	   $47.52	      ---	       --	005	0	0	0.53	    $0.00	Y	
G	G0299	HHS/HOSPICE OF RN EA 15 MIN             	    10.15	   $10.15	      ---	       --	009	0	0	0.00	    $0.00	N	
V	G0299	HHS/HOSPICE OF RN EA 15 MIN             	    15.21	   $15.21	      ---	       --	009	0	0	0.00	    $0.00	Y	
T	G0299	HHS/HOSPICE OF RN EA 15 MIN             	    15.21	   $15.21	      ---	       --	009	0	0	0.00	    $0.00	Y	
T	G0300	HHS/HOSPICE OF LPN EA 15 MIN            	    11.03	   $11.03	      ---	       --	009	0	0	0.00	    $0.00	Y	
V	G0300	HHS/HOSPICE OF LPN EA 15 MIN            	    11.03	   $11.03	      ---	       --	009	0	0	0.00	    $0.00	Y	
G	G0300	HHS/HOSPICE OF LPN EA 15 MIN            	     7.36	    $7.36	      ---	       --	009	0	0	0.00	    $0.00	N	
1	G0310	IMMUNIZE COUNSEL 5-15 MIN               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	G0311	IMMUNIZE COUNSEL 16-30 MINS             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	G0312	IMMUNIZE COUNS < 21YR 5-15 M            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	G0313	IMMUNIZE COUNS < 21YR 6-30 M            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	G0314	COUNSEL IMMUNE <21 16-30 M              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	G0315	COUNSEL IMMUNE <21 5-15 M               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	G0323	CARE MANAGE BEH SVS 20MINS              	    38.99	   $38.99	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	G0323	CARE MANAGE BEH SVS 20MINS              	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
N	G0330	FACILITY SVS DENTAL REHAB               	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
Y	G0396	ALCOHOL/SUBS INTERV 15-30MN             	    31.24	   $31.24	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	G0396	ALCOHOL/SUBS INTERV 15-30MN             	    31.24	   $31.24	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	G0397	ALCOHOL/SUBS INTERV >30 MIN             	    60.61	   $60.61	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	G0397	ALCOHOL/SUBS INTERV >30 MIN             	    60.61	   $60.61	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	G0398	HOME SLEEP TEST/TYPE 2 PORTA            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	G0399	HOME SLEEP TEST/TYPE 3 PORTA            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	G0400	HOME SLEEP TEST/TYPE 4 PORTA            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
M	G0416	PROSTATE BIOPSY, ANY MTHD               	   342.30	  $342.30	      ---	       --	009	0	0	0.27	    $0.00	N	
N	G0422	INTENS CARDIAC REHAB W/EXERC            	    94.80	   $94.80	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	G0423	INTENS CARDIAC REHAB NO EXER            	    94.80	   $94.80	      ---	       --	009	0	0	0.00	    $0.00	Y	
M	G0432	EIA HIV-1/HIV-2 SCREEN                  	    14.93	   $14.93	      ---	       --	009	0	0	0.00	    $0.00	N	
M	G0433	ELISA HIV-1/HIV-2 SCREEN                	    14.63	   $14.63	      ---	       --	009	0	0	0.00	    $0.00	N	
M	G0435	ORAL HIV-1/HIV-2 SCREEN                 	    10.10	   $10.10	      ---	       --	009	0	0	0.00	    $0.00	N	
E	G0442	ANNUAL ALCOHOL SCREEN 15 MIN            	    17.14	   $17.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	G0442	ANNUAL ALCOHOL SCREEN 15 MIN            	    20.12	   $16.50	      ---	       --	007	0	0	0.00	    $0.00	Y	
Q	G0442	ANNUAL ALCOHOL SCREEN 15 MIN            	    20.12	   $16.50	      ---	       --	007	0	0	0.00	    $0.00	N	
X	G0442	ANNUAL ALCOHOL SCREEN 15 MIN            	    17.14	   $17.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	G0446	INTENS BEHAVE THER CARDIO DX            	    21.28	   $21.28	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	G0447	BEHAVIOR COUNSEL OBESITY 15M            	    22.26	   $22.26	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	G0447	BEHAVIOR COUNSEL OBESITY 15M            	    22.95	   $22.95	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	G0452	MOLECULAR PATHOLOGY INTERPR             	    44.99	   $44.99	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	G0452	MOLECULAR PATHOLOGY INTERPR             	    15.89	   $15.89	      ---	       --	009	0	0	1.00	    $0.00	Y	
L	G0458	LDR PROSTATE BRACHY COMP RAT            	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
M	G0472	HEP C SCREEN HIGH RISK/OTHER            	    46.35	   $46.35	      ---	       --	009	0	0	0.00	    $0.00	N	
N	G0473	GROUP BEHAVE COUNS 2-10                 	    10.68	   $10.68	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	G0473	GROUP BEHAVE COUNS 2-10                 	    11.29	   $11.29	      ---	       --	009	0	0	0.00	    $0.00	Y	
M	G0475	HIV COMBINATION ASSAY                   	    24.08	   $24.08	      ---	       --	009	0	0	0.00	    $0.00	N	
M	G0480	DRUG TEST DEF 1-7 CLASSES               	    63.95	   $63.95	      ---	       --	009	0	0	0.00	    $0.00	N	
M	G0481	DRUG TEST DEF 8-14 CLASSES              	    98.39	   $98.39	      ---	       --	009	0	0	0.00	    $0.00	N	
M	G0482	DRUG TEST DEF 15-21 CLASSES             	   132.82	  $132.82	      ---	       --	009	0	0	0.00	    $0.00	N	
M	G0483	DRUG TEST DEF 22+ CLASSES               	   172.18	  $172.18	      ---	       --	009	0	0	0.00	    $0.00	N	
N	G0492	MD/OTH EVAL ACUT KID NO ESRD            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	G0493	RN CARE EA 15 MIN HH/HOSPICE            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	G0494	LPN CARE EA 15MIN HH/HOSPICE            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	G0495	RN CARE TRAIN/EDU IN HH                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	G0496	LPN CARE TRAIN/EDU IN HH                	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
M	G0499	HEPB SCREEN HIGH RISK INDIV             	    28.27	   $28.27	      ---	       --	009	0	0	0.00	    $0.00	N	
N	G0500	MOD SEDAT ENDO SERVICE >5YRS            	    53.85	   $53.85	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	G0506	COMP ASSES CARE PLAN CCM SVC            	    55.57	   $55.57	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	G0506	COMP ASSES CARE PLAN CCM SVC            	    56.16	   $56.16	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	G0508	CRIT CARE TELEHEA CONSULT 60            	   168.71	  $168.71	      ---	       --	009	0	0	0.00	    $0.00	N	
N	G0509	CRIT CARE TELEHEA CONSULT 50            	   162.69	  $162.69	      ---	       --	009	0	0	0.00	    $0.00	N	
N	G0537	RISK ASCVD TST ONCE PR 12 MO            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	G0539	INITIAL CARE TRAINING 30 M              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
Q	G0539	INITIAL CARE TRAINING 30 M              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
Q	G0540	TRAIN FOR CAREGIVER ADD 15              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	G0540	TRAIN FOR CAREGIVER ADD 15              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	G0541	NO PT PRSNT TRAIN INITIAL 30            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	G0542	NO PT PRSNT TRAIN ADD 15                	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	G0543	GROUP TRAIN W/O PATIENT                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	G0552	SUPPLY OF DIGITAL DEVICE                	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
Q	G0552	SUPPLY OF DIGITAL DEVICE                	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
Q	G0553	MONTHLY TX FOR DMHT 20MINS              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	G0553	MONTHLY TX FOR DMHT 20MINS              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	G0554	ADD 20 M OF MONTHLY TX                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
Q	G0554	ADD 20 M OF MONTHLY TX                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	G0555	REPLACMENT PT ELECTRONIC SYS            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
Q	G0560	SAFETY PLAN INTERVEN                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	G0560	SAFETY PLAN INTERVEN                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	G0562	COMPLEX SIMULATION W/PET-CT             	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	G0563	SBRT W/POSITRON EMISSION DEL            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	G0566	3D BN IMG ALGOR DRVD FR MRI             	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
M	G0659	DRUG TEST DEF SIMPLE ALL CL             	    62.14	   $62.14	      ---	       --	009	0	0	0.00	    $0.00	N	
1	G2010	REMOT IMAGE SUBMIT BY PT                	    10.87	   $10.87	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	G2010	REMOT IMAGE SUBMIT BY PT                	    11.06	   $11.06	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	G2011	ALCOHOL/SUB MISUSE ASSESS               	    14.81	   $14.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	G2011	ALCOHOL/SUB MISUSE ASSESS               	    14.81	   $14.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	G2086	OFF BASE OPIOID TX 70MIN                	   355.35	  $355.35	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	G2086	OFF BASE OPIOID TX 70MIN                	   355.35	  $355.35	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	G2087	OFF BASE OPIOID TX, 60 M                	   314.60	  $314.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	G2087	OFF BASE OPIOID TX, 60 M                	   316.29	  $316.29	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	G2088	OFF BASE OPIOID TX, ADD30               	    61.69	   $61.69	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	G2088	OFF BASE OPIOID TX, ADD30               	    61.69	   $61.69	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	G2212	PROLONG OUTPT/OFFICE VIS                	    26.29	   $26.29	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	G2213	INITIAT MED ASSIST TX IN ER             	    58.30	   $58.30	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	G2213	INITIAT MED ASSIST TX IN ER             	    58.05	   $58.05	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	G6001	ECHO GUIDANCE RADIOTHERAPY              	    11.84	   $45.23	      ---	       --	005	0	0	0.56	    $0.00	Y	
L	G6002	STEREOSCOPIC X-RAY GUIDANCE             	    17.67	   $67.50	      ---	       --	005	0	0	0.25	    $0.00	Y	
L	G6003	RADIATION TREATMENT DELIVERY            	    36.37	  $138.93	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	G6004	RADIATION TREATMENT DELIVERY            	    30.11	  $115.02	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	G6005	RADIATION TREATMENT DELIVERY            	    32.69	  $124.88	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	G6006	RADIATION TREATMENT DELIVERY            	    32.69	  $124.88	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	G6007	RADIATION TREATMENT DELIVERY            	    60.22	  $230.04	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	G6008	RADIATION TREATMENT DELIVERY            	    41.64	  $159.06	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	G6009	RADIATION TREATMENT DELIVERY            	    44.91	  $171.56	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	G6010	RADIATION TREATMENT DELIVERY            	    44.66	  $170.60	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	G6011	RADIATION TREATMENT DELIVERY            	    59.60	  $227.67	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	G6012	RADIATION TREATMENT DELIVERY            	    54.82	  $209.41	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	G6013	RADIATION TREATMENT DELIVERY            	    59.69	  $228.02	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	G6014	RADIATION TREATMENT DELIVERY            	    59.35	  $226.72	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	G6015	RADIATION TX DELIVERY IMRT              	    87.23	  $333.22	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	G6016	DELIVERY COMP IMRT                      	    87.09	  $332.68	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	G6017	INTRAFRACTION TRACK MOTION              	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
E	G8431	POS CLIN DEPRES SCRN F/U DOC            	    37.25	   $37.25	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	G8431	POS CLIN DEPRES SCRN F/U DOC            	    29.68	   $29.68	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	G8431	POS CLIN DEPRES SCRN F/U DOC            	    37.25	   $37.25	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	G8510	SCR DEP NEG, NO PLAN REQD               	    17.14	   $17.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	G8510	SCR DEP NEG, NO PLAN REQD               	    10.70	   $10.70	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	G8510	SCR DEP NEG, NO PLAN REQD               	    17.14	   $17.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	G9001	MCCD, INITIAL RATE                      	   256.27	  $256.27	      ---	       --	009	0	0	0.00	    $0.00	N	
1	G9001	MCCD, INITIAL RATE                      	  1000.00	 $1000.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	G9002	MCCD,MAINTENANCE RATE                   	   200.00	  $200.00	      ---	       --	009	0	0	0.00	    $0.00	N	
Y	G9002	MCCD,MAINTENANCE RATE                   	    52.16	   $52.16	      ---	       --	009	0	0	0.00	    $0.00	N	
N	G9002	MCCD,MAINTENANCE RATE                   	    50.89	   $50.89	      ---	       --	009	0	0	0.00	    $0.00	N	
Y	G9012	OTHER SPECIFIED CASE MGMT               	   166.70	  $166.70	      ---	       --	009	0	0	0.00	    $0.00	N	
1	G9012	OTHER SPECIFIED CASE MGMT               	    35.77	   $35.77	      ---	       --	009	0	0	0.00	    $0.00	N	
1	G9654	MON ANESTH CARE                         	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	G9873	1 EM CORE SESSION                       	    20.00	   $20.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	G9874	4 EM CORE SESSIONS                      	    40.00	   $40.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	G9875	9 EM CORE SESSIONS                      	    72.00	   $72.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	G9876	2 EM CORE MS MO 7-9 NO WL               	    12.00	   $12.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	G9877	2 EM CORE MS MO 10-12 NO WL             	    12.00	   $12.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	G9878	2 EM CORE MS MO 7-9 WL                  	    48.00	   $48.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	G9879	2 EM CORE MS MO 10-12 WL                	    48.00	   $48.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	G9880	EM 5 PERCENT WL                         	   128.00	  $128.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	G9881	EM 9 PERCENT WL                         	    20.00	   $20.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	G9882	2 EM ONGOING MS MO 13-15 WL             	    40.00	   $40.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	G9883	2 EM ONGOING MS MO 16-18 WL             	    40.00	   $40.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	G9884	2 EM ONGOING MS MO 19-21 WL             	    40.00	   $40.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	G9885	2 EM ONGOING MS MO 22-24 WL             	    40.00	   $40.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	G9890	EM BRIDGE PAYMENT                       	    20.00	   $20.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	G9919	SCRN ND POS ND PROV OF REC              	    29.00	   $29.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	G9919	SCRN ND POS ND PROV OF REC              	    13.49	   $13.49	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	G9920	SCRNING PERF AND NEGATIVE               	    13.49	   $13.49	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	G9920	SCRNING PERF AND NEGATIVE               	    29.00	   $29.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	H0001	ALCOHOL AND/OR DRUG ASSESS              	    17.14	   $17.14	      ---	       --	009	0	0	0.00	    $0.00	N	
Y	H0003	ALCOHOL AND/OR DRUG SCREENIN            	    10.08	   $10.08	      ---	       --	009	0	0	0.00	    $0.00	N	
Y	H0004	ALCOHOL AND/OR DRUG SERVICES            	    28.38	   $28.38	      ---	       --	009	0	0	0.00	    $0.00	N	
Y	H0005	ALCOHOL AND/OR DRUG SERVICES            	     1.34	    $1.34	      ---	       --	009	0	0	0.00	    $0.00	N	
Y	H0007	ALCOHOL AND/OR DRUG SERVICES            	   126.55	  $126.55	      ---	       --	009	0	0	0.00	    $0.00	N	
1	H0014	ALCOHOL AND/OR DRUG SERVICES            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
Y	H0025	ALCOHOL AND/OR DRUG PREVENTI            	    35.37	   $35.37	      ---	       --	009	0	0	0.00	    $0.00	N	
Y	H0031	MH HEALTH ASSESS BY NON-MD              	   163.08	  $163.08	      ---	       --	009	0	0	0.00	    $0.00	N	
N	H0031	MH HEALTH ASSESS BY NON-MD              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
Q	H0031	MH HEALTH ASSESS BY NON-MD              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
Q	H0032	MH SVC PLAN DEV BY NON-MD               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
N	H0032	MH SVC PLAN DEV BY NON-MD               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	H0032	MH SVC PLAN DEV BY NON-MD               	   163.08	  $163.08	      ---	       --	009	0	0	0.00	    $0.00	N	
Y	H0033	ORAL MED ADM DIRECT OBSERVE             	    19.23	   $19.23	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	H0033	ORAL MED ADM DIRECT OBSERVE             	    19.23	   $19.23	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	H0034	MED TRNG & SUPPORT PER 15MIN            	    22.94	   $22.94	      ---	       --	009	0	0	0.00	    $0.00	N	
U	H0034	MED TRNG & SUPPORT PER 15MIN            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
E	H0034	MED TRNG & SUPPORT PER 15MIN            	    22.94	   $22.94	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	H0038	SELF-HELP/PEER SVC PER 15MIN            	    28.38	   $28.38	      ---	       --	009	0	0	0.00	    $0.00	N	
U	H0045	RESPITE NOT-IN-HOME PER DIEM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	H0045	RESPITE NOT-IN-HOME PER DIEM            	    91.28	   $91.28	      ---	       --	009	0	0	0.00	    $0.00	N	
Y	H0048	SPEC COLL NON-BLOOD:A/D TEST            	    10.08	   $10.08	      ---	       --	009	0	0	0.00	    $0.00	N	
Y	H0049	ALCOHOL/DRUG SCREENING                  	    17.14	   $17.14	      ---	       --	009	0	0	0.00	    $0.00	N	
X	H0049	ALCOHOL/DRUG SCREENING                  	    17.14	   $17.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	H0049	ALCOHOL/DRUG SCREENING                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
Q	H0049	ALCOHOL/DRUG SCREENING                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
Q	H0050	ALCOHOL/DRUG SERVICE 15 MIN             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
N	H0050	ALCOHOL/DRUG SERVICE 15 MIN             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	H0050	ALCOHOL/DRUG SERVICE 15 MIN             	    17.14	   $17.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	H0050	ALCOHOL/DRUG SERVICE 15 MIN             	    17.14	   $17.14	      ---	       --	009	0	0	0.00	    $0.00	N	
N	H0052	MMIP MENTAL HEALTH AND CARE             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
Q	H0052	MMIP MENTAL HEALTH AND CARE             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
Q	H0053	HT MENTAL HEALTH AND CARE               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	H0053	HT MENTAL HEALTH AND CARE               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	H1000	PRENATAL CARE ATRISK ASSESSM            	   197.98	  $197.98	      ---	       --	009	0	0	0.00	    $0.00	N	
X	H1011	FAMILY ASSESSMENT                       	   116.39	  $116.39	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	H1011	FAMILY ASSESSMENT                       	    92.46	   $92.46	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	H2000	COMP MULTIDISIPLN EVALUATION            	    80.08	   $80.08	      ---	       --	009	0	0	0.00	    $0.00	N	
1	H2000	COMP MULTIDISIPLN EVALUATION            	    80.08	   $80.08	      ---	       --	009	0	0	0.00	    $0.00	N	
Y	H2011	CRISIS INTERVEN SVC, 15 MIN             	    28.38	   $28.38	      ---	       --	009	0	0	0.00	    $0.00	N	
N	H2012	BEHAV HLTH DAV TREAT, PER HR            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
Q	H2012	BEHAV HLTH DAV TREAT, PER HR            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
Q	H2014	SKILLS TRAIN AND DEV, 15 MIN            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
N	H2014	SKILLS TRAIN AND DEV, 15 MIN            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	H2014	SKILLS TRAIN AND DEV, 15 MIN            	    20.11	   $20.11	      ---	       --	009	0	0	0.00	    $0.00	N	
E	H2014	SKILLS TRAIN AND DEV, 15 MIN            	    20.11	   $20.11	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	H2015	COMP COMM SUPP SVC, 15 MIN              	    20.11	   $20.11	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	H2015	COMP COMM SUPP SVC, 15 MIN              	    20.11	   $20.11	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	H2015	COMP COMM SUPP SVC, 15 MIN              	    19.31	   $19.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	H2017	PSYSOC REHAB SVC, PER 15 MIN            	    28.38	   $28.38	      ---	       --	009	0	0	0.00	    $0.00	N	
Y	H2019	THER BEHAV SVC, PER 15 MIN              	    28.38	   $28.38	      ---	       --	009	0	0	0.00	    $0.00	N	
U	H2019	THER BEHAV SVC, PER 15 MIN              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
N	H2019	THER BEHAV SVC, PER 15 MIN              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
Q	H2019	THER BEHAV SVC, PER 15 MIN              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
Y	H2021	COM WRAP-AROUND SV, 15 MIN              	    28.38	   $28.38	      ---	       --	009	0	0	0.00	    $0.00	N	
Y	H2027	PSYCHOED SVC, PER 15 MIN                	    20.11	   $20.11	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	H2027	PSYCHOED SVC, PER 15 MIN                	    20.11	   $20.11	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	H2027	PSYCHOED SVC, PER 15 MIN                	    19.31	   $19.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	H2027	PSYCHOED SVC, PER 15 MIN                	    20.11	   $20.11	      ---	       --	009	0	0	0.00	    $0.00	Y	
U	H2032	ACTIVITY THERAPY, PER 15 MIN            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
Y	H2035	A/D TX PROGRAM, PER HOUR                	    81.58	   $81.58	      ---	       --	009	0	0	0.00	    $0.00	N	
I	J0121	INJ., OMADACYCLINE, 1 MG                	     3.87	    $3.87	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0122	INJ., ERAVACYCLINE, 1 MG                	     1.21	    $1.21	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0129	ABATACEPT INJECTION                     	    47.84	   $47.84	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0131	INJ, ACETAMINOPHEN (NOS)                	     0.05	    $0.05	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0132	ACETYLCYSTEINE INJECTION                	     0.45	    $0.45	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0133	ACYCLOVIR INJECTION                     	     0.04	    $0.04	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0134	INJ ACETAMINOPHEN -FRESENIUS            	     0.05	    $0.05	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0136	INJ, ACETAMINOPHEN (B BRAUN)            	     0.05	    $0.05	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0137	INJ, ACETAMINOPHEN (HIKMA)              	     0.03	    $0.03	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0138	INJ ACETAMINOPH 10MG/IBU 3MG            	     0.22	    $0.22	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0139	INJ, ADALIMUMAB, 1 MG                   	     0.00	    $0.00	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0153	ADENOSINE INJ 1MG                       	     0.39	    $0.39	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0165	INJ EPINEPHRINE NOS 0.1 MG              	     0.00	    $0.00	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0167	INJ EPINEPHRINE (HOSPIRA)               	     0.00	    $0.00	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0168	EPINEPHRINE (INTL MED SYS)              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0169	INJ EPINEPHRINE (ADRENALIN)             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0172	INJ, ADUCANUMAB-AVWA, 2 MG              	    10.44	   $10.44	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0174	INJ, LECANEMAB-IRMB, 1 MG               	     1.33	    $1.33	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0175	INJ, DONANEMAB-AZBT, 2 MG               	     4.18	    $4.18	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0177	INJ, AFLIBERCEPT HD, 1 MG               	   321.18	  $321.18	      ---	       --	009	0	0	0.00	    $0.00	N	
I	J0178	AFLIBERCEPT INJECTION                   	   795.86	  $795.86	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0179	INJ, BROLUCIZUMAB-DBLL, 1 MG            	   339.99	  $339.99	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0180	AGALSIDASE BETA INJECTION               	   222.84	  $222.84	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0184	INJ, AMISULPRIDE, 1 MG                  	     9.54	    $9.54	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0185	INJ., APREPITANT, 1 MG                  	     6.17	    $6.17	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0202	INJECTION, ALEMTUZUMAB                  	  2441.49	 $2441.49	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0206	INJ ALLOPURINOL SODIUM 1 MG             	     8.91	    $8.91	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0207	AMIFOSTINE                              	  1075.87	 $1075.87	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0208	INJ, PEDMARK, 100 MG                    	    95.80	   $95.80	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0210	METHYLDOPATE HCL INJECTION              	    44.46	   $44.46	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0216	INJ, ALFENTANIL HCL, 500MCG             	     7.42	    $7.42	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0217	INJ VELMANASE ALFA-TYCV 1 MG            	   444.98	  $444.98	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0218	INJ OLIPUDASE ALFA-RPCP 1MG             	   381.24	  $381.24	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0219	INJ AVAL ALFA-NQPT 4MG                  	    77.82	   $77.82	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0220	ALGLUCOSIDASE ALFA INJECTION            	   211.10	  $211.10	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0221	LUMIZYME INJECTION                      	   201.57	  $201.57	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0222	INJ., PATISIRAN, 0.1 MG                 	    99.04	   $99.04	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0223	INJ GIVOSIRAN 0.5 MG                    	   120.93	  $120.93	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0224	INJ. LUMASIRAN, 0.5 MG                  	   323.31	  $323.31	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0225	INJ, VUTRISIRAN, 1 MG                   	  4960.77	 $4960.77	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0248	INJ, REMDESIVIR, 1 MG                   	     6.35	    $6.35	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0256	ALPHA 1 PROTEINASE INHIBITOR            	     5.16	    $5.16	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0257	GLASSIA INJECTION                       	     5.45	    $5.45	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0278	AMIKACIN SULFATE INJECTION              	     5.06	    $5.06	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0281	INJ AMINOCAPROIC ACID 1 GRAM            	     1.30	    $1.30	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0283	INJ, AMIODARONE (NEXTERONE)             	     2.59	    $2.59	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0285	AMPHOTERICIN B                          	    50.07	   $50.07	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0287	AMPHOTERICIN B LIPID COMPLEX            	    10.30	   $10.30	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0288	AMPHO B CHOLESTERYL SULFATE             	    25.49	   $25.49	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0289	AMPHOTERICIN B LIPOSOME INJ             	    23.31	   $23.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0290	AMPICILLIN 500 MG INJ                   	     5.06	    $5.06	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0291	INJ., PLAZOMICIN, 5 MG                  	     3.57	    $3.57	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0300	AMOBARBITAL 125 MG INJ                  	   187.72	  $187.72	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0330	SUCCINYCHOLINE CHLORIDE INJ             	     5.71	    $5.71	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0348	ANIDULAFUNGIN INJECTION                 	     0.47	    $0.47	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0349	INJ, REZAFUNGIN, 1 MG                   	    10.42	   $10.42	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0360	HYDRALAZINE HCL INJECTION               	     8.86	    $8.86	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0391	INJ, ARTESUNATE, 1MG                    	    53.36	   $53.36	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0400	ARIPIPRAZOLE INJECTION                  	     5.22	    $5.22	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0401	INJ, ABILIFY MAINTENA, 1 MG             	    11.49	   $11.49	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0402	INJ, ABILIFY ASIMTUFII, 1 MG            	    10.33	   $10.33	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0456	AZITHROMYCIN                            	     2.22	    $2.22	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0457	INJECTION, AZTREONAM, 100 MG            	     6.94	    $6.94	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0461	ATROPINE SULFATE INJECTION              	     4.57	    $4.57	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0470	DIMECAPROL INJECTION                    	    60.88	   $60.88	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0475	BACLOFEN 10 MG INJECTION                	   174.80	  $174.80	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0476	BACLOFEN INTRATHECAL TRIAL              	    53.82	   $53.82	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0480	BASILIXIMAB                             	  4687.66	 $4687.66	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0485	BELATACEPT INJECTION                    	     3.89	    $3.89	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0490	BELIMUMAB INJECTION                     	    59.43	   $59.43	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0491	INJ ANIFROLUMAB-FNIA 1MG                	    17.78	   $17.78	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0500	DICYCLOMINE INJECTION                   	    17.32	   $17.32	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0515	INJ BENZTROPINE MESYLATE                	    21.23	   $21.23	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0517	INJ., BENRALIZUMAB, 1 MG                	   167.76	  $167.76	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0558	PENG BENZATHINE/PROCAINE INJ            	    21.83	   $21.83	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0561	PENICILLIN G BENZATHINE INJ             	    31.44	   $31.44	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0565	INJ, BEZLOTOXUMAB, 10 MG                	    39.87	   $39.87	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0567	INJ., CERLIPONASE ALFA 1 MG             	   115.85	  $115.85	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J0571	BUPRENORPHINE ORAL 1MG                  	     0.09	    $0.09	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J0572	BUPREN/NAL UP TO 3MG BUPRENO            	     0.74	    $0.74	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J0573	BUPREN/NAL 3.1 TO 6MG BUPREN            	     3.27	    $3.27	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J0574	BUPREN/NAL 6.1 TO 10MG BUPRE            	     2.36	    $2.36	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J0575	BUPREN/NAL OVER 10MG BUPRENO            	     8.37	    $8.37	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0577	INJ, BRIXADI, 7 DAYS OR LESS            	   429.86	  $429.86	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0578	INJ BRIXADI, MORE THAN 7 DAY            	  1706.08	 $1706.08	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0584	INJECTION, BUROSUMAB-TWZA 1M            	   474.20	  $474.20	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0585	INJECTION,ONABOTULINUMTOXINA            	    10.94	   $10.94	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0586	ABOBOTULINUMTOXINA                      	    13.50	   $13.50	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0587	INJ, RIMABOTULINUMTOXINB                	    17.46	   $17.46	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0588	INCOBOTULINUMTOXIN A                    	     9.79	    $9.79	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0593	INJ., LANADELUMAB-FLYO, 1 MG            	    89.26	   $89.26	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0595	BUTORPHANOL TARTRATE 1 MG               	     9.15	    $9.15	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0596	INJECTION, RUCONEST                     	    34.75	   $34.75	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0597	C-1 ESTERASE, BERINERT                  	    72.27	   $72.27	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0598	C-1 ESTERASE, CINRYZE                   	    63.88	   $63.88	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0599	INJ., HAEGARDA 10 UNITS                 	    16.56	   $16.56	      ---	       --	030	0	0	0.00	    $0.00	Y	
1	J0601	SEVELAMER CARBONATE 20 MG               	     0.01	    $0.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J0602	SEVELAMER CARBONATE PDR 20MG            	     0.06	    $0.06	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J0603	SEVELAMER HYDROCHLORIDE 20MG            	     0.06	    $0.06	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J0604	CINACALCET, ESRD ON DIALYSIS            	     0.01	    $0.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J0605	SUCROFERRIC OXYHYDROXIDE 5MG            	     0.17	    $0.17	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0606	INJ, ETELCALCETIDE, 0.1 MG              	     4.13	    $4.13	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J0607	LANTHANUM CARBONATE ORAL 5MG            	     0.03	    $0.03	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J0608	LANTHANUM CARBONATE PWDR 5MG            	     0.07	    $0.07	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J0609	FERRIC CITRATE ORL 3 MG IRON            	     0.10	    $0.10	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0612	INJ, CALCIUM GLUCONATE, NOS             	     0.05	    $0.05	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0613	CALCIUM GLUCON (WG CRITICAL)            	     0.08	    $0.08	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J0615	CALCIUM ACETATE, ORAL, 23 MG            	     0.01	    $0.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0616	INJ METOPROLOL TARTRATE 1 MG            	     0.28	    $0.28	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0618	INJ, CALCIUM CHLORIDE, 2 MG             	     0.03	    $0.03	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0630	CALCITONIN SALMON INJECTION             	  1204.46	 $1204.46	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0636	INJ CALCITRIOL PER 0.1 MCG              	     0.80	    $0.80	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0638	CANAKINUMAB INJECTION                   	   141.02	  $141.02	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0640	LEUCOVORIN CALCIUM INJECTION            	     7.97	    $7.97	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0641	INJ LEVOLEUCOVORIN NOS 0.5MG            	     0.02	    $0.02	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0642	INJECTION, KHAPZORY, 0.5 MG             	     1.18	    $1.18	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0650	INJ, LEVOTHYROXINE NOS 10MCG            	     7.26	    $7.26	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0651	INJ, LEVOTHYROXINE, FRESKABI            	     6.40	    $6.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0652	INJ, LEVOTHYROXINE, HIKMA               	     5.14	    $5.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0665	INJ, BUPIVACAINE, NOS, 0.5MG            	     4.47	    $4.47	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0666	INJ, BUPIVACAINE LIPOSOME               	     5.88	    $5.88	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0670	INJ MEPIVACAINE HCL/10 ML               	     8.09	    $8.09	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0687	INJ CEFAZOLIN (WG CRIT CARE)            	     0.97	    $0.97	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0688	INJ CEFAZOLIN SODIUM, HIKMA             	     0.98	    $0.98	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0689	INJ CEFAZOLIN SODIUM, BAXTER            	     1.25	    $1.25	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0690	CEFAZOLIN SODIUM INJECTION              	     5.29	    $5.29	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0691	INJ LEFAMULIN 1 MG                      	     5.14	    $5.14	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0694	CEFOXITIN SODIUM INJECTION              	     9.47	    $9.47	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0696	CEFTRIAXONE SODIUM INJECTION            	     4.95	    $4.95	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0698	CEFOTAXIME SODIUM INJECTION             	     9.49	    $9.49	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0699	INJ, CEFIDEROCOL, 10 MG                 	     2.28	    $2.28	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0701	INJ. CEFEPIME HCL (BAXTER)              	     5.80	    $5.80	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0702	BETAMETHASONE ACET&SOD PHOSP            	    11.31	   $11.31	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0703	INJ, CEFEPIME HCL (B BRAUN)             	     5.04	    $5.04	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0712	CEFTAROLINE FOSAMIL INJ                 	     3.99	    $3.99	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0714	CEFTAZIDIME AND AVIBACTAM               	   100.50	  $100.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0716	CENTRUROIDES IMMUNE F(AB)               	  5250.56	 $5250.56	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0717	CERTOLIZUMAB PEGOL INJ 1MG              	     8.44	    $8.44	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0720	CHLORAMPHENICOL SODIUM INJEC            	    53.11	   $53.11	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0725	CHORIONIC GONADOTROPIN/1000U            	    22.71	   $22.71	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0735	CLONIDINE HYDROCHLORIDE                 	    16.20	   $16.20	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0736	INJ, CLINDAMYCIN PHOSP 300MG            	     6.07	    $6.07	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0737	INJ, CLINDAMYCIN (BAXTER)               	     6.99	    $6.99	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0739	HIV PREP, INJ, CABOTEGRAVIR             	    11.35	   $11.35	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0740	CIDOFOVIR INJECTION                     	   521.83	  $521.83	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0741	INJ, CABOTE RILPIVIR 2MG 3MG            	    27.59	   $27.59	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0742	INJ IMIP 4 CILAS 4 RELEB 2MG            	     2.50	    $2.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J0750	HIV PREP, FTC/TDF 200/300MG             	     1.28	    $1.28	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J0751	HIV PREP, FTC/TAF 200/25MG              	    71.27	   $71.27	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0775	COLLAGENASE, CLOST HIST INJ             	    73.38	   $73.38	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0780	PROCHLORPERAZINE INJECTION              	     7.38	    $7.38	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0791	INJ CRIZANLIZUMAB-TMCA 5MG              	   129.50	  $129.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0795	CORTICORELIN OVINE TRIFLUTAL            	    13.59	   $13.59	      ---	       --	030	0	0	0.00	    $0.00	Y	
1	J0799	HIV PREP, FDA APPROVED, NOC             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0801	INJ. ACTHAR GEL TO 40 UNITS             	  3897.89	 $3897.89	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0802	INJ. (ANI), UP TO 40 UNITS              	  3450.04	 $3450.04	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0834	INJ., COSYNTROPIN, 0.25 MG              	    37.86	   $37.86	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0840	CROTALIDAE POLY IMMUNE FAB              	  1755.81	 $1755.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0841	INJ CROTALIDAE IM F(AB')2 EQ            	  1043.55	 $1043.55	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0850	CYTOMEGALOVIRUS IMM IV /VIAL            	  1812.01	 $1812.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0870	INJECTION, IMETELSTAT, 1 MG             	    55.51	   $55.51	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0872	DAPTOMYCIN (XELLIA) UNREFRIG            	     0.05	    $0.05	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0873	INJ DAPTOMYCIN (XELLIA)                 	     0.03	    $0.03	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0874	INJ, DAPTOMYCIN (BAXTER)                	     0.07	    $0.07	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0875	INJECTION, DALBAVANCIN                  	    15.57	   $15.57	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0877	INJ, DAPTOMYCIN (HOSPIRA)               	     0.06	    $0.06	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0878	DAPTOMYCIN INJECTION                    	     0.03	    $0.03	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0879	DIFELIKEFALIN, ESRD ON DIALY            	     4.69	    $4.69	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0881	DARBEPOETIN ALFA, NON-ESRD              	     7.38	    $7.38	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0882	DARBEPOETIN ALFA, ESRD USE              	     7.38	    $7.38	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0883	ARGATROBAN NONESRD USE 1MG              	     0.95	    $0.95	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0884	ARGATROBAN ESRD DIALYSIS 1MG            	     0.95	    $0.95	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0885	EPOETIN ALFA, NON-ESRD                  	    11.54	   $11.54	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0887	EPOETIN BETA ESRD USE                   	     5.72	    $5.72	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0888	EPOETIN BETA NON ESRD                   	     5.72	    $5.72	      ---	       --	030	0	0	0.00	    $0.00	Y	
1	J0889	DAPRODUSTAT ORAL 1MG ESRD               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0891	ARGATROBAN NONESRD (ACCORD)             	     3.96	    $3.96	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0892	ARGATROBAN DIALYSIS (ACCORD)            	     3.96	    $3.96	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0893	INJ, DECITABINE (SUN PHARMA)            	     0.78	    $0.78	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0894	DECITABINE INJECTION                    	     1.77	    $1.77	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0895	DEFEROXAMINE MESYLATE INJ               	    12.67	   $12.67	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0896	INJ LUSPATERCEPT-AAMT 0.25MG            	    45.70	   $45.70	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0897	DENOSUMAB INJECTION                     	    32.27	   $32.27	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J0898	ARGATROBAN NONESRD (AUROMED)            	     1.34	    $1.34	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J0899	ARGATROBAN DIALYSIS, AUROMED            	     1.34	    $1.34	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J0901	VADADUSTAT ORAL 1MG FOR ESRD            	     0.14	    $0.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J0911	INST TAURO 1.35MG/HEP 100U              	     8.33	    $8.33	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1000	DEPO-ESTRADIOL CYPIONATE INJ            	    46.78	   $46.78	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1010	INJ, METHYLPRED ACETATE 1 MG            	     4.57	    $4.57	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1050	MEDROXYPROGESTERONE ACETATE             	     5.03	    $5.03	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1071	INJ TESTOSTERONE CYPIONATE              	     4.49	    $4.49	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1072	INJ, TESTOSTERONE, AZMIRO               	     5.71	    $5.71	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1095	INJECTION, DEXAMETHASONE 9%             	     5.61	    $5.61	      ---	       --	030	0	0	0.00	    $0.00	Y	
1	J1096	DEXAMETHA OPTH INSERT 0.1 MG            	   110.68	  $110.68	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J1097	PHENYLEP KETOROLAC OPTH SOLN            	   118.00	  $118.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1100	DEXAMETHASONE SODIUM PHOS               	     4.55	    $4.55	      ---	       --	030	0	0	0.00	    $0.00	Y	
1	J1105	DEXMEDETOMIDINE FILM, 1 MCG             	     0.73	    $0.73	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1110	INJ DIHYDROERGOTAMINE MESYLT            	    85.75	   $85.75	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1120	ACETAZOLAMID SODIUM INJECTIO            	    23.52	   $23.52	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1130	INJ DICLOFENAC SODIUM 0.5MG             	     4.67	    $4.67	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1160	DIGOXIN INJECTION                       	     9.34	    $9.34	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1162	DIGOXIN IMMUNE FAB (OVINE)              	  4968.58	 $4968.58	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1163	INJ, DILTIAZEM HCL, 0.5 MG              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1165	PHENYTOIN SODIUM INJECTION              	     0.52	    $0.52	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1171	INJ, HYDROMORPHONE, 0.1 MG              	     4.60	    $4.60	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1200	DIPHENHYDRAMINE HCL INJECTIO            	     5.12	    $5.12	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1201	INJ. CETIRIZINE HCL 0.5MG               	    15.62	   $15.62	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J1202	MIGLUSTAT ORAL 65 MG                    	    33.52	   $33.52	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1203	INJ, CIPAGLUCOSIDASE, 5 MG              	    89.85	   $89.85	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1205	CHLOROTHIAZIDE SODIUM INJ               	    36.94	   $36.94	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1230	METHADONE INJECTION                     	    25.37	   $25.37	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1250	INJ DOBUTAMINE HCL/250 MG               	     8.15	    $8.15	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1260	DOLASETRON MESYLATE                     	    10.63	   $10.63	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1265	DOPAMINE INJECTION                      	     0.71	    $0.71	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1267	DORIPENEM INJECTION                     	     5.22	    $5.22	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1270	INJECTION, DOXERCALCIFEROL              	     0.38	    $0.38	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1271	INJ DOXYCYCLINE HYCLATE 1 MG            	     0.12	    $0.12	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1290	ECALLANTIDE INJECTION                   	   569.10	  $569.10	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1299	INJ, ECULIZUMAB, 2 MG                   	    44.81	   $44.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1301	INJECTION, EDARAVONE, 1 MG              	    20.41	   $20.41	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1302	INJ, SUTIMLIMAB-JOME, 10 MG             	    18.13	   $18.13	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1303	INJ., RAVULIZUMAB-CWVZ 10 MG            	   220.32	  $220.32	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1304	INJ TOFERSEN INTRATHEC 1 MG             	   155.34	  $155.34	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1305	INJ, EVINACUMAB-DGNB, 5MG               	   186.31	  $186.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1306	INJECTION, INCLISIRAN, 1 MG             	    16.73	   $16.73	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1307	INJ, CROVALIMAB-AKKZ, 10 MG             	   524.75	  $524.75	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1308	INJ, FAMOTIDINE, 0.25 MG                	     0.01	    $0.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1322	ELOSULFASE ALFA, INJECTION              	   293.94	  $293.94	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1323	INJ, ELRANATAMAB-BCMM, 1 MG             	   187.44	  $187.44	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1326	INJ, ZOLBETUXIMAB-CLZB, 2 MG            	    32.00	   $32.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1335	ERTAPENEM INJECTION                     	    13.64	   $13.64	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1364	ERYTHRO LACTOBIONATE /500 MG            	    65.96	   $65.96	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1380	ESTRADIOL VALERATE 10 MG INJ            	    11.76	   $11.76	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1410	INJ ESTROGEN CONJUGATE 25 MG            	   387.35	  $387.35	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1411	INJ, HEMGENIX, PER TX DOSE              	     0.00	    $0.00	      ---	       --	030	0	0	0.00	    $0.00	N	
I	J1412	INJ ROCTAVIAN ML 2X10^13VC G            	 11668.13	$11668.13	      ---	       --	009	0	0	0.00	    $0.00	N	
I	J1413	INJ DELANDISTROGENE MOX ROKL            	     0.00	    $0.00	      ---	       --	030	0	0	0.00	    $0.00	N	
I	J1414	INJ, BEQVEZ, PER TX DOSE                	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
I	J1426	INJECTION, CASIMERSEN, 10 MG            	   164.46	  $164.46	      ---	       --	030	0	0	0.00	    $0.00	N	
I	J1427	INJ. VILTOLARSEN                        	    60.86	   $60.86	      ---	       --	030	0	0	0.00	    $0.00	N	
I	J1428	INJ, ETEPLIRSEN, 10 MG                  	   164.46	  $164.46	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1429	INJ GOLODIRSEN 10 MG                    	   164.46	  $164.46	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1434	INJ, FOCINVEZ, 1MG                      	     3.02	    $3.02	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1437	INJ. FE DERISOMALTOSE 10 MG             	    20.83	   $20.83	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1439	INJ FERRIC CARBOXYMALTOS 1MG            	     1.13	    $1.13	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J1440	FECAL MICROBIOTA JSLM 1 ML              	    63.93	   $63.93	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1442	INJ FILGRASTIM EXCL BIOSIMIL            	     5.44	    $5.44	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1445	INJ TRIFERIC AVNU 0.1MG IRON            	     4.64	    $4.64	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1447	INJ TBO FILGRASTIM 1 MICROG             	     4.83	    $4.83	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1448	INJECTION, TRILACICLIB, 1MG             	     5.39	    $5.39	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1449	INJ EFLAPEGRASTIM-XNST 0.1MG            	    27.07	   $27.07	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1451	FOMEPIZOLE, 15 MG                       	    15.00	   $15.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1453	FOSAPREPITANT INJECTION                 	     0.12	    $0.12	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1454	INJ FOSNETUPITANT, PALONOSET            	   632.88	  $632.88	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1455	FOSCARNET SODIUM INJECTION              	    21.63	   $21.63	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1456	INJ, FOSAPREPITANT (TEVA)               	     1.21	    $1.21	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1458	GALSULFASE INJECTION                    	   484.88	  $484.88	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1459	INJ IVIG PRIVIGEN 500 MG                	    49.18	   $49.18	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1460	GAMMA GLOBULIN 1 CC INJ                 	    53.35	   $53.35	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1551	INJ CUTAQUIG 100 MG                     	    14.34	   $14.34	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1552	INJ, ALYGLO, 500 MG                     	   138.11	  $138.11	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1554	INJ. ASCENIV                            	   496.68	  $496.68	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1555	INJ CUVITRU, 100 MG                     	    16.68	   $16.68	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1556	INJ, IMM GLOB BIVIGAM, 500MG            	    77.30	   $77.30	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1557	GAMMAPLEX INJECTION                     	    57.48	   $57.48	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1558	INJ. XEMBIFY, 100 MG                    	    14.28	   $14.28	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1559	HIZENTRA INJECTION                      	    13.64	   $13.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1560	GAMMA GLOBULIN > 10 CC INJ              	   493.31	  $493.31	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1561	GAMUNEX-C/GAMMAKED                      	    48.35	   $48.35	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1562	VIVAGLOBIN, INJ                         	    16.41	   $16.41	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1566	IMMUNE GLOBULIN, POWDER                 	    81.01	   $81.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1568	OCTAGAM INJECTION                       	    48.06	   $48.06	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1569	GAMMAGARD LIQUID INJECTION              	    45.13	   $45.13	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1571	HEPAGAM B IM INJECTION                  	    69.61	   $69.61	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1572	FLEBOGAMMA INJECTION                    	    57.40	   $57.40	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1573	HEPAGAM B INTRAVENOUS, INJ              	    65.15	   $65.15	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1574	INJ, GANCICLOVIR (EXELA)                	    54.46	   $54.46	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1575	HYQVIA 100MG IMMUNEGLOBULIN             	    22.03	   $22.03	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1576	INJ, PANZYGA, 500 MG                    	    70.43	   $70.43	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1580	GARAMYCIN GENTAMICIN INJ                	     6.93	    $6.93	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1596	INJ, GLYCOPYRROLATE, 0.1 MG             	     4.97	    $4.97	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1597	INJ GLYCOPYRROLATE, GLYRX-PF            	     6.06	    $6.06	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1598	INJ GLYCOPYRROLATE FRES KABI            	     6.12	    $6.12	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1599	IVIG NON-LYOPHILIZED, NOS               	   111.26	  $111.26	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1600	GOLD SODIUM THIOMALEATE INJ             	    26.97	   $26.97	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1602	GOLIMUMAB FOR IV USE 1MG                	    10.77	   $10.77	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1610	GLUCAGON HYDROCHLORIDE/1 MG             	   195.22	  $195.22	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1611	INJ GLUCAGON HCL, FRESENIUS             	   154.90	  $154.90	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1626	GRANISETRON HCL INJECTION               	     0.26	    $0.26	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1627	INJ, GRANISETRON, XR, 0.1 MG            	     9.75	    $9.75	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1628	INJ., GUSELKUMAB, 1 MG                  	    74.89	   $74.89	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1630	HALOPERIDOL INJECTION                   	     5.24	    $5.24	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1631	HALOPERIDOL DECANOATE INJ               	     9.07	    $9.07	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1632	INJ., BREXANOLONE, 1 MG                 	    78.96	   $78.96	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1640	HEMIN, 1 MG                             	    33.07	   $33.07	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1642	INJ HEPARIN SODIUM PER 10 U             	     4.48	    $4.48	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1643	INJ HEPARIN, PFIZER, 1000U              	     7.40	    $7.40	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1644	INJ HEPARIN SODIUM PER 1000U            	     4.68	    $4.68	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1650	INJ ENOXAPARIN SODIUM                   	     4.98	    $4.98	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1670	TETANUS IMMUNE GLOBULIN INJ             	   580.22	  $580.22	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1675	HISTRELIN ACETATE                       	     0.00	    $0.00	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1720	HYDROCORTISONE SODIUM SUCC I            	    25.04	   $25.04	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1729	INJ HYDROXYPROGST CAPOAT NOS            	    18.10	   $18.10	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1738	INJ. MELOXICAM 1 MG                     	     7.59	    $7.59	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1740	IBANDRONATE SODIUM INJECTION            	    26.68	   $26.68	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1741	IBUPROFEN INJECTION                     	     2.98	    $2.98	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1743	IDURSULFASE INJECTION                   	   542.57	  $542.57	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1745	INFLIXIMAB NOT BIOSIMIL 10MG            	    30.52	   $30.52	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1746	INJ., IBALIZUMAB-UIYK, 10 MG            	    76.95	   $76.95	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1747	INJ, SPESOLIMAB-SBZO, 1 MG              	    61.43	   $61.43	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1748	INJ, ZYMFENTRA, 10 MG                   	   450.87	  $450.87	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1750	INJ IRON DEXTRAN                        	    21.69	   $21.69	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1756	IRON SUCROSE INJECTION                  	     0.24	    $0.24	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1786	IMUGLUCERASE INJECTION                  	    43.14	   $43.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1790	DROPERIDOL INJECTION                    	    13.03	   $13.03	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1800	PROPRANOLOL INJECTION                   	    10.32	   $10.32	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1805	INJ, ESMOLOL HCL, 10MG                  	     0.28	    $0.28	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1806	INJ ESMOLOL HCL WG CRIT CARE            	     0.41	    $0.41	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1808	INJ, FOLIC ACID, 0.1 MG                 	     0.06	    $0.06	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1811	FIASP FOR INSULIN PUMP USE              	    11.13	   $11.13	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1812	INJ. INSULIN (FIASP)                    	     6.09	    $6.09	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1813	LYUMJEV FOR INSULIN PUMP USE            	    19.79	   $19.79	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1814	INJ. INSULIN (LYUMJEV)                  	     6.06	    $6.06	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1815	INSULIN INJECTION                       	     4.86	    $4.86	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1823	INJ. INEBILIZUMAB-CDON, 1 MG            	   484.40	  $484.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1826	INTERFERON BETA-1A INJ                  	  2099.43	 $2099.43	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1836	INJ, METRONIDAZOLE, 10 MG               	     0.03	    $0.03	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1885	KETOROLAC TROMETHAMINE INJ              	     4.96	    $4.96	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1920	INJ, LABETALOL HCL, 5MG                 	     0.42	    $0.42	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1921	INJ LABETALOL HCL HIKMA, 5MG            	     1.38	    $1.38	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1930	LANREOTIDE INJECTION                    	    44.01	   $44.01	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1931	LARONIDASE INJECTION                    	    38.61	   $38.61	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1932	INJ, LANREOTIDE, (CIPLA) 1MG            	    29.88	   $29.88	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1938	INJ, FUROSEMIDE, 1 MG                   	     4.48	    $4.48	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1939	INJ, BUMETANIDE, 0.5 MG                 	     0.57	    $0.57	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1941	INJ, FUROSCIX, 20 MG                    	  2373.04	 $2373.04	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1943	INJ., ARISTADA INITIO, 1 MG             	     7.60	    $7.60	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1944	ARIPIPRAZOLE LAUROXIL 1 MG              	     7.72	    $7.72	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1945	LEPIRUDIN                               	   540.55	  $540.55	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1950	LEUPROLIDE ACETATE /3.75 MG             	  1674.76	 $1674.76	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1951	INJ FENSOLVI 0.25 MG                    	   138.72	  $138.72	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1952	LEUPROLIDE INJ, CAMCEVI, 1MG            	    56.84	   $56.84	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J1953	LEVETIRACETAM INJECTION                 	     0.05	    $0.05	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J1961	INJ, LENACAPAVIR, 1 MG                  	    26.49	   $26.49	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2002	INJ, LIDOCAINE IN D5W, 1 MG             	     0.01	    $0.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2003	INJ, LIDOCAINE HCL, 1 MG                	     4.49	    $4.49	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2004	INJ, LIDOCAINE W EPINEPHRINE            	     4.47	    $4.47	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2010	LINCOMYCIN INJECTION                    	    10.70	   $10.70	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2020	LINEZOLID INJECTION                     	     3.47	    $3.47	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2021	INJ, LINEZOLID (HOSPIRA)                	     6.34	    $6.34	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2060	LORAZEPAM INJECTION                     	     6.03	    $6.03	      ---	       --	030	0	0	0.00	    $0.00	Y	
1	J2062	LOXAPINE FOR INHALATION 1 MG            	    15.00	   $15.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2150	MANNITOL INJECTION                      	     2.26	    $2.26	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2175	MEPERIDINE HYDROCHL /100 MG             	    14.60	   $14.60	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2182	INJECTION, MEPOLIZUMAB, 1MG             	    35.00	   $35.00	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2183	INJ MEROPENEM (WG CRIT CARE)            	     1.60	    $1.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2184	INJ, MEROPENEM (B. BRAUN)               	     2.09	    $2.09	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2186	INJ., MEROPENEM, VABORBACTAM            	     2.19	    $2.19	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2210	METHYLERGONOVIN MALEATE INJ             	    25.75	   $25.75	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2246	INJ, MICAFUNGIN (BAXTER)                	     0.64	    $0.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2247	INJ, MICAFUNGIN (PAR PHARM)             	     0.31	    $0.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2248	MICAFUNGIN SODIUM INJECTION             	     0.28	    $0.28	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2249	INJ, REMIMAZOLAM, 1 MG                  	     2.19	    $2.19	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2250	INJ MIDAZOLAM HYDROCHLORIDE             	     4.59	    $4.59	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2251	INJ MIDAZOLAM IN 0.9% NACL              	     0.17	    $0.17	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2252	INJ MIDAZOLAM IN 0.8% NACL              	     0.07	    $0.07	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2265	MINOCYCLINE HYDROCHLORIDE               	     2.49	    $2.49	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2267	INJ, MIRIKIZUMAB-MRKZ, 1 MG             	    52.03	   $52.03	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2270	MORPHINE SULFATE INJECTION              	     4.63	    $4.63	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2272	INJ, MORPHINE (FRESENIUS)               	     6.64	    $6.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2274	INJ MORPHINE PF EPID ITHC               	     9.82	    $9.82	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2277	INJ, MOTIXAFORTIDE, 0.25 MG             	    29.68	   $29.68	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2278	ZICONOTIDE INJECTION                    	     9.70	    $9.70	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2281	INJ MOXIFLOXACIN (FRES KABI)            	     7.10	    $7.10	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2290	INJ, NAFCILLIN SODIUM, 20 MG            	     4.65	    $4.65	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2300	INJ NALBUPHINE HYDROCHLORIDE            	     7.54	    $7.54	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2305	INJ, NITROGLYCERIN, 5 MG                	     1.34	    $1.34	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2312	INJ NALOXONE HCL NOS, 0.01MG            	     5.08	    $5.08	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2313	INJ, NALOXONE (ZIMHI) 0.01MG            	     4.59	    $4.59	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2315	NALTREXONE, DEPOT FORM                  	     8.58	    $8.58	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2323	NATALIZUMAB INJECTION                   	    24.37	   $24.37	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2325	NESIRITIDE INJECTION                    	    75.06	   $75.06	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2326	INJ, NUSINERSEN, 0.1MG                  	  1188.11	 $1188.11	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2327	INJ RISANKIZUMAB-RZAA 1 MG              	    14.86	   $14.86	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2329	INJ UBLITUXIMAB-XIIY, 1 MG              	    68.66	   $68.66	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2350	INJECTION, OCRELIZUMAB, 1 MG            	    57.81	   $57.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2351	INJ OCRELIZUMAB 1MG HYA-OCSQ            	    49.65	   $49.65	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2353	OCTREOTIDE INJECTION, DEPOT             	   209.05	  $209.05	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2354	OCTREOTIDE INJ, NON-DEPOT               	     5.05	    $5.05	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2356	INJ TEZEPELUMAB-EKKO, 1MG               	    22.23	   $22.23	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2357	OMALIZUMAB INJECTION                    	    44.58	   $44.58	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2358	OLANZAPINE LONG-ACTING INJ              	     7.38	    $7.38	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2359	INJ. OLANZAPINE, 0.5MG                  	     5.39	    $5.39	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2360	ORPHENADRINE INJECTION                  	    16.79	   $16.79	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2371	INJ PHENYLEPHRINE HCL 20 MCG            	     4.47	    $4.47	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2372	INJ, BIORPHEN, 20 MICROGRAMS            	     0.18	    $0.18	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2373	INJ, IMMPHENTIV, 20 MCG                 	     0.14	    $0.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2401	CHLOROPROCAINE HCL INJECTION            	     4.50	    $4.50	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2402	CHLOROPROCAINE (CLOROTEKAL)             	     4.77	    $4.77	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2404	INJ, NICARDIPINE 0.1 MG                 	     0.09	    $0.09	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2405	ONDANSETRON HCL INJECTION               	     4.55	    $4.55	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2406	INJECTION, ORITAVANCIN 10 MG            	    42.77	   $42.77	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2407	INJECTION, ORITAVANCIN                  	    28.53	   $28.53	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2425	PALIFERMIN INJECTION                    	    33.99	   $33.99	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2426	INJ, INVEGA SUSTENNA, 1 MG              	    19.20	   $19.20	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2427	INJ, INVEGA HAFYERA/TRINZA              	    17.13	   $17.13	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2428	INJ, ERZOFRI, 1 MG                      	    21.11	   $21.11	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2430	PAMIDRONATE DISODIUM /30 MG             	    13.88	   $13.88	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2468	INJ, PALONOSETRON (POSFREA)             	    59.91	   $59.91	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2469	PALONOSETRON HCL                        	     0.50	    $0.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2470	INJ PANTOPRAZOLE SODIUM 40MG            	     3.55	    $3.55	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2471	INJ PANTOPRAZOLE(HIKMA) 40MG            	     2.06	    $2.06	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2472	INJ, PANTOPRAZOLE SODIUM CHL            	     7.98	    $7.98	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2501	PARICALCITOL                            	     0.81	    $0.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2503	PEGAPTANIB SODIUM INJECTION             	   789.96	  $789.96	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2504	PEGADEMASE BOVINE, 25 IU                	   372.42	  $372.42	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2506	INJ PEGFILGRAST EX BIO 0.5MG            	    24.44	   $24.44	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2507	PEGLOTICASE INJECTION                   	  3565.32	 $3565.32	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2508	PEGUNIGALSIDASE ALFA-IWXJ               	   226.93	  $226.93	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2510	PENICILLIN G PROCAINE INJ               	    47.84	   $47.84	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2515	PENTOBARBITAL SODIUM INJ                	    64.97	   $64.97	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2540	PENICILLIN G POTASSIUM INJ              	     5.24	    $5.24	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2547	INJECTION, PERAMIVIR                    	     6.04	    $6.04	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2550	PROMETHAZINE HCL INJECTION              	     7.77	    $7.77	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2560	PHENOBARBITAL SODIUM INJ                	    33.90	   $33.90	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2561	INJ, SEZABY, 1 MG                       	     5.79	    $5.79	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2562	PLERIXAFOR INJECTION                    	    29.44	   $29.44	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2590	OXYTOCIN INJECTION                      	     7.37	    $7.37	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2598	INJ, VASOPRESSIN, 1 UNIT                	     5.88	    $5.88	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2599	INJ VASOPRESSIN (AM REG) 1 U            	     5.79	    $5.79	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2601	INJ, VASOPRESSIN (BAXTER)               	     3.50	    $3.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2675	INJ PROGESTERONE PER 50 MG              	     5.12	    $5.12	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2679	INJ FLUPHENAZINE HCL 1.25 MG            	    11.61	   $11.61	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2680	FLUPHENAZINE DECANOATE 25 MG            	    13.29	   $13.29	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2690	PROCAINAMIDE HCL INJECTION              	   284.34	  $284.34	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2700	OXACILLIN SODIUM INJECITON              	     0.64	    $0.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2704	INJ, PROPOFOL, 10 MG                    	     0.09	    $0.09	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2710	NEOSTIGMINE METHYLSLFTE INJ             	     1.16	    $1.16	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2720	INJ PROTAMINE SULFATE/10 MG             	     1.40	    $1.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2724	PROTEIN C CONCENTRATE                   	    15.02	   $15.02	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2760	PHENTOLAINE MESYLATE INJ                	   453.76	  $453.76	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2765	METOCLOPRAMIDE HCL INJECTION            	     5.59	    $5.59	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2777	INJ, FARICIMAB-SVOA, 0.1MG              	    34.72	   $34.72	      ---	       --	009	0	0	0.00	    $0.00	N	
I	J2778	RANIBIZUMAB INJECTION                   	    90.41	   $90.41	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J2779	INJ, SUSVIMO 0.1 MG                     	    79.74	   $79.74	      ---	       --	009	0	0	0.00	    $0.00	N	
I	J2781	INJ, PEGCETACOPLAN, 1MG                 	   143.99	  $143.99	      ---	       --	009	0	0	0.00	    $0.00	N	
I	J2782	INJ AVACINCAPTAD PEGOL 0.1MG            	   107.44	  $107.44	      ---	       --	009	0	0	0.00	    $0.00	N	
I	J2785	REGADENOSON INJECTION                   	    65.61	   $65.61	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2786	INJECTION, RESLIZUMAB, 1MG              	    10.49	   $10.49	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J2787	RIBOFLAVIN 5'PHOS OPTH<=3ML             	  2320.48	 $2320.48	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2788	RHO D IMMUNE GLOBULIN 50 MCG            	    28.08	   $28.08	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2790	RHO D IMMUNE GLOBULIN INJ               	    81.62	   $81.62	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2791	RHOPHYLAC INJECTION                     	     9.34	    $9.34	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2792	RHO(D) IMMUNE GLOBULIN H, SD            	    32.51	   $32.51	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2793	RILONACEPT INJECTION                    	    31.56	   $31.56	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2794	INJ RISPERDAL CONSTA, 0.5 MG            	    14.96	   $14.96	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2797	INJ., ROLAPITANT, 0.5 MG                	     5.35	    $5.35	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2798	INJ., PERSERIS, 0.5 MG                  	    16.61	   $16.61	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2799	INJ, UZEDY, 1 MG                        	    29.08	   $29.08	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2800	METHOCARBAMOL INJECTION                 	    10.82	   $10.82	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2801	INJ, RYKINDO, 0.5 MG                    	    15.40	   $15.40	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2802	INJ, ROMIPLOSTIM 1 MICROGRAM            	    14.98	   $14.98	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2804	INJ, RIFAMPIN, 1 MG                     	     0.14	    $0.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2805	SINCALIDE INJECTION                     	   143.26	  $143.26	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2820	SARGRAMOSTIM INJECTION                  	    64.34	   $64.34	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2840	INJ SEBELIPASE ALFA 1 MG                	   514.96	  $514.96	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2850	INJ SECRETIN SYNTHETIC HUMAN            	    37.27	   $37.27	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2860	INJECTION, SILTUXIMAB                   	   163.37	  $163.37	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2865	INJ SULFAMETH/TRIM 5 MG/1 MG            	     0.06	    $0.06	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2916	NA FERRIC GLUCONATE COMPLEX             	     1.94	    $1.94	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2919	INJ, METHYLPRED SOD SUCC 5MG            	     4.71	    $4.71	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J2997	ALTEPLASE RECOMBINANT                   	    91.46	   $91.46	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J2998	INJ PLASMINOGEN TVMH 1MG                	    30.00	   $30.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J3010	FENTANYL CITRATE INJECTION              	     5.30	    $5.30	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J3031	INJ., FREMANEZUMAB-VFRM 1 MG            	     7.69	    $7.69	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J3032	INJ. EPTINEZUMAB-JJMR 1 MG              	    19.32	   $19.32	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J3055	INJ TALQUETAMAB-TGVS 0.25 MG            	    74.46	   $74.46	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J3060	INJ, TALIGLUCERASE ALFA 10 U            	    40.64	   $40.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J3070	PENTAZOCINE INJECTION                   	   112.85	  $112.85	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J3090	INJ TEDIZOLID PHOSPHATE                 	     1.80	    $1.80	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J3095	TELAVANCIN INJECTION                    	     7.09	    $7.09	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J3105	TERBUTALINE SULFATE INJ                 	     1.41	    $1.41	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J3111	INJ. ROMOSOZUMAB-AQQG 1 MG              	    15.95	   $15.95	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J3145	TESTOSTERONE UNDECANOATE 1MG            	     6.48	    $6.48	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J3230	CHLORPROMAZINE HCL INJECTION            	    33.50	   $33.50	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J3240	THYROTROPIN INJECTION                   	  2083.17	 $2083.17	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J3241	INJ. TEPROTUMUMAB-TRBW 10 MG            	   352.56	  $352.56	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J3243	TIGECYCLINE INJECTION                   	     0.30	    $0.30	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J3244	INJ. TIGECYCLINE (ACCORD)               	     6.96	    $6.96	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J3245	INJ., TILDRAKIZUMAB, 1 MG               	   135.92	  $135.92	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J3247	INJ SECUKINUMAB INTRAV 1MG              	    17.73	   $17.73	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J3260	TOBRAMYCIN SULFATE INJECTION            	     6.06	    $6.06	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J3262	TOCILIZUMAB INJECTION                   	    10.34	   $10.34	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J3263	INJ, TORIPALIMAB-TPZI, 1 MG             	    39.10	   $39.10	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J3285	TREPROSTINIL INJECTION                  	    56.83	   $56.83	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J3299	INJ XIPERE 1 MG                         	    48.23	   $48.23	      ---	       --	009	0	0	0.00	    $0.00	N	
I	J3300	TRIAMCINOLONE A INJ PRS-FREE            	    25.02	   $25.02	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J3301	TRIAMCINOLONE ACET INJ NOS              	     5.33	    $5.33	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J3303	TRIAMCINOLONE HEXACETONL INJ            	     8.07	    $8.07	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J3304	INJ TRIAMCINOLONE ACE XR 1MG            	    18.01	   $18.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J3315	TRIPTORELIN PAMOATE                     	   476.09	  $476.09	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J3316	INJ., TRIPTORELIN XR 3.75 MG            	  3510.50	 $3510.50	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J3357	USTEKINUMAB SUB CU INJ, 1 MG            	   318.19	  $318.19	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J3358	USTEKINUMAB, IV INJECT, 1 MG            	    12.81	   $12.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J3360	DIAZEPAM INJECTION                      	    10.25	   $10.25	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J3373	INJ, VANCOMYCIN HCL, 10 MG              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J3374	INJ, VANCOMYCIN (MYLAN) 10MG            	     0.21	    $0.21	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J3375	INJ VANCOMYCIN (XELLIA) 10MG            	     0.06	    $0.06	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J3380	INJ VEDOLIZUMAB IV 1 MG                 	    21.16	   $21.16	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J3385	VELAGLUCERASE ALFA                      	   374.36	  $374.36	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J3391	INJ, ATIDARSAGENE AUTOTEMCEL            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
I	J3392	INJ, EXAGAMGLOGENE AUTOTEM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
I	J3393	INJ, BETIBEGLOGENE AUTOTEMCE            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
I	J3394	INJ, LOVOTIBEGLOGENE AUTOTEM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
I	J3396	VERTEPORFIN INJECTION                   	    11.52	   $11.52	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J3397	INJ., VESTRONIDASE ALFA-VJBK            	   271.60	  $271.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J3398	INJ LUXTURNA 1 BILLION VEC G            	  3045.83	 $3045.83	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J3399	INJ ONASE ABEPAR-XIOI TREAT             	     0.00	    $0.00	      ---	       --	030	0	0	0.00	    $0.00	N	
1	J3401	VYJUVEK 5X10^9PFU/ML, 0.1 ML            	  1016.67	 $1016.67	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J3410	HYDROXYZINE HCL INJECTION               	    22.22	   $22.22	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J3420	VITAMIN B12 INJECTION                   	     5.13	    $5.13	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J3424	INJ HYDROXOCOBALAMIN IV 25MG            	     4.99	    $4.99	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J3425	HYDROXOCOBALAMIN IM 10MCG               	     4.47	    $4.47	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J3430	VITAMIN K PHYTONADIONE INJ              	     6.91	    $6.91	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J3475	INJ MAGNESIUM SULFATE                   	     4.95	    $4.95	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J3486	ZIPRASIDONE MESYLATE                    	     9.64	    $9.64	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J3489	ZOLEDRONIC ACID 1MG                     	     9.52	    $9.52	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J3490	DRUGS UNCLASSIFIED INJECTION            	     0.00	    $0.00	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J3590	UNCLASSIFIED BIOLOGICS                  	     0.00	    $0.00	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J3591	ESRD ON DIALYSI DRUG/BIO NOC            	     0.00	    $0.00	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J7030	NORMAL SALINE SOLUTION INFUS            	     2.47	    $2.47	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J7040	NORMAL SALINE SOLUTION INFUS            	     1.24	    $1.24	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J7042	5% DEXTROSE/NORMAL SALINE               	     1.25	    $1.25	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J7050	NORMAL SALINE SOLUTION INFUS            	     0.62	    $0.62	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J7060	5% DEXTROSE/WATER                       	     1.82	    $1.82	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J7070	D5W INFUSION                            	     3.64	    $3.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J7120	RINGERS LACTATE INFUSION                	     2.30	    $2.30	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J7165	INJ, HUMAN-LANS, PER I.U                	     7.61	    $7.61	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J7168	PROTHROMBIN COMPLEX KCENTRA             	     7.44	    $7.44	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J7169	INJ ANDEXXA, 10 MG                      	   129.46	  $129.46	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J7170	INJ., EMICIZUMAB-KXWH 0.5 MG            	    56.44	   $56.44	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J7171	INJ, ADZYNMA, 10 IU                     	    34.52	   $34.52	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J7172	INJ MARSTACIM-HNCQ, 0.5 MG              	    55.46	   $55.46	      ---	       --	030	0	0	0.00	    $0.00	Y	
1	J7175	INJ, FACTOR X, (HUMAN), 1IU             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J7177	INJ., FIBRYGA, 1 MG                     	     1.10	    $1.10	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J7178	INJ HUMAN FIBRINOGEN CON NOS            	     1.48	    $1.48	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7179	VONVENDI INJ 1 IU VWF:RCO               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7180	FACTOR XIII ANTI-HEM FACTOR             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7181	FACTOR XIII RECOMB A-SUBUNIT            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7182	FACTOR VIII RECOMB NOVOEIGHT            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7183	WILATE INJECTION                        	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7185	XYNTHA INJ                              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7186	ANTIHEMOPHILIC VIII/VWF COMP            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7187	HUMATE-P, INJ                           	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7188	FACTOR VIII RECOMB OBIZUR               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7189	FACTOR VIIA RECOMB NOVOSEVEN            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7190	FACTOR VIII                             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7192	FACTOR VIII RECOMBINANT NOS             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7193	FACTOR IX NON-RECOMBINANT               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7194	FACTOR IX COMPLEX                       	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7195	FACTOR IX RECOMBINANT NOS               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7197	ANTITHROMBIN III INJECTION              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7198	ANTI-INHIBITOR                          	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7199	HEMOPHILIA CLOT FACTOR NOC              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7200	FACTOR IX RECOMBINAN RIXUBIS            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7201	FACTOR IX ALPROLIX RECOMB               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7202	FACTOR IX IDELVION INJ                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7203	FACTOR IX RECOMB GLY REBINYN            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7204	INJ RECOMBIN ESPEROCT PER IU            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7205	FACTOR VIII FC FUSION RECOMB            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7207	FACTOR VIII PEGYLATED RECOMB            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7208	INJ. JIVI 1 IU                          	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7209	FACTOR VIII NUWIQ RECOMB 1IU            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7210	INJ, AFSTYLA, 1 I.U.                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7211	INJ, KOVALTRY, 1 I.U.                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7212	FACTOR VIIA RECOMB SEVENFACT            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7213	INJ, IXINITY, 1 I.U.                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7214	ALTUVIIIO PER FACTOR VIII IU            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7294	SEG ACET AND ETH ESTR YEARLY            	  2318.40	 $2318.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7295	ETH ESTR AND ETON MONTHLY               	   146.29	  $146.29	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7296	KYLEENA, 19.5 MG                        	  1214.63	 $1214.63	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7297	LILETTA, 52 MG                          	   931.73	  $931.73	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7298	MIRENA, 52 MG                           	  1214.63	 $1214.63	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7300	INTRAUT COPPER CONTRACEPTIVE            	  1139.00	 $1139.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7301	SKYLA, 13.5 MG                          	  1011.38	 $1011.38	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7304	CONTRACEPTIVE HORMONE PATCH             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7307	ETONOGESTREL IMPLANT SYSTEM             	  1214.63	 $1214.63	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7309	METHYL AMINOLEVULINATE, TOP             	    74.17	   $74.17	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7310	GANCICLOVIR LONG ACT IMPLANT            	 16960.00	$16960.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7311	INJ., RETISERT, 0.01 MG                 	   340.04	  $340.04	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7312	DEXAMETHASONE INTRA IMPLANT             	   205.24	  $205.24	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7313	INJ., ILUVIEN, 0.01 MG                  	   490.77	  $490.77	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7314	INJ., YUTIQ, 0.01 MG                    	   524.57	  $524.57	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7315	OPHTHALMIC MITOMYCIN                    	   430.00	  $430.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J7316	INJ, OCRIPLASMIN, 0.125 MG              	  1051.39	 $1051.39	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J7318	INJ, DUROLANE 1 MG                      	     6.93	    $6.93	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J7320	GENVISC 850, INJ, 1MG                   	     6.31	    $6.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J7321	HYALGAN SUPARTZ VISCO-3 DOSE            	    73.96	   $73.96	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J7322	HYMOVIS INJECTION 1 MG                  	    17.50	   $17.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J7323	EUFLEXXA INJ PER DOSE                   	   128.71	  $128.71	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J7324	ORTHOVISC INJ PER DOSE                  	   125.30	  $125.30	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J7325	SYNVISC OR SYNVISC-ONE                  	     9.25	    $9.25	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J7326	GEL-ONE                                 	   538.48	  $538.48	      ---	       --	009	0	0	0.00	    $0.00	N	
I	J7327	MONOVISC INJ PER DOSE                   	   663.64	  $663.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J7328	GELSYN-3 INJECTION 0.1 MG               	     0.59	    $0.59	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J7331	SYNOJOYNT, INJ., 1 MG                   	     8.43	    $8.43	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J7332	INJ., TRILURON, 1 MG                    	    10.28	   $10.28	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7336	CAPSAICIN 8% PATCH                      	     3.38	    $3.38	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7340	CARBIDOPA LEVODOPA ENT 100ML            	   235.77	  $235.77	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7342	CIPROFLOXACIN OTIC SUSP 6 MG            	    28.32	   $28.32	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7345	AMINOLEVULINIC ACID, 10% GEL            	     1.78	    $1.78	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7351	INJ BIMATOPROST ITC IMP1MCG             	   209.91	  $209.91	      ---	       --	009	0	0	0.00	    $0.00	N	
1	J7352	AFAMELANOTIDE IMPLANT, 1 MG             	  2423.63	 $2423.63	      ---	       --	009	0	0	0.00	    $0.00	N	
1	J7354	CANTHARIDIN TOP, APPLICATOR             	   682.26	  $682.26	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7355	INJ TRAVOPROST INTRA IMPL               	   194.41	  $194.41	      ---	       --	009	0	0	0.00	    $0.00	N	
I	J7356	INJ FOSCARB/FOSLEVODOPA 5 MG            	     0.68	    $0.68	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7402	MOMETASONE SINUS SINUVA                 	    11.35	   $11.35	      ---	       --	009	0	0	0.00	    $0.00	N	
1	J7514	MYCOPHENOL (MYHIBBIN) 100 MG            	     2.18	    $2.18	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J7519	INJ. MYCOPHENOLATE MOFETIL              	     0.31	    $0.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7521	TACROLIM GRANULES ORAL SUSP             	     1.33	    $1.33	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7601	ENSIFENTRINE INH 3 MG                   	    52.12	   $52.12	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7605	ARFORMOTEROL NON-COMP UNIT              	     0.69	    $0.69	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7606	FORMOTEROL FUMARATE, INH                	     1.70	    $1.70	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7611	ALBUTEROL NON-COMP CON                  	     0.18	    $0.18	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7613	ALBUTEROL NON-COMP UNIT                 	     0.08	    $0.08	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7639	DORNASE ALFA NON-COMP UNIT              	    53.59	   $53.59	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J7999	COMPOUNDED DRUG, NOC                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	J8499	ORAL PRESCRIP DRUG NON CHEMO            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	J8522	CAPECITABINE, ORAL, 50 MG               	     0.07	    $0.07	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J8541	ORAL, HEMADY, 0.25 MG                   	     0.35	    $0.35	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J8611	ORAL METHOTREXATE (JYLAMVO)             	    18.26	   $18.26	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J8612	ORAL METHOTREXATE (XATMEP)              	    20.95	   $20.95	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J8670	ROLAPITANT, ORAL, 1MG                   	     1.79	    $1.79	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9000	DOXORUBICIN HCL INJECTION               	     3.15	    $3.15	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9015	ALDESLEUKIN INJECTION                   	  5555.93	 $5555.93	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9017	ARSENIC TRIOXIDE INJECTION              	     4.79	    $4.79	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9019	ERWINAZE INJECTION                      	   431.73	  $431.73	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9020	ASPARAGINASE, NOS                       	    69.02	   $69.02	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9021	INJ, ASPARA, RYLAZE, 0.1 MG             	    58.84	   $58.84	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9022	INJ, ATEZOLIZUMAB,10 MG                 	    89.39	   $89.39	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9023	INJECTION, AVELUMAB, 10 MG              	    97.14	   $97.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9024	INJ ATEZOLIZUMB 5MG HYA-TQJS            	    35.34	   $35.34	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9025	AZACITIDINE INJECTION                   	     4.78	    $4.78	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9026	INJ, TARLATAMAB-DLLE, 1 MG              	  1570.77	 $1570.77	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9027	CLOFARABINE INJECTION                   	    16.01	   $16.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J9028	INJ, NOGAPENDEKIN PMLN, 1MCG            	    94.58	   $94.58	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J9029	INSTILL ADSTILADRIN, TX DOSE            	 63235.61	$63235.61	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J9030	BCG LIVE INTRAVESICAL 1MG               	     3.14	    $3.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9032	INJECTION, BELINOSTAT, 10MG             	    50.92	   $50.92	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9033	INJ, BENDAMUSTINE HCL, 1MG              	     1.24	    $1.24	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9034	INJ., BENDEKA 1 MG                      	    13.58	   $13.58	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9035	BEVACIZUMAB INJECTION                   	    72.73	   $72.73	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9036	INJ. BELRAPZO/BENDAMUSTINE              	    14.20	   $14.20	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9038	INJ AXATILIMAB-CSFR 0.1 MG              	    52.50	   $52.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9039	INJECTION, BLINATUMOMAB                 	   152.28	  $152.28	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9040	BLEOMYCIN SULFATE INJECTION             	    26.02	   $26.02	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9041	INJECTION, BORTEZOMIB, 0.1MG            	     6.96	    $6.96	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9042	BRENTUXIMAB VEDOTIN INJ                 	   248.93	  $248.93	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9043	CABAZITAXEL INJECTION                   	   221.71	  $221.71	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9045	CARBOPLATIN INJECTION                   	     2.93	    $2.93	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9046	INJ, BORTEZOMIB, DR. REDDY'S            	    50.26	   $50.26	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9047	INJECTION, CARFILZOMIB, 1 MG            	    51.85	   $51.85	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9048	INJ, BORTEZOMIB FRESENIUSKAB            	    50.26	   $50.26	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9049	INJ, BORTEZOMIB, HOSPIRA                	     5.89	    $5.89	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9050	CARMUSTINE INJECTION                    	   145.60	  $145.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9051	INJ, BORTEZOMIB (MAIA)                  	     7.89	    $7.89	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9052	INJ, CARMUSTINE (ACCORD)                	   245.00	  $245.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9054	INJ BORTEZOMIB BORUZU 0.1 MG            	    29.96	   $29.96	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9055	CETUXIMAB INJECTION                     	    77.52	   $77.52	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9056	INJ, VIVIMUSTA, 1 MG                    	    27.24	   $27.24	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9060	CISPLATIN 10 MG INJECTION               	     2.86	    $2.86	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9061	INJ, AMIVANTAMAB-VMJW                   	    21.51	   $21.51	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9063	INJ, ELAHERE, 1 MG                      	    68.07	   $68.07	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9064	INJ, CABAZITAXEL (SANDOZ)               	     0.00	    $0.00	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9065	INJ CLADRIBINE PER 1 MG                 	    10.20	   $10.20	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9071	INJ CYCLOPHOSPHAMD AUROMEDIC            	     0.87	    $0.87	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9072	INJ CYCLOPHOS AVYXA 5MG                 	     9.05	    $9.05	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9073	INJ CYCLOPHOS DR REDDYS 5 MG            	     1.76	    $1.76	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9074	INJ, CYCLOPHOSPHAMD, SANDOZ             	     4.34	    $4.34	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9075	INJ, CYCLOPHOSPHAMIDE, NOS              	     0.80	    $0.80	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9076	INJ, CYCLOPHOS (BAXTER) 5MG             	     4.84	    $4.84	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9100	CYTARABINE HCL 100 MG INJ               	     5.27	    $5.27	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9118	INJ. CALASPARGASE PEGOL-MKNL            	    76.53	   $76.53	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9119	INJ., CEMIPLIMAB-RWLC, 1 MG             	    28.92	   $28.92	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9120	DACTINOMYCIN INJECTION                  	   288.80	  $288.80	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9130	DACARBAZINE 100 MG INJ                  	     4.50	    $4.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9144	DARATUMUMAB, HYALURONIDASE              	    57.45	   $57.45	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9145	INJECTION, DARATUMUMAB 10 MG            	    67.63	   $67.63	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9150	DAUNORUBICIN INJECTION                  	    26.40	   $26.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9153	INJ DAUNORUBICIN, CYTARABINE            	   249.02	  $249.02	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9155	DEGARELIX INJECTION                     	     8.82	    $8.82	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9161	INJ DENILEUK DIFTI-CXDL 1MCG            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9171	DOCETAXEL INJECTION                     	     0.61	    $0.61	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9172	DOCETAXEL (DOCIVYX), 1 MG               	    51.62	   $51.62	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9173	INJ., DURVALUMAB, 10 MG                 	    83.87	   $83.87	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9175	ELLIOTTS B SOLUTION PER ML              	    14.66	   $14.66	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9176	INJECTION, ELOTUZUMAB, 1MG              	     7.73	    $7.73	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9177	INJ ENFORT VEDO-EJFV 0.25MG             	    36.64	   $36.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9178	INJ, EPIRUBICIN HCL, 2 MG               	     1.62	    $1.62	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9179	ERIBULIN MESYLATE INJECTION             	   118.75	  $118.75	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9181	ETOPOSIDE INJECTION                     	     1.07	    $1.07	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9185	FLUDARABINE PHOSPHATE INJ               	    59.53	   $59.53	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9190	FLUOROURACIL INJECTION                  	     2.21	    $2.21	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9196	INJ GEMCITABINE HCL (ACCORD)            	     8.65	    $8.65	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9198	INJ. INFUGEM, 100 MG                    	    38.00	   $38.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9200	FLOXURIDINE INJECTION                   	  3988.33	 $3988.33	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9201	IN GEMCITABINE HCL NOS 200MG            	     2.98	    $2.98	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J9202	GOSERELIN ACETATE IMPLANT               	   705.14	  $705.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9203	GEMTUZUMAB OZOGAMICIN 0.1 MG            	   233.12	  $233.12	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9204	INJ MOGAMULIZUMAB-KPKC, 1 MG            	   243.63	  $243.63	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9205	INJ IRINOTECAN LIPOSOME 1 MG            	    65.28	   $65.28	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9206	IRINOTECAN INJECTION                    	     1.64	    $1.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9207	IXABEPILONE INJECTION                   	   136.21	  $136.21	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9208	IFOSFAMIDE INJECTION                    	    24.62	   $24.62	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9209	MESNA INJECTION                         	     1.36	    $1.36	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9210	INJ., EMAPALUMAB-LZSG, 1 MG             	   381.50	  $381.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9214	INTERFERON ALFA-2B INJ                  	    37.03	   $37.03	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9217	LEUPROLIDE ACETATE SUSPNSION            	   176.75	  $176.75	      ---	       --	030	0	0	0.00	    $0.00	Y	
1	J9219	LEUPROLIDE ACETATE IMPLANT              	  4528.81	 $4528.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9220	INDIGOTINDISULFONATE SOD 1MG            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9223	INJ. LURBINECTEDIN, 0.1 MG              	   205.04	  $205.04	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J9225	VANTAS IMPLANT                          	  5166.29	 $5166.29	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J9226	SUPPRELIN LA IMPLANT                    	 45212.04	$45212.04	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9227	INJ. ISATUXIMAB-IRFC 10 MG              	    78.86	   $78.86	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9228	IPILIMUMAB INJECTION                    	   180.22	  $180.22	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9229	INJ INOTUZUMAB OZOGAM 0.1 MG            	  2658.13	 $2658.13	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9230	MECHLORETHAMINE HCL INJ                 	   326.18	  $326.18	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9245	INJ MELPHA HYDROCH NOS 50 MG            	   157.10	  $157.10	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9246	INJ., EVOMELA, 1 MG                     	    18.50	   $18.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9249	INJ, MELPHALAN (APOTEX) 1 MG            	     0.00	    $0.00	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9260	INJ METHOTREXATE SODIUM 50MG            	     7.04	    $7.04	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9261	NELARABINE INJECTION                    	    63.18	   $63.18	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9263	OXALIPLATIN                             	     0.05	    $0.05	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9264	PACLITAXEL PROTEIN BOUND                	    13.06	   $13.06	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9266	PEGASPARGASE INJECTION                  	 27074.99	$27074.99	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9267	PACLITAXEL INJECTION                    	     0.13	    $0.13	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9269	INJ. TAGRAXOFUSP-ERZS 10 MCG            	   338.53	  $338.53	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9271	INJ PEMBROLIZUMAB                       	    59.35	   $59.35	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9272	INJ, DOSTARLIMAB-GXLY, 10 MG            	   240.14	  $240.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9273	INJ TISOTU VEDOTIN-TFTV, 1MG            	   188.65	  $188.65	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9274	INJ, TEBENTAFUSP-TEBN, 1 MCG            	   214.76	  $214.76	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9276	INJ ZANIDATAMAB-HRII, 2 MG              	    23.70	   $23.70	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9280	MITOMYCIN INJECTION                     	    25.60	   $25.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	J9281	MITOMYCIN INSTILLATION                  	   313.00	  $313.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9285	INJ, OLARATUMAB, 10 MG                  	    56.53	   $56.53	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9286	INJ GLOFITAMAB GXBM, 2.5 MG             	  2772.80	 $2772.80	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9289	INJ NIVOLUMAB 2 MG HYALURON             	     9.65	    $9.65	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9292	INJ, PEMETREXED DIPOTASSIUM             	    79.00	   $79.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9293	MITOXANTRONE HYDROCHL / 5 MG            	    27.69	   $27.69	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9294	INJ PEMETREXED, HOSPIRA 10MG            	     3.86	    $3.86	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9295	INJECTION, NECITUMUMAB, 1 MG            	     5.73	    $5.73	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9296	INJ PEMETREXED (ACCORD) 10MG            	     9.74	    $9.74	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9297	INJ PEMETREXED (SANDOZ) 10MG            	     1.74	    $1.74	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9298	INJ NIVOL RELATLIMAB 3MG/1MG            	   194.08	  $194.08	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9299	INJECTION, NIVOLUMAB                    	    32.35	   $32.35	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9301	OBINUTUZUMAB INJ                        	    75.21	   $75.21	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9302	OFATUMUMAB INJECTION                    	    64.80	   $64.80	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9303	PANITUMUMAB INJECTION                   	   164.92	  $164.92	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9304	INJ. PEMETREXED, 10 MG                  	    46.35	   $46.35	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9305	INJ. PEMETREXED NOS 10MG                	     3.77	    $3.77	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9306	INJECTION, PERTUZUMAB, 1 MG             	    16.23	   $16.23	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9307	PRALATREXATE INJECTION                  	   373.77	  $373.77	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9308	INJECTION, RAMUCIRUMAB                  	    73.37	   $73.37	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9309	INJ, POLATUZUMAB VEDOTIN 1MG            	   132.73	  $132.73	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9311	INJ RITUXIMAB, HYALURONIDASE            	    41.99	   $41.99	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9312	INJ., RITUXIMAB, 10 MG                  	    76.43	   $76.43	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9313	INJ., LUMOXITI, 0.01 MG                 	    22.07	   $22.07	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9314	INJ PEMETREXED (TEVA) 10MG              	     8.37	    $8.37	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9316	PERTUZU, TRASTUZU, 10 MG                	    67.45	   $67.45	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9317	SACITUZUMAB GOVITECAN-HZIY              	    35.80	   $35.80	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9318	INJ ROMIDEPSIN NON-LYO 0.1MG            	    36.45	   $36.45	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9319	INJ ROMIDEPSIN LYOPHIL 0.1MG            	    31.54	   $31.54	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9320	STREPTOZOCIN INJECTION                  	   353.69	  $353.69	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9321	INJ EPCORITAMAB-BYSP 0.16 MG            	    59.32	   $59.32	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9322	INJ PEMETREXED (BLUEPOINT)              	    14.07	   $14.07	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9323	INJ PEMETREXED DITROMETHAMIN            	    10.34	   $10.34	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9324	INJ, PEMRYDI RTU, 10 MG                 	    81.06	   $81.06	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9325	INJ TALIMOGENE LAHERPAREPVEC            	    70.38	   $70.38	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9328	TEMOZOLOMIDE INJECTION                  	    10.41	   $10.41	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9329	INJ, TISLELIZUMAB-JSGR                  	    54.64	   $54.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9330	TEMSIROLIMUS INJECTION                  	    30.32	   $30.32	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9331	INJ SIROLIMUS PROT PART 1 MG            	   117.63	  $117.63	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9332	INJ EFGARTIGIMOD 2MG                    	    32.38	   $32.38	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9333	INJ RONZANOLIXIZUM-NOLI 1 MG            	    27.30	   $27.30	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9334	INJ EFGART-ALFA 2MG HYA-QVFC            	    37.83	   $37.83	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9341	INJ THIOTEPA (TEPYLUTE) 1 MG            	    37.14	   $37.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9342	INJ THIOTEPA NOS 1 MG                   	    32.46	   $32.46	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9345	INJ, RETIFANLIMAB-DLWR, 1 MG            	    29.74	   $29.74	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9347	INJ, TREMELIMUMAB-ACTL, 1 MG            	   138.24	  $138.24	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9348	INJ. NAXITAMAB-GQGK, 1 MG               	   641.83	  $641.83	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9349	INJ., TAFASITAMAB-CXIX                  	    13.93	   $13.93	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9350	INJ MOSUNETUZUMAB-AXGB, 1 MG            	   640.96	  $640.96	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9351	TOPOTECAN INJECTION                     	     1.27	    $1.27	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9352	INJECTION TRABECTEDIN 0.1MG             	   363.83	  $363.83	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9353	INJ. MARGETUXIMAB-CMKB, 5 MG            	    48.53	   $48.53	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9354	INJ, ADO-TRASTUZUMAB EMT 1MG            	    41.11	   $41.11	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9355	INJ TRASTUZUMAB EXCL BIOSIMI            	    75.69	   $75.69	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9356	INJ. HERCEPTIN HYLECTA, 10MG            	    67.38	   $67.38	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9358	INJ FAM-TRASTU DERU-NXKI 1MG            	    28.90	   $28.90	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9359	INJ LON TESIRIN-LPYL 0.075MG            	   212.00	  $212.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9360	VINBLASTINE SULFATE INJ                 	     5.14	    $5.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9370	VINCRISTINE SULFATE 1 MG INJ            	     8.20	    $8.20	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9376	INJ POZELIMAB-BBFG, 1 MG                	    91.00	   $91.00	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9380	INJ TECLISTAMAB CQYV 0.5 MG             	    36.88	   $36.88	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9381	INJ TEPLIZUMAB MZWV 5 MCG               	    37.31	   $37.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9390	VINORELBINE TARTRATE INJ                	     6.59	    $6.59	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	J9393	INJ, FULVESTRANT (TEVA)                 	    24.46	   $24.46	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9394	INJ, FULVESTRANT (FRESENIUS)            	     7.78	    $7.78	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9395	INJECTION, FULVESTRANT                  	    11.36	   $11.36	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	J9400	INJ, ZIV-AFLIBERCEPT, 1MG               	     8.30	    $8.30	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0001	STANDARD WHEELCHAIR                     	   639.24	  $639.24	      ---	       --	009	0	0	0.00	   $42.91	Y	
1	K0002	STND HEMI (LOW SEAT) WHLCHR             	   871.92	  $871.92	      ---	       --	009	0	0	0.00	   $62.96	Y	
1	K0003	LIGHTWEIGHT WHEELCHAIR                  	   943.80	  $943.80	      ---	       --	009	0	0	0.00	   $63.64	Y	
1	K0004	HIGH STRENGTH LTWT WHLCHR               	  1363.08	 $1363.08	      ---	       --	009	0	0	0.00	   $88.02	Y	
1	K0005	ULTRALIGHTWEIGHT WHEELCHAIR             	  1817.84	 $1817.84	      ---	       --	009	0	0	0.00	  $181.78	Y	
1	K0006	HEAVY DUTY WHEELCHAIR                   	  1279.20	 $1279.20	      ---	       --	009	0	0	0.00	   $94.95	Y	
1	K0007	EXTRA HEAVY DUTY WHEELCHAIR             	  2034.00	 $2034.00	      ---	       --	009	0	0	0.00	  $144.74	Y	
1	K0008	CSTM MANUAL WHEELCHAIR/BASE             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0009	OTHER MANUAL WHEELCHAIR/BASE            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0010	STND WT FRAME POWER WHLCHR              	  4259.90	 $4259.90	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0011	STND WT PWR WHLCHR W CONTROL            	  5046.00	 $5046.00	      ---	       --	009	0	0	0.00	  $504.60	Y	
1	K0012	LTWT PORTBL POWER WHLCHR                	  3095.10	 $3095.10	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0013	CUSTOM POWER WHLCHR BASE                	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0014	OTHER POWER WHLCHR BASE                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0015	DETACH NON-ADJ HT ARMRST REP            	   107.68	  $107.68	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0017	DETACH ADJUST ARMREST BASE              	    38.46	   $38.46	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0018	DETACH ADJUST ARMRST UPPER              	    21.50	   $21.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0019	ARM PAD REPL, EACH                      	    15.51	   $15.51	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0020	FIXED ADJUST ARMREST PAIR               	    43.70	   $43.70	      ---	       --	009	0	0	0.00	    $4.37	Y	
1	K0037	HI MOUNT FLIP-UP FOOTREST EA            	    42.12	   $42.12	      ---	       --	009	0	0	0.00	    $4.17	Y	
1	K0038	LEG STRAP EACH                          	    22.82	   $22.82	      ---	       --	009	0	0	0.00	    $2.27	Y	
1	K0039	LEG STRAP H STYLE EACH                  	    50.69	   $50.69	      ---	       --	009	0	0	0.00	    $5.10	Y	
1	K0040	ADJUSTABLE ANGLE FOOTPLATE              	    63.88	   $63.88	      ---	       --	009	0	0	0.00	    $6.39	Y	
1	K0041	LARGE SIZE FOOTPLATE EACH               	    49.46	   $49.46	      ---	       --	009	0	0	0.00	    $4.94	Y	
1	K0042	STANDARD SIZE FTPLATE REP EA            	    29.03	   $29.03	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0043	FTRST LOWR EXTEN TUBE REP EA            	    17.92	   $17.92	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0044	FTRST UPR HANGER BRAC REP EA            	    15.59	   $15.59	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0045	FTRST COMPL ASSEMBLY REPL EA            	    51.28	   $51.28	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0046	ELEV LGRST LWR EXTEN REPL EA            	    18.04	   $18.04	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0047	ELEV LEGRST UPR HANGR REP EA            	    63.74	   $63.74	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0050	RATCHET ASSEMBLY REPLACEMENT            	    29.57	   $29.57	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0051	CAM REL ASM FT/LEGRST REP EA            	    46.78	   $46.78	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0052	SWINGAWAY DETACH FTREST REPL            	    65.40	   $65.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0053	ELEVATE FOOTREST ARTICULATE             	    94.02	   $94.02	      ---	       --	009	0	0	0.00	    $9.40	Y	
1	K0056	SEAT HT <17 OR >=21 LTWT WC             	    93.51	   $93.51	      ---	       --	009	0	0	0.00	    $9.36	Y	
1	K0069	RR WHL COMPL SOL TIRE REP EA            	    98.23	   $98.23	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0070	RR WHL COMPL PNE TIRE REP EA            	   146.10	  $146.10	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0071	FR CSTR COMP PNE TIRE REP EA            	    98.30	   $98.30	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0072	FR CSTR SEMI-PNE TIRE REP EA            	    61.00	   $61.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0073	CASTER PIN LOCK EACH                    	    31.60	   $31.60	      ---	       --	009	0	0	0.00	    $3.16	Y	
1	K0077	FR CSTR ASMB SOL TIRE REP EA            	    50.40	   $50.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0098	DRIVE BELT FOR PWC, REPL                	    16.92	   $16.92	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0105	IV HANGER                               	    97.76	   $97.76	      ---	       --	009	0	0	0.00	    $9.76	Y	
1	K0108	W/C COMPONENT-ACCESSORY NOS             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0195	ELEVATING WHLCHAIR LEG RESTS            	   246.60	  $246.60	      ---	       --	009	0	0	0.00	   $15.92	Y	
1	K0455	PUMP UNINTERRUPTED INFUSION             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	  $211.90	Y	
1	K0552	SUP/EXT NON-INS INF PUMP SYR            	     2.09	    $2.09	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0601	REPL BATT SILVER OXIDE 1.5 V            	     0.88	    $0.88	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0602	REPL BATT SILVER OXIDE 3 V              	     5.09	    $5.09	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0603	REPL BATT ALKALINE 1.5 V                	     0.46	    $0.46	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0604	REPL BATT LITHIUM 3.6 V                 	     4.87	    $4.87	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0605	REPL BATT LITHIUM 4.5 V                 	    11.68	   $11.68	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0606	AED GARMENT W ELEC ANALYSIS             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	 $1814.56	N	
1	K0669	SEAT/BACK CUS NO DMEPDAC VER            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0672	REMOVABLE SOFT INTERFACE LE             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	K0672	REMOVABLE SOFT INTERFACE LE             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0733	12-24HR SEALED LEAD ACID                	    28.90	   $28.90	      ---	       --	009	0	0	0.00	    $2.91	Y	
1	K0738	PORTABLE GAS OXYGEN SYSTEM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	   $45.01	Y	
1	K0739	REPAIR/SVC DME NON-OXYGEN EQ            	    16.47	   $16.47	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0740	REPAIR/SVC OXYGEN EQUIPMENT             	    16.47	   $16.47	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0743	PORTABLE HOME SUCTION PUMP              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0744	ABSORP DRG <= 16 SUC PUMP               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0745	ABSORP DRG >16<=48 SUC PUMP             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0746	ABSORP DRG >48 SUC PUMP                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0800	POV GROUP 1 STD UP TO 300LBS            	   989.40	  $989.40	      ---	       --	009	0	0	0.00	   $98.95	Y	
1	K0801	POV GROUP 1 HD 301-450 LBS              	  1595.13	 $1595.13	      ---	       --	009	0	0	0.00	  $159.49	Y	
1	K0802	POV GROUP 1 VHD 451-600 LBS             	  1805.18	 $1805.18	      ---	       --	009	0	0	0.00	  $180.51	Y	
1	K0806	POV GROUP 2 STD UP TO 300LBS            	  1196.90	 $1196.90	      ---	       --	009	0	0	0.00	  $119.69	Y	
1	K0807	POV GROUP 2 HD 301-450 LBS              	  1816.18	 $1816.18	      ---	       --	009	0	0	0.00	  $181.62	Y	
1	K0808	POV GROUP 2 VHD 451-600 LBS             	  2810.01	 $2810.01	      ---	       --	009	0	0	0.00	  $281.00	Y	
1	K0812	POWER OPERATED VEHICLE NOC              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0813	PWC GP 1 STD PORT SEAT/BACK             	  2894.88	 $2894.88	      ---	       --	009	0	0	0.00	  $318.44	Y	
1	K0814	PWC GP 1 STD PORT CAP CHAIR             	  3705.36	 $3705.36	      ---	       --	009	0	0	0.00	  $373.50	Y	
1	K0815	PWC GP 1 STD SEAT/BACK                  	  4219.56	 $4219.56	      ---	       --	009	0	0	0.00	  $420.21	Y	
1	K0816	PWC GP 1 STD CAP CHAIR                  	  4040.88	 $4040.88	      ---	       --	009	0	0	0.00	  $397.62	Y	
1	K0820	PWC GP 2 STD PORT SEAT/BACK             	  3091.92	 $3091.92	      ---	       --	009	0	0	0.00	  $334.47	Y	
1	K0821	PWC GP 2 STD PORT CAP CHAIR             	  3969.24	 $3969.24	      ---	       --	009	0	0	0.00	  $393.43	Y	
1	K0822	PWC GP 2 STD SEAT/BACK                  	  3997.50	 $3997.50	      ---	       --	009	0	0	0.00	  $455.88	Y	
1	K0823	PWC GP 2 STD CAP CHAIR                  	  4828.44	 $4828.44	      ---	       --	009	0	0	0.00	  $446.84	Y	
1	K0824	PWC GP 2 HD SEAT/BACK                   	  5811.24	 $5811.24	      ---	       --	009	0	0	0.00	  $587.54	Y	
1	K0825	PWC GP 2 HD CAP CHAIR                   	  4433.20	 $4433.20	      ---	       --	009	0	0	0.00	  $540.40	Y	
1	K0826	PWC GP 2 VHD SEAT/BACK                  	  7523.16	 $7523.16	      ---	       --	009	0	0	0.00	  $851.15	Y	
1	K0827	PWC GP VHD CAP CHAIR                    	  6397.08	 $6397.08	      ---	       --	009	0	0	0.00	  $732.74	Y	
1	K0828	PWC GP 2 XTRA HD SEAT/BACK              	  8289.84	 $8289.84	      ---	       --	009	0	0	0.00	  $990.72	Y	
1	K0829	PWC GP 2 XTRA HD CAP CHAIR              	  7612.44	 $7612.44	      ---	       --	009	0	0	0.00	  $935.40	Y	
1	K0830	PWC GP2 STD SEAT ELEVATE S/B            	  4696.92	 $4696.92	      ---	       --	009	0	0	0.00	  $391.41	Y	
1	K0831	PWC GP2 STD SEAT ELEVATE CAP            	  4696.92	 $4696.92	      ---	       --	009	0	0	0.00	  $391.41	Y	
1	K0835	PWC GP2 STD SING POW OPT S/B            	  4057.40	 $4057.40	      ---	       --	009	0	0	0.00	  $477.44	Y	
1	K0836	PWC GP2 STD SING POW OPT CAP            	  5049.00	 $5049.00	      ---	       --	009	0	0	0.00	  $495.15	Y	
1	K0837	PWC GP 2 HD SING POW OPT S/B            	  5811.24	 $5811.24	      ---	       --	009	0	0	0.00	  $585.46	Y	
1	K0838	PWC GP 2 HD SING POW OPT CAP            	  4332.20	 $4332.20	      ---	       --	009	0	0	0.00	  $521.89	Y	
1	K0839	PWC GP2 VHD SING POW OPT S/B            	  7523.16	 $7523.16	      ---	       --	009	0	0	0.00	  $765.55	Y	
1	K0840	PWC GP2 XHD SING POW OPT S/B            	 11397.96	$11397.96	      ---	       --	009	0	0	0.00	 $1165.87	Y	
1	K0841	PWC GP2 STD MULT POW OPT S/B            	  5182.32	 $5182.32	      ---	       --	009	0	0	0.00	  $519.15	Y	
1	K0842	PWC GP2 STD MULT POW OPT CAP            	  5182.32	 $5182.32	      ---	       --	009	0	0	0.00	  $518.87	Y	
1	K0843	PWC GP2 HD MULT POW OPT S/B             	  6239.52	 $6239.52	      ---	       --	009	0	0	0.00	  $621.37	Y	
1	K0848	PWC GP 3 STD SEAT/BACK                  	  5284.40	 $5284.40	      ---	       --	009	0	0	0.00	  $528.44	Y	
1	K0849	PWC GP 3 STD CAP CHAIR                  	  6096.84	 $6096.84	      ---	       --	009	0	0	0.00	  $508.07	Y	
1	K0850	PWC GP 3 HD SEAT/BACK                   	  6129.80	 $6129.80	      ---	       --	009	0	0	0.00	  $612.98	Y	
1	K0851	PWC GP 3 HD CAP CHAIR                   	  5893.70	 $5893.70	      ---	       --	009	0	0	0.00	  $589.37	Y	
1	K0852	PWC GP 3 VHD SEAT/BACK                  	  8499.12	 $8499.12	      ---	       --	009	0	0	0.00	  $708.26	Y	
1	K0853	PWC GP 3 VHD CAP CHAIR                  	  8730.72	 $8730.72	      ---	       --	009	0	0	0.00	  $727.56	Y	
1	K0854	PWC GP 3 XHD SEAT/BACK                  	 11566.32	$11566.32	      ---	       --	009	0	0	0.00	  $963.86	Y	
1	K0855	PWC GP 3 XHD CAP CHAIR                  	 10926.12	$10926.12	      ---	       --	009	0	0	0.00	  $910.51	Y	
1	K0856	PWC GP3 STD SING POW OPT S/B            	  6806.76	 $6806.76	      ---	       --	009	0	0	0.00	  $567.23	Y	
1	K0857	PWC GP3 STD SING POW OPT CAP            	  6943.20	 $6943.20	      ---	       --	009	0	0	0.00	  $578.60	Y	
1	K0858	PWC GP3 HD SING POW OPT S/B             	  8445.12	 $8445.12	      ---	       --	009	0	0	0.00	  $703.76	Y	
1	K0859	PWC GP3 HD SING POW OPT CAP             	  6711.70	 $6711.70	      ---	       --	009	0	0	0.00	  $671.17	Y	
1	K0860	PWC GP3 VHD SING POW OPT S/B            	 12064.92	$12064.92	      ---	       --	009	0	0	0.00	 $1005.41	Y	
1	K0861	PWC GP3 STD MULT POW OPT S/B            	  6817.68	 $6817.68	      ---	       --	009	0	0	0.00	  $568.14	Y	
1	K0862	PWC GP3 HD MULT POW OPT S/B             	  8445.12	 $8445.12	      ---	       --	009	0	0	0.00	  $703.76	Y	
1	K0863	PWC GP3 VHD MULT POW OPT S/B            	 12064.92	$12064.92	      ---	       --	009	0	0	0.00	 $1005.41	Y	
1	K0864	PWC GP3 XHD MULT POW OPT S/B            	 11964.50	$11964.50	      ---	       --	009	0	0	0.00	 $1196.45	Y	
1	K0868	PWC GP 4 STD SEAT/BACK                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0869	PWC GP 4 STD CAP CHAIR                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0870	PWC GP 4 HD SEAT/BACK                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0871	PWC GP 4 VHD SEAT/BACK                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0877	PWC GP4 STD SING POW OPT S/B            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0878	PWC GP4 STD SING POW OPT CAP            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0879	PWC GP4 HD SING POW OPT S/B             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0880	PWC GP4 VHD SING POW OPT S/B            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0884	PWC GP4 STD MULT POW OPT S/B            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0885	PWC GP4 STD MULT POW OPT CAP            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0886	PWC GP4 HD MULT POW S/B                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0890	PWC GP5 PED SING POW OPT S/B            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0891	PWC GP5 PED MULT POW OPT S/B            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K0898	POWER WHEELCHAIR NOC                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	K1030	EXT RECHARGE BAT REPLACEMENT            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0113	CRANIAL CERVICAL TORTICOLLIS            	   201.62	  $201.62	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0120	CERV FLEX N/ADJ FOAM PRE OTS            	    21.30	   $21.30	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0130	FLEX THERMOPLASTIC COLLAR MO            	    74.10	   $74.10	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0140	CERVICAL SEMI-RIGID ADJUSTAB            	    38.55	   $38.55	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0150	CERV SEMI-RIG ADJ MOLDED CHN            	    68.26	   $68.26	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0160	CERV SR WIRE OCC/MAN PRE OTS            	    76.48	   $76.48	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0170	CERVICAL COLLAR MOLDED TO PT            	   357.73	  $357.73	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0172	CERV COL SR FOAM 2PC PRE OTS            	    90.81	   $90.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0174	CERV SR 2PC THOR EXT PRE OTS            	   182.93	  $182.93	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0180	CER POST COL OCC/MAN SUP ADJ            	   177.53	  $177.53	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0190	CERV COLLAR SUPP ADJ CERV BA            	   259.73	  $259.73	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0200	CERV COL SUPP ADJ BAR & THOR            	   349.54	  $349.54	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0220	THOR RIB BELT CUSTOM FABRICA            	    34.48	   $34.48	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0450	TLSO FLEX TRUNK/THOR PRE OTS            	   139.55	  $139.55	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0452	TLSO FLEX CUSTOM FAB THORACI            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0454	TLSO TRNK SJ-T9 PRE CST                 	   218.02	  $218.02	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0455	TLSO FLEX TRNK SJ-T9 PRE OTS            	   255.37	  $255.37	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0456	TLSO FLEX TRNK SJ-SS PRE CST            	   625.21	  $625.21	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0457	TLSO FLEX TRNK SJ-SS PRE OTS            	   732.33	  $732.33	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0458	TLSO 2MOD SYMPHIS-XIPHO PRE             	   560.62	  $560.62	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0460	TLSO 2 SHL SYMPHYS-STERN CST            	   631.00	  $631.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0462	TLSO 3MOD SACRO-SCAP PRE                	   784.86	  $784.86	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0464	TLSO 4MOD SACRO-SCAP PRE                	   934.38	  $934.38	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0466	TLSO R FRAM SOFT ANT PRE CST            	   299.99	  $299.99	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0467	TLSO R FRAM SOFT PRE OTS                	   351.40	  $351.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0468	TLSO RIG FRAM PELVIC PRE CST            	   363.60	  $363.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0469	TLSO RIG FRAM PELVIC PRE OTS            	   425.90	  $425.90	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0470	TLSO RIGID FRAME PRE SUBCLAV            	   511.92	  $511.92	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0472	TLSO RIGID FRAME HYPEREX PRE            	   324.66	  $324.66	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0480	TLSO RIGID PLASTIC CUSTOM FA            	   974.23	  $974.23	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0482	TLSO RIGID LINED CUSTOM FAB             	  1111.01	 $1111.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0484	TLSO RIGID PLASTIC CUST FAB             	  1250.29	 $1250.29	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0486	TLSO RIGIDLINED CUST FAB TWO            	  1354.09	 $1354.09	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0488	TLSO RIGID LINED PRE ONE PIE            	   631.00	  $631.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0490	TLSO RIGID PLASTIC PRE ONE              	   177.82	  $177.82	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0491	TLSO 2 PIECE RIGID SHELL                	   482.78	  $482.78	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0492	TLSO 3 PIECE RIGID SHELL                	   333.14	  $333.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0621	SIO FLEX PELVIC/SACR PRE OTS            	    74.04	   $74.04	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0622	SIO FLEX PELVISACRAL CUSTOM             	   207.43	  $207.43	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0623	SIO RIG PNL PELV/SAC PRE OTS            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0624	SIO PANEL CUSTOM                        	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0625	LO FLEX L1-BELOW L5 PRE OTS             	    34.62	   $34.62	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0626	LO SAG RIG PNL STAYS PRE CST            	    49.00	   $49.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0627	LO SAG RI AN/POS PNL PRE CST            	   258.38	  $258.38	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0628	LSO FLEX NO RI STAYS PRE OTS            	    52.74	   $52.74	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0629	LSO FLEX W/RIGID STAYS CUST             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0630	LSO R POST PNL SJ-T9 PRE CST            	   101.81	  $101.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0631	LSO SAG R AN/POS PNL PRE CST            	   645.31	  $645.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0632	LSO SAG RIGID FRAME CUST                	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0633	LSO SC R POS/LAT PNL PRE CST            	   180.25	  $180.25	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0634	LSO FLEXION CONTROL CUSTOM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0635	LSO SAGIT RIGID PANEL PREFAB            	   768.58	  $768.58	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0636	LSO SAGITTAL RIGID PANEL CUS            	  1137.77	 $1137.77	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0637	LSO SC R ANT/POS PNL PRE CST            	   760.51	  $760.51	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0638	LSO SAG-CORONAL PANEL CUSTOM            	   829.08	  $829.08	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0639	LSO S/C SHELL/PANEL PREFAB              	   760.51	  $760.51	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0640	LSO S/C SHELL/PANEL CUSTOM              	   657.77	  $657.77	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0641	LO RIG POS PNL L1-L5 PRE OTS            	    57.38	   $57.38	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0642	LO SAG RI AN/POS PNL PRE OTS            	   302.67	  $302.67	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0643	LSO SAG CTR RIGI POS PRE OTS            	   119.25	  $119.25	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0648	LSO SAG R AN/POS PNL PRE OTS            	   755.89	  $755.89	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0649	LSO SC R POS/LAT PNL PRE OTS            	   211.14	  $211.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0650	LSO SC R ANT/POS PNL PRE OTS            	   890.84	  $890.84	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0651	LSO SAG-CO SHELL PNL PRE OTS            	   890.84	  $890.84	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0700	CTLSO A-P-L CONTROL MOLDED              	   917.54	  $917.54	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0710	CTLSO A-P-L CONTROL W/ INTER            	  1036.20	 $1036.20	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0810	HALO CERVICAL INTO JCKT VEST            	  1861.11	 $1861.11	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0820	HALO CERVICAL INTO BODY JACK            	  1109.32	 $1109.32	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0830	HALO CERV INTO MILWAUKEE TYP            	  2517.85	 $2517.85	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0859	MRI COMPATIBLE SYSTEM                   	   733.62	  $733.62	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0861	HALO REPL LINER/INTERFACE               	   135.49	  $135.49	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0970	TLSO CORSET FRONT                       	    74.83	   $74.83	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0972	LSO CORSET FRONT                        	    74.83	   $74.83	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0974	TLSO FULL CORSET                        	   114.88	  $114.88	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0976	LSO FULL CORSET                         	    82.00	   $82.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0978	AXILLARY CRUTCH EXTENSION               	   154.56	  $154.56	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L0978	AXILLARY CRUTCH EXTENSION               	   154.56	  $154.56	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L0980	PERONEAL STRAPS PAIR PRE OTS            	     5.99	    $5.99	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0980	PERONEAL STRAPS PAIR PRE OTS            	     5.99	    $5.99	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0982	STOCKING SUP GRIPS 4 PRE OTS            	     7.12	    $7.12	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L0982	STOCKING SUP GRIPS 4 PRE OTS            	     7.12	    $7.12	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L0984	PROTECT BODY SOCK EA PRE OTS            	    38.10	   $38.10	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1000	CTLSO MILWAUKE INITIAL MODEL            	  1260.07	 $1260.07	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1001	CTLSO INFANT IMMOBILIZER                	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1005	TENSION BASED SCOLIOSIS ORTH            	  2011.94	 $2011.94	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1010	CTLSO AXILLA SLING                      	    31.31	   $31.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1020	KYPHOSIS PAD                            	    62.06	   $62.06	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1025	KYPHOSIS PAD FLOATING                   	    68.69	   $68.69	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1030	LUMBAR BOLSTER PAD                      	    23.75	   $23.75	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1040	LUMBAR OR LUMBAR RIB PAD                	    54.85	   $54.85	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1050	STERNAL PAD                             	    58.02	   $58.02	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1060	THORACIC PAD                            	    57.78	   $57.78	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1070	TRAPEZIUS SLING                         	    53.75	   $53.75	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1080	OUTRIGGER                               	    29.15	   $29.15	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1085	OUTRIGGER BIL W/ VERT EXTENS            	   102.92	  $102.92	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1090	LUMBAR SLING                            	    57.13	   $57.13	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1100	RING FLANGE PLASTIC/LEATHER             	   118.66	  $118.66	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1110	RING FLANGE PLAS/LEATHER MOL            	   167.60	  $167.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1120	COVERS FOR UPRIGHT EACH                 	    31.89	   $31.89	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1200	FURNSH INITIAL ORTHOSIS ONLY            	  1237.87	 $1237.87	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1210	LATERAL THORACIC EXTENSION              	   139.61	  $139.61	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1220	ANTERIOR THORACIC EXTENSION             	   139.61	  $139.61	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1230	MILWAUKEE TYPE SUPERSTRUCTUR            	   139.61	  $139.61	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1240	LUMBAR DEROTATION PAD                   	    50.40	   $50.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1250	ANTERIOR ASIS PAD                       	    38.06	   $38.06	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1260	ANTERIOR THORACIC DEROTATION            	    41.96	   $41.96	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1270	ABDOMINAL PAD                           	    56.61	   $56.61	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1280	RIB GUSSET (ELASTIC) EACH               	    64.40	   $64.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1290	LATERAL TROCHANTERIC PAD                	    63.11	   $63.11	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1300	BODY JACKET MOLD TO PATIENT             	  1026.38	 $1026.38	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1310	POST-OPERATIVE BODY JACKET              	   811.44	  $811.44	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1600	HO FLEX FREJKA W/COV PRE CST            	    74.47	   $74.47	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1610	HO FREJKA COV ONLY PRE CST              	    18.63	   $18.63	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1620	HO FLEX PAVLIK HARNS PRE CST            	   100.03	  $100.03	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1630	ABDUCT CONTROL HIP SEMI-FLEX            	    77.60	   $77.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1640	PELV BAND/SPREAD BAR THIGH C            	   167.12	  $167.12	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1650	HO ABDUCTION HIP ADJUSTABLE             	   154.60	  $154.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1652	HO BI THIGHCUFFS W SPRDR BAR            	   224.08	  $224.08	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1660	HO ABDUCTION STATIC PLASTIC             	    73.10	   $73.10	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1680	PELVIC & HIP CONTROL THIGH C            	   780.18	  $780.18	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1685	POST-OP HIP ABDUCT CUSTOM FA            	   955.08	  $955.08	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1686	HO POST-OP HIP ABDUCTION                	   654.94	  $654.94	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1690	COMBINATION BILATERAL HO                	   977.03	  $977.03	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1700	LEG PERTHES ORTH TORONTO TYP            	   850.78	  $850.78	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1710	LEGG PERTHES ORTH NEWINGTON             	  1263.72	 $1263.72	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1720	LEGG PERTHES ORTHOSIS TRILAT            	   827.65	  $827.65	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1730	LEGG PERTHES ORTH SCOTTISH R            	   820.70	  $820.70	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1755	LEGG PERTHES PATTEN BOTTOM T            	   565.86	  $565.86	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1810	KO ELASTIC WITH JOINTS                  	    72.69	   $72.69	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1812	KO ELASTIC W/JOINTS PRE OTS             	    91.64	   $91.64	      ---	       --	009	0	0	0.00	    $0.00	N	
1	L1820	KO ELAS W/ CONDYLE PADS & JO            	    80.69	   $80.69	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1830	KO IMMOB CANVAS LONG PRE OTS            	    70.24	   $70.24	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1831	KNEE ORTH POS LOCKING JOINT             	   185.01	  $185.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1832	KO ADJ JNT POS R SUP PRE CST            	   384.13	  $384.13	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1833	KO ADJ JNT POS R SUP PRE OTS            	   512.10	  $512.10	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1834	KO W/0 JOINT RIGID MOLDED TO            	   400.40	  $400.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1836	KO RIGID W/O JOINTS PRE OTS             	    83.37	   $83.37	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1840	KO DEROT ANT CRUCIATE CUSTOM            	   655.72	  $655.72	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1843	KO SINGLE UPRIGHT PRE CST               	   259.70	  $259.70	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1844	KO W/ADJ JT ROT CNTRL MOLDED            	   980.95	  $980.95	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1845	KO DOUBLE UPRIGHT PRE CST               	   349.56	  $349.56	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1846	KO W ADJ FLEX/EXT ROTAT MOLD            	   644.44	  $644.44	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1847	KO DBL UPRIGHT W/AIR PRE CST            	   290.60	  $290.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1848	KO DBL UPRIGHT W/AIR PRE OTS            	   423.51	  $423.51	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1850	KO SWEDISH TYPE PRE OTS                 	   174.42	  $174.42	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1851	KO SINGLE UPRIGHT PREFAB OTS            	   672.58	  $672.58	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1852	KO DOUBLE UPRIGHT PREFAB OTS            	   586.95	  $586.95	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1860	KO SUPRACONDYLAR SOCKET MOLD            	   518.05	  $518.05	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1900	AFO SPRNG WIR DRSFLX CALF BD            	   132.35	  $132.35	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L1900	AFO SPRNG WIR DRSFLX CALF BD            	   132.35	  $132.35	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L1904	AFO MOLDED ANKLE GAUNTLET               	   337.31	  $337.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1904	AFO MOLDED ANKLE GAUNTLET               	   337.31	  $337.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1906	AFO MULTILIG ANK SUP PRE OTS            	    96.56	   $96.56	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L1906	AFO MULTILIG ANK SUP PRE OTS            	    96.56	   $96.56	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L1907	AFO SUPRAMALLEOLAR CUSTOM               	   353.71	  $353.71	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1907	AFO SUPRAMALLEOLAR CUSTOM               	   353.71	  $353.71	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1910	AFO SING BAR CLASP ATTACH SH            	   147.95	  $147.95	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L1910	AFO SING BAR CLASP ATTACH SH            	   147.95	  $147.95	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L1920	AFO SING UPRIGHT W/ ADJUST S            	   219.54	  $219.54	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1920	AFO SING UPRIGHT W/ ADJUST S            	   219.54	  $219.54	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1930	AFO PLASTIC                             	   132.43	  $132.43	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L1930	AFO PLASTIC                             	   132.43	  $132.43	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L1932	AFO RIG ANT TIB TCF/= CUSTOM            	   560.94	  $560.94	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1932	AFO RIG ANT TIB TCF/= CUSTOM            	   560.94	  $560.94	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1940	AFO MOLDED TO PATIENT PLASTI            	   347.88	  $347.88	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L1940	AFO MOLDED TO PATIENT PLASTI            	   347.88	  $347.88	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L1945	AFO MOLDED PLAS RIG ANT TIB             	   554.40	  $554.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1945	AFO MOLDED PLAS RIG ANT TIB             	   554.40	  $554.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1950	AFO SPIRAL MOLDED TO PT PLAS            	   437.48	  $437.48	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L1950	AFO SPIRAL MOLDED TO PT PLAS            	   437.48	  $437.48	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L1951	AFO SPIRAL PREFAB CUSTOM                	   527.93	  $527.93	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1951	AFO SPIRAL PREFAB CUSTOM                	   527.93	  $527.93	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1960	AFO POS SOLID ANK PLASTIC MO            	   332.00	  $332.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L1960	AFO POS SOLID ANK PLASTIC MO            	   332.00	  $332.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L1970	AFO PLASTIC MOLDED W/ANKLE J            	   449.28	  $449.28	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1970	AFO PLASTIC MOLDED W/ANKLE J            	   449.28	  $449.28	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1971	AFO W/ANKLE JOINT, PREFAB               	   294.64	  $294.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L1971	AFO W/ANKLE JOINT, PREFAB               	   294.64	  $294.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L1980	AFO SING SOLID STIRRUP CALF             	   235.66	  $235.66	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1980	AFO SING SOLID STIRRUP CALF             	   235.66	  $235.66	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L1990	AFO DOUB SOLID STIRRUP CALF             	   274.89	  $274.89	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L1990	AFO DOUB SOLID STIRRUP CALF             	   274.89	  $274.89	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2000	KAFO SING FRE STIRR THI/CALF            	   814.41	  $814.41	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2000	KAFO SING FRE STIRR THI/CALF            	   814.41	  $814.41	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2005	KAFO SNG/DBL MECHANICAL ACT             	  2575.86	 $2575.86	      ---	       --	009	0	0	0.00	    $0.00	N	
P	L2005	KAFO SNG/DBL MECHANICAL ACT             	  2575.86	 $2575.86	      ---	       --	009	0	0	0.00	    $0.00	N	
P	L2006	KAF SNG/DBL SWG/STN MCPR CUS            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2006	KAF SNG/DBL SWG/STN MCPR CUS            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2010	KAFO SNG SOLID STIRRUP W/O J            	   742.41	  $742.41	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2010	KAFO SNG SOLID STIRRUP W/O J            	   742.41	  $742.41	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2020	KAFO DBL SOLID STIRRUP BAND/            	   925.91	  $925.91	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2020	KAFO DBL SOLID STIRRUP BAND/            	   925.91	  $925.91	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2030	KAFO DBL SOLID STIRRUP W/O J            	   753.20	  $753.20	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2030	KAFO DBL SOLID STIRRUP W/O J            	   753.20	  $753.20	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2034	KAFO PLA SIN UP W/WO K/A CUS            	  1259.40	 $1259.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2034	KAFO PLA SIN UP W/WO K/A CUS            	  1259.40	 $1259.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2035	KAFO PLASTIC PEDIATRIC SIZE             	    83.31	   $83.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2035	KAFO PLASTIC PEDIATRIC SIZE             	    83.31	   $83.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2036	KAFO PLAS DOUB FREE KNEE MOL            	   943.12	  $943.12	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2036	KAFO PLAS DOUB FREE KNEE MOL            	   943.12	  $943.12	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2037	KAFO PLAS SING FREE KNEE MOL            	   943.12	  $943.12	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2037	KAFO PLAS SING FREE KNEE MOL            	   943.12	  $943.12	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2038	KAFO W/O JOINT MULTI-AXIS AN            	   811.87	  $811.87	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2038	KAFO W/O JOINT MULTI-AXIS AN            	   811.87	  $811.87	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2040	HKAFO TORSION BIL ROT STRAPS            	    68.52	   $68.52	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2040	HKAFO TORSION BIL ROT STRAPS            	    68.52	   $68.52	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2050	HKAFO TORSION CABLE HIP PELV            	   249.84	  $249.84	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2050	HKAFO TORSION CABLE HIP PELV            	   249.84	  $249.84	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2060	HKAFO TORSION BALL BEARING J            	   427.86	  $427.86	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2060	HKAFO TORSION BALL BEARING J            	   427.86	  $427.86	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2070	HKAFO TORSION UNILAT ROT STR            	    61.09	   $61.09	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2070	HKAFO TORSION UNILAT ROT STR            	    61.09	   $61.09	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2080	HKAFO UNILAT TORSION CABLE              	   173.82	  $173.82	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2080	HKAFO UNILAT TORSION CABLE              	   173.82	  $173.82	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2090	HKAFO UNILAT TORSION BALL BR            	   264.25	  $264.25	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2090	HKAFO UNILAT TORSION BALL BR            	   264.25	  $264.25	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2106	AFO TIB FX CAST PLASTER MOLD            	   162.40	  $162.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2106	AFO TIB FX CAST PLASTER MOLD            	   162.40	  $162.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2108	AFO TIB FX CAST MOLDED TO PT            	   565.16	  $565.16	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2108	AFO TIB FX CAST MOLDED TO PT            	   565.16	  $565.16	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2112	AFO TIBIAL FRACTURE SOFT                	   237.44	  $237.44	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2112	AFO TIBIAL FRACTURE SOFT                	   237.44	  $237.44	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2114	AFO TIB FX SEMI-RIGID                   	   434.00	  $434.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2114	AFO TIB FX SEMI-RIGID                   	   434.00	  $434.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2116	AFO TIBIAL FRACTURE RIGID               	   477.58	  $477.58	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2116	AFO TIBIAL FRACTURE RIGID               	   477.58	  $477.58	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2126	KAFO FEM FX CAST THERMOPLAS             	   660.98	  $660.98	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2126	KAFO FEM FX CAST THERMOPLAS             	   660.98	  $660.98	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2128	KAFO FEM FX CAST MOLDED TO P            	   991.29	  $991.29	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2128	KAFO FEM FX CAST MOLDED TO P            	   991.29	  $991.29	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2132	KAFO FEMORAL FX CAST SOFT               	   500.63	  $500.63	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2132	KAFO FEMORAL FX CAST SOFT               	   500.63	  $500.63	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2134	KAFO FEM FX CAST SEMI-RIGID             	   644.00	  $644.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2134	KAFO FEM FX CAST SEMI-RIGID             	   644.00	  $644.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2136	KAFO FEMORAL FX CAST RIGID              	   820.93	  $820.93	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2136	KAFO FEMORAL FX CAST RIGID              	   820.93	  $820.93	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2180	PLAS SHOE INSERT W ANK JOINT            	    94.02	   $94.02	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2180	PLAS SHOE INSERT W ANK JOINT            	    94.02	   $94.02	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2182	DROP LOCK KNEE                          	    44.63	   $44.63	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2182	DROP LOCK KNEE                          	    44.63	   $44.63	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2184	LIMITED MOTION KNEE JOINT               	    40.08	   $40.08	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2184	LIMITED MOTION KNEE JOINT               	    40.08	   $40.08	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2186	ADJ MOTION KNEE JNT LERMAN T            	    61.32	   $61.32	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2186	ADJ MOTION KNEE JNT LERMAN T            	    61.32	   $61.32	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2188	QUADRILATERAL BRIM                      	    38.99	   $38.99	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2188	QUADRILATERAL BRIM                      	    38.99	   $38.99	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2190	WAIST BELT                              	    44.24	   $44.24	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2190	WAIST BELT                              	    44.24	   $44.24	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2192	PELVIC BAND & BELT THIGH FLA            	   250.24	  $250.24	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2192	PELVIC BAND & BELT THIGH FLA            	   250.24	  $250.24	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2200	LIMITED ANKLE MOTION EA JNT             	    28.64	   $28.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2200	LIMITED ANKLE MOTION EA JNT             	    28.64	   $28.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2210	DORSIFLEXION ASSIST EACH JOI            	    30.80	   $30.80	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2210	DORSIFLEXION ASSIST EACH JOI            	    30.80	   $30.80	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2220	DORSI & PLANTAR FLEX ASS/RES            	    50.55	   $50.55	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2220	DORSI & PLANTAR FLEX ASS/RES            	    50.55	   $50.55	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2230	SPLIT FLAT CALIPER STIRR & P            	    54.08	   $54.08	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2230	SPLIT FLAT CALIPER STIRR & P            	    54.08	   $54.08	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2232	ROCKER BOTTOM, CONTACT AFO              	    62.56	   $62.56	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2232	ROCKER BOTTOM, CONTACT AFO              	    62.56	   $62.56	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2240	ROUND CALIPER AND PLATE ATTA            	    50.85	   $50.85	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2240	ROUND CALIPER AND PLATE ATTA            	    50.85	   $50.85	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2250	FOOT PLATE MOLDED STIRRUP AT            	   285.31	  $285.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2250	FOOT PLATE MOLDED STIRRUP AT            	   285.31	  $285.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2260	REINFORCED SOLID STIRRUP                	   160.96	  $160.96	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2260	REINFORCED SOLID STIRRUP                	   160.96	  $160.96	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2265	LONG TONGUE STIRRUP                     	    52.64	   $52.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2265	LONG TONGUE STIRRUP                     	    52.64	   $52.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2270	VARUS/VALGUS STRAP PADDED/LI            	    43.12	   $43.12	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2270	VARUS/VALGUS STRAP PADDED/LI            	    43.12	   $43.12	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2275	PLASTIC MOD LOW EXT PAD/LINE            	    72.37	   $72.37	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2275	PLASTIC MOD LOW EXT PAD/LINE            	    72.37	   $72.37	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2280	MOLDED INNER BOOT                       	   258.15	  $258.15	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2280	MOLDED INNER BOOT                       	   258.15	  $258.15	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2300	ABDUCTION BAR JOINTED ADJUST            	   216.18	  $216.18	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2300	ABDUCTION BAR JOINTED ADJUST            	   216.18	  $216.18	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2310	ABDUCTION BAR-STRAIGHT                  	    98.78	   $98.78	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2310	ABDUCTION BAR-STRAIGHT                  	    98.78	   $98.78	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2320	NON-MOLDED LACER                        	    93.10	   $93.10	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2320	NON-MOLDED LACER                        	    93.10	   $93.10	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2330	LACER MOLDED TO PATIENT MODE            	   206.53	  $206.53	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2335	ANTERIOR SWING BAND                     	   147.53	  $147.53	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2340	PRE-TIBIAL SHELL MOLDED TO P            	   262.19	  $262.19	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2340	PRE-TIBIAL SHELL MOLDED TO P            	   262.19	  $262.19	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2350	PROSTHETIC TYPE SOCKET MOLDE            	   715.46	  $715.46	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2350	PROSTHETIC TYPE SOCKET MOLDE            	   715.46	  $715.46	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2360	EXTENDED STEEL SHANK                    	    27.36	   $27.36	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2360	EXTENDED STEEL SHANK                    	    27.36	   $27.36	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2370	PATTEN BOTTOM                           	   206.12	  $206.12	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2370	PATTEN BOTTOM                           	   206.12	  $206.12	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2375	TORSION ANK & HALF SOLID STI            	    70.18	   $70.18	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2375	TORSION ANK & HALF SOLID STI            	    70.18	   $70.18	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2380	TORSION STRAIGHT KNEE JOINT             	    82.86	   $82.86	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2385	STRAIGHT KNEE JOINT HEAVY DU            	    76.95	   $76.95	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2387	ADD LE POLY KNEE CUSTOM KAFO            	   132.88	  $132.88	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2390	OFFSET KNEE JOINT EACH                  	    62.06	   $62.06	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2395	OFFSET KNEE JOINT HEAVY DUTY            	    85.54	   $85.54	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2397	SUSPENSION SLEEVE LOWER EXT             	    61.16	   $61.16	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2405	KNEE JOINT DROP LOCK EA JNT             	    37.82	   $37.82	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2415	KNEE JOINT CAM LOCK EACH JOI            	    73.41	   $73.41	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2425	KNEE DISC/DIAL LOCK/ADJ FLEX            	    70.12	   $70.12	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2430	KNEE JNT RATCHET LOCK EA JNT            	    46.55	   $46.55	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2492	KNEE LIFT LOOP DROP LOCK RIN            	    57.20	   $57.20	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2500	THI/GLUT/ISCHIA WGT BEARING             	   158.01	  $158.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2510	TH/WGHT BEAR QUAD-LAT BRIM M            	   401.20	  $401.20	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2520	TH/WGHT BEAR QUAD-LAT BRIM C            	   307.56	  $307.56	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2525	TH/WGHT BEAR NAR M-L BRIM MO            	   415.52	  $415.52	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2526	TH/WGHT BEAR NAR M-L BRIM CU            	   200.48	  $200.48	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2530	THIGH/WGHT BEAR LACER NON-MO            	   151.25	  $151.25	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2540	THIGH/WGHT BEAR LACER MOLDED            	   242.50	  $242.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2550	THIGH/WGHT BEAR HIGH ROLL CU            	   171.62	  $171.62	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2570	HIP CLEVIS TYPE 2 POSIT JNT             	   257.60	  $257.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2580	PELVIC CONTROL PELVIC SLING             	   308.61	  $308.61	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2600	HIP CLEVIS/THRUST BEARING FR            	   122.42	  $122.42	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2610	HIP CLEVIS/THRUST BEARING LO            	   194.99	  $194.99	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2620	PELVIC CONTROL HIP HEAVY DUT            	   190.07	  $190.07	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2622	HIP JOINT ADJUSTABLE FLEXION            	   238.26	  $238.26	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2624	HIP ADJ FLEX EXT ABDUCT CONT            	   265.89	  $265.89	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2627	PLASTIC MOLD RECIPRO HIP & C            	   874.72	  $874.72	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2628	METAL FRAME RECIPRO HIP & CA            	   666.32	  $666.32	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2630	PELVIC CONTROL BAND & BELT U            	   116.70	  $116.70	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2640	PELVIC CONTROL BAND & BELT B            	   165.93	  $165.93	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2650	PELV & THOR CONTROL GLUTEAL             	    48.18	   $48.18	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2660	THORACIC CONTROL THORACIC BA            	   104.65	  $104.65	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2670	THORAC CONT PARASPINAL UPRIG            	    89.17	   $89.17	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2680	THORAC CONT LAT SUPPORT UPRI            	    78.31	   $78.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2750	PLATING CHROME/NICKEL PR BAR            	    31.68	   $31.68	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2755	CARBON GRAPHITE LAMINATION              	    61.87	   $61.87	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2760	EXTENSION PER EXTENSION PER             	    37.59	   $37.59	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2768	ORTHO SIDEBAR DISCONNECT                	    81.90	   $81.90	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2780	NON-CORROSIVE FINISH                    	    40.07	   $40.07	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2785	DROP LOCK RETAINER EACH                 	    11.15	   $11.15	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2795	KNEE CONTROL FULL KNEECAP               	    59.71	   $59.71	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2800	KNEE CAP MEDIAL OR LATERAL P            	    73.36	   $73.36	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2810	KNEE CONTROL CONDYLAR PAD               	    59.15	   $59.15	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2820	SOFT INTERFACE BELOW KNEE SE            	    69.73	   $69.73	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2820	SOFT INTERFACE BELOW KNEE SE            	    69.73	   $69.73	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2830	SOFT INTERFACE ABOVE KNEE SE            	    75.44	   $75.44	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2840	TIBIAL LENGTH SOCK FX OR EQU            	    18.48	   $18.48	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2840	TIBIAL LENGTH SOCK FX OR EQU            	    18.48	   $18.48	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2850	FEMORAL LGTH SOCK FX OR EQUA            	    24.64	   $24.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2850	FEMORAL LGTH SOCK FX OR EQUA            	    24.64	   $24.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L2861	TORSION MECHANISM KNEE/ANKLE            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L2861	TORSION MECHANISM KNEE/ANKLE            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3000	FT INSERT UCB BERKELEY SHELL            	   227.19	  $227.19	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3000	FT INSERT UCB BERKELEY SHELL            	   227.19	  $227.19	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3100	HALLUS-VALGUS NT DYN PRE OTS            	    16.73	   $16.73	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3100	HALLUS-VALGUS NT DYN PRE OTS            	    16.73	   $16.73	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3140	ABDUCTION ROTATION BAR SHOE             	    55.97	   $55.97	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3140	ABDUCTION ROTATION BAR SHOE             	    55.97	   $55.97	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3150	ABDUCT ROTATION BAR W/O SHOE            	    51.17	   $51.17	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3150	ABDUCT ROTATION BAR W/O SHOE            	    51.17	   $51.17	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3160	SHOE STYLED POSITIONING DEV             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3160	SHOE STYLED POSITIONING DEV             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3201	OXFORD W SUPINAT/PRONAT INF             	    40.44	   $40.44	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3201	OXFORD W SUPINAT/PRONAT INF             	    40.44	   $40.44	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3202	OXFORD W/ SUPINAT/PRONATOR C            	    42.68	   $42.68	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3202	OXFORD W/ SUPINAT/PRONATOR C            	    42.68	   $42.68	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3203	OXFORD W/ SUPINATOR/PRONATOR            	    42.68	   $42.68	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3203	OXFORD W/ SUPINATOR/PRONATOR            	    42.68	   $42.68	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3204	HIGHTOP W/ SUPP/PRONATOR INF            	    40.44	   $40.44	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3204	HIGHTOP W/ SUPP/PRONATOR INF            	    40.44	   $40.44	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3206	HIGHTOP W/ SUPP/PRONATOR CHI            	    42.68	   $42.68	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3206	HIGHTOP W/ SUPP/PRONATOR CHI            	    42.68	   $42.68	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3207	HIGHTOP W/ SUPP/PRONATOR JUN            	    42.68	   $42.68	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3207	HIGHTOP W/ SUPP/PRONATOR JUN            	    42.68	   $42.68	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3208	SURGICAL BOOT EACH INFANT               	    19.60	   $19.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3208	SURGICAL BOOT EACH INFANT               	    19.60	   $19.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3209	SURGICAL BOOT EACH CHILD                	    21.84	   $21.84	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3209	SURGICAL BOOT EACH CHILD                	    21.84	   $21.84	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3211	SURGICAL BOOT EACH JUNIOR               	    23.52	   $23.52	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3211	SURGICAL BOOT EACH JUNIOR               	    23.52	   $23.52	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3212	BENESCH BOOT PAIR INFANT                	    36.40	   $36.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3212	BENESCH BOOT PAIR INFANT                	    36.40	   $36.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3213	BENESCH BOOT PAIR CHILD                 	    39.20	   $39.20	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3213	BENESCH BOOT PAIR CHILD                 	    39.20	   $39.20	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3214	BENESCH BOOT PAIR JUNIOR                	    44.24	   $44.24	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3214	BENESCH BOOT PAIR JUNIOR                	    44.24	   $44.24	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3215	ORTHOPEDIC FTWEAR LADIES OXF            	    42.12	   $42.12	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3215	ORTHOPEDIC FTWEAR LADIES OXF            	    42.12	   $42.12	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3216	ORTHOPED LADIES SHOES DPTH I            	    73.92	   $73.92	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3216	ORTHOPED LADIES SHOES DPTH I            	    73.92	   $73.92	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3217	LADIES SHOES HIGHTOP DEPTH I            	    58.80	   $58.80	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3217	LADIES SHOES HIGHTOP DEPTH I            	    58.80	   $58.80	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3219	ORTHOPEDIC MENS SHOES OXFORD            	    53.35	   $53.35	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3219	ORTHOPEDIC MENS SHOES OXFORD            	    53.35	   $53.35	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3221	ORTHOPEDIC MENS SHOES DPTH I            	    73.92	   $73.92	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3221	ORTHOPEDIC MENS SHOES DPTH I            	    73.92	   $73.92	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3222	MENS SHOES HIGHTOP DEPTH INL            	    58.80	   $58.80	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3222	MENS SHOES HIGHTOP DEPTH INL            	    58.80	   $58.80	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3230	CUSTOM SHOES DEPTH INLAY                	   171.02	  $171.02	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3230	CUSTOM SHOES DEPTH INLAY                	   171.02	  $171.02	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3250	CUSTOM MOLD SHOE REMOV PROST            	   171.02	  $171.02	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3250	CUSTOM MOLD SHOE REMOV PROST            	   171.02	  $171.02	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3251	SHOE MOLDED TO PT SILICONE S            	   255.36	  $255.36	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3251	SHOE MOLDED TO PT SILICONE S            	   255.36	  $255.36	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3252	SHOE MOLDED PLASTAZOTE CUST             	   157.92	  $157.92	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3252	SHOE MOLDED PLASTAZOTE CUST             	   157.92	  $157.92	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3253	SHOE MOLDED PLASTAZOTE CUST             	    50.40	   $50.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3253	SHOE MOLDED PLASTAZOTE CUST             	    50.40	   $50.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3254	ORTH FOOT NON-STNDARD SIZE/W            	    21.28	   $21.28	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3254	ORTH FOOT NON-STNDARD SIZE/W            	    21.28	   $21.28	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3255	ORTH FOOT NON-STANDARD SIZE/            	    21.28	   $21.28	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3255	ORTH FOOT NON-STANDARD SIZE/            	    21.28	   $21.28	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3257	ORTH FOOT ADD CHARGE SPLIT S            	    39.20	   $39.20	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3257	ORTH FOOT ADD CHARGE SPLIT S            	    39.20	   $39.20	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3260	AMBULATORY SURGICAL BOOT EAC            	    76.53	   $76.53	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3260	AMBULATORY SURGICAL BOOT EAC            	    76.53	   $76.53	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3265	PLASTAZOTE SANDAL EACH                  	    50.40	   $50.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3265	PLASTAZOTE SANDAL EACH                  	    50.40	   $50.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3300	SHO LIFT TAPER TO METATARSAL            	    32.78	   $32.78	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3300	SHO LIFT TAPER TO METATARSAL            	    32.78	   $32.78	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3310	SHOE LIFT ELEV HEEL/SOLE NEO            	    41.17	   $41.17	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3310	SHOE LIFT ELEV HEEL/SOLE NEO            	    41.17	   $41.17	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3320	SHOE LIFT ELEV HEEL/SOLE COR            	   100.78	  $100.78	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3320	SHOE LIFT ELEV HEEL/SOLE COR            	   100.78	  $100.78	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3330	LIFTS ELEVATION METAL EXTENS            	   224.25	  $224.25	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3330	LIFTS ELEVATION METAL EXTENS            	   224.25	  $224.25	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3332	SHOE LIFTS TAPERED TO ONE-HA            	    39.16	   $39.16	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3332	SHOE LIFTS TAPERED TO ONE-HA            	    39.16	   $39.16	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3334	SHOE LIFTS ELEVATION HEEL /I            	     4.93	    $4.93	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3334	SHOE LIFTS ELEVATION HEEL /I            	     4.93	    $4.93	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3340	SHOE WEDGE SACH                         	    21.36	   $21.36	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3340	SHOE WEDGE SACH                         	    21.36	   $21.36	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3350	SHOE HEEL WEDGE                         	     6.57	    $6.57	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3350	SHOE HEEL WEDGE                         	     6.57	    $6.57	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3360	SHOE SOLE WEDGE OUTSIDE SOLE            	     7.96	    $7.96	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3360	SHOE SOLE WEDGE OUTSIDE SOLE            	     7.96	    $7.96	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3370	SHOE SOLE WEDGE BETWEEN SOLE            	    12.53	   $12.53	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3370	SHOE SOLE WEDGE BETWEEN SOLE            	    12.53	   $12.53	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3380	SHOE CLUBFOOT WEDGE                     	    10.33	   $10.33	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3380	SHOE CLUBFOOT WEDGE                     	    10.33	   $10.33	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3390	SHOE OUTFLARE WEDGE                     	    19.04	   $19.04	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3390	SHOE OUTFLARE WEDGE                     	    19.04	   $19.04	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3400	SHOE METATARSAL BAR WEDGE RO            	     6.17	    $6.17	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3400	SHOE METATARSAL BAR WEDGE RO            	     6.17	    $6.17	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3410	SHOE METATARSAL BAR BETWEEN             	    22.79	   $22.79	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3410	SHOE METATARSAL BAR BETWEEN             	    22.79	   $22.79	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3420	FULL SOLE/HEEL WEDGE BTWEEN             	    17.36	   $17.36	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3420	FULL SOLE/HEEL WEDGE BTWEEN             	    17.36	   $17.36	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3430	SHO HEEL COUNT PLAST REINFOR            	    20.64	   $20.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3430	SHO HEEL COUNT PLAST REINFOR            	    20.64	   $20.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3440	HEEL LEATHER REINFORCED                 	    22.78	   $22.78	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3440	HEEL LEATHER REINFORCED                 	    22.78	   $22.78	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3450	SHOE HEEL SACH CUSHION TYPE             	    62.81	   $62.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3450	SHOE HEEL SACH CUSHION TYPE             	    62.81	   $62.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3455	SHOE HEEL NEW LEATHER STANDA            	     9.25	    $9.25	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3455	SHOE HEEL NEW LEATHER STANDA            	     9.25	    $9.25	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3460	SHOE HEEL NEW RUBBER STANDAR            	     4.10	    $4.10	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3460	SHOE HEEL NEW RUBBER STANDAR            	     4.10	    $4.10	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3465	SHOE HEEL THOMAS WITH WEDGE             	    15.27	   $15.27	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3465	SHOE HEEL THOMAS WITH WEDGE             	    15.27	   $15.27	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3470	SHOE HEEL THOMAS EXTEND TO B            	    17.80	   $17.80	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3470	SHOE HEEL THOMAS EXTEND TO B            	    17.80	   $17.80	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3480	SHOE HEEL PAD & DEPRESS FOR             	    15.66	   $15.66	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3480	SHOE HEEL PAD & DEPRESS FOR             	    15.66	   $15.66	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3485	SHOE HEEL PAD REMOVABLE FOR             	    30.24	   $30.24	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3485	SHOE HEEL PAD REMOVABLE FOR             	    30.24	   $30.24	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3500	ORTHO SHOE ADD LEATHER INSOL            	     6.16	    $6.16	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3500	ORTHO SHOE ADD LEATHER INSOL            	     6.16	    $6.16	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3510	ORTHOPEDIC SHOE ADD RUB INSL            	     6.16	    $6.16	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3510	ORTHOPEDIC SHOE ADD RUB INSL            	     6.16	    $6.16	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3520	O SHOE ADD FELT W LEATH INSL            	     8.40	    $8.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3520	O SHOE ADD FELT W LEATH INSL            	     8.40	    $8.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3530	ORTHO SHOE ADD HALF SOLE                	    19.97	   $19.97	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3530	ORTHO SHOE ADD HALF SOLE                	    19.97	   $19.97	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3540	ORTHO SHOE ADD FULL SOLE                	    31.99	   $31.99	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3540	ORTHO SHOE ADD FULL SOLE                	    31.99	   $31.99	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3550	O SHOE ADD STANDARD TOE TAP             	     5.58	    $5.58	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3550	O SHOE ADD STANDARD TOE TAP             	     5.58	    $5.58	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3560	O SHOE ADD HORSESHOE TOE TAP            	     4.48	    $4.48	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3560	O SHOE ADD HORSESHOE TOE TAP            	     4.48	    $4.48	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3570	O SHOE ADD INSTEP EXTENSION             	    53.57	   $53.57	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3570	O SHOE ADD INSTEP EXTENSION             	    53.57	   $53.57	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3580	O SHOE ADD INSTEP VELCRO CLO            	    18.17	   $18.17	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3580	O SHOE ADD INSTEP VELCRO CLO            	    18.17	   $18.17	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3590	O SHOE CONVERT TO SOF COUNTE            	    20.64	   $20.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3590	O SHOE CONVERT TO SOF COUNTE            	    20.64	   $20.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3595	ORTHO SHOE ADD MARCH BAR                	     9.60	    $9.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3595	ORTHO SHOE ADD MARCH BAR                	     9.60	    $9.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3600	TRANS SHOE CALIP PLATE EXIST            	    34.09	   $34.09	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3600	TRANS SHOE CALIP PLATE EXIST            	    34.09	   $34.09	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3610	TRANS SHOE CALIPER PLATE NEW            	    63.15	   $63.15	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3610	TRANS SHOE CALIPER PLATE NEW            	    63.15	   $63.15	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3620	TRANS SHOE SOLID STIRRUP EXI            	    27.30	   $27.30	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3620	TRANS SHOE SOLID STIRRUP EXI            	    27.30	   $27.30	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3630	TRANS SHOE SOLID STIRRUP NEW            	    62.31	   $62.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3630	TRANS SHOE SOLID STIRRUP NEW            	    62.31	   $62.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L3640	SHOE DENNIS BROWNE SPLINT BO            	    13.82	   $13.82	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3640	SHOE DENNIS BROWNE SPLINT BO            	    13.82	   $13.82	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3650	SO 8 ABD RESTRAINT PRE OTS              	    35.98	   $35.98	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3660	SO 8 AB RSTR CAN/WEB PRE OTS            	    66.05	   $66.05	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3670	SO ACRO/CLAV CAN WEB PRE OTS            	    88.85	   $88.85	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3671	SO CAP DESIGN W/O JNTS CF               	   515.50	  $515.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3674	SO AIRPLANE W/WO JOINT CF               	   759.82	  $759.82	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3675	SO VEST CANVAS/WEB PRE OTS              	    87.86	   $87.86	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3677	SO HARD PLAS STABILI PRE CST            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3678	SO HARD PLAS STABILI PRE OTS            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3702	EO W/O JOINTS CF                        	   165.19	  $165.19	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3710	EO ELAS W/METAL JNTS PRE OTS            	    58.14	   $58.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3720	FOREARM/ARM CUFFS FREE MOTIO            	   513.92	  $513.92	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3730	FOREARM/ARM CUFFS EXT/FLEX A            	   560.26	  $560.26	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3740	CUFFS ADJ LOCK W/ ACTIVE CON            	   842.23	  $842.23	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3760	EO ADJ JT PREFAB CUSTOM FIT             	   286.10	  $286.10	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3761	EO, ADJ LOCK JOINT PREFAB OT            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3762	EO RIGID W/O JOINTS PRE OTS             	    61.51	   $61.51	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3763	EWHO RIGID W/O JNTS CF                  	   733.55	  $733.55	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3764	EWHO W/JOINT(S) CF                      	   776.78	  $776.78	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3765	EWHFO RIGID W/O JNTS CF                 	   733.55	  $733.55	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3766	EWHFO W/JOINT(S) CF                     	   776.78	  $776.78	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3806	WHFO W/JOINT(S) CUSTOM FAB              	   292.28	  $292.28	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3807	WHFO W/O JOINTS PRE CST                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3808	WHFO, RIGID W/O JOINTS                  	   168.41	  $168.41	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3809	WHFO W/O JOINTS PRE OTS                 	   167.56	  $167.56	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3891	TORSION MECHANISM WRIST/ELBO            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3900	HINGE EXTENSION/FLEX WRIST/F            	   612.56	  $612.56	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3901	HINGE EXT/FLEX WRIST FINGER             	   815.48	  $815.48	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3904	WHFO ELECTRIC CUSTOM FITTED             	  2049.88	 $2049.88	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3905	WHO W/NONTORSION JNT(S) CF              	   567.35	  $567.35	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3906	WHO W/O JOINTS CF                       	   310.46	  $310.46	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3908	WHO COCK-UP NONMOLDE PRE OTS            	    47.08	   $47.08	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3912	HFO FLEXION GLOVE PRE OTS               	    62.73	   $62.73	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3913	HFO W/O JOINTS CF                       	   154.95	  $154.95	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3915	WHO NONTORSION JNTS PRE CST             	   317.18	  $317.18	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3916	WHO NONTORSION JNTS PRE OTS             	   356.20	  $356.20	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3917	METACARP FX ORTHOSIS PRE CST            	    60.43	   $60.43	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3918	METACARP FX ORTHOSIS PRE OTS            	    70.80	   $70.80	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3919	HO W/O JOINTS CF                        	   154.95	  $154.95	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3921	HFO W/JOINT(S) CF                       	   183.77	  $183.77	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3923	HFO WITHOUT JOINTS PRE CST              	    22.26	   $22.26	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3924	HFO WITHOUT JOINTS PRE OTS              	    60.04	   $60.04	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3925	FO PIP DIP JNT/SPRNG PRE OTS            	    40.25	   $40.25	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3927	FO PIP DIP NO JT SPR PRE OTS            	    21.42	   $21.42	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3929	HFO NONTORSION JNTS PRE CST             	    65.79	   $65.79	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3930	HFO NONTORSION JNTS PRE OTS             	    71.94	   $71.94	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3931	WHFO NONTORSION JOINT PREFAB            	   146.94	  $146.94	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3933	FO W/O JOINTS CF                        	   122.06	  $122.06	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3935	FO NONTORSION JOINT CF                  	   126.38	  $126.38	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3956	ADD JOINT UPPER EXT ORTHOSIS            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3960	SEWHO AIRPLAN DESIG ABDU POS            	   392.52	  $392.52	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3961	SEWHO CAP DESIGN W/O JNTS CF            	   961.18	  $961.18	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3962	SEWHO ERBS PALSEY DESIGN ABD            	   396.89	  $396.89	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3967	SEWHO AIRPLANE W/O JNTS CF              	  1134.82	 $1134.82	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3971	SEWHO CAP DESIGN W/JNT(S) CF            	  1077.21	 $1077.21	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3973	SEWHO AIRPLANE W/JNT(S) CF              	  1134.82	 $1134.82	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3975	SEWHFO CAP DESIGN W/O JNT CF            	   961.18	  $961.18	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3976	SEWHFO AIRPLANE W/O JNTS CF             	   961.18	  $961.18	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3977	SEWHFO CAP DESGN W/JNT(S) CF            	  1077.21	 $1077.21	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3978	SEWHFO AIRPLANE W/JNT(S) CF             	  1134.82	 $1134.82	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3980	UP EXT FX ORTHOS HUMERAL NOS            	   242.90	  $242.90	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3981	UE FX ORTH SHOUL CAP FOREARM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3982	UPPER EXT FX ORTHOSIS RAD/UL            	   293.32	  $293.32	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3984	UPPER EXT FX ORTHOSIS WRIST             	   168.89	  $168.89	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L3995	SOCK FRACTURE OR EQUAL EACH             	    18.48	   $18.48	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L4000	REPL GIRDLE MILWAUKEE ORTH              	   394.20	  $394.20	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L4002	REPLACE STRAP, ANY ORTHOSIS             	     7.50	    $7.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L4002	REPLACE STRAP, ANY ORTHOSIS             	     7.50	    $7.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L4010	REPLACE TRILATERAL SOCKET BR            	   439.24	  $439.24	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L4020	REPLACE QUADLAT SOCKET BRIM             	   488.05	  $488.05	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L4030	REPLACE SOCKET BRIM CUST FIT            	   313.41	  $313.41	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L4040	REPLACE MOLDED THIGH LACER              	   327.76	  $327.76	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L4045	REPLACE NON-MOLDED THIGH LAC            	   251.30	  $251.30	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L4050	REPLACE MOLDED CALF LACER               	   331.49	  $331.49	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L4050	REPLACE MOLDED CALF LACER               	   331.49	  $331.49	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L4055	REPLACE NON-MOLDED CALF LACE            	   214.65	  $214.65	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L4055	REPLACE NON-MOLDED CALF LACE            	   214.65	  $214.65	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L4060	REPLACE HIGH ROLL CUFF                  	   234.96	  $234.96	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L4070	REPLACE PROX & DIST UPRIGHT             	   225.97	  $225.97	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L4070	REPLACE PROX & DIST UPRIGHT             	   225.97	  $225.97	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L4080	REPL MET BAND KAFO-AFO PROX             	    46.92	   $46.92	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L4080	REPL MET BAND KAFO-AFO PROX             	    46.92	   $46.92	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L4090	REPL MET BAND KAFO-AFO CALF/            	    44.60	   $44.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L4090	REPL MET BAND KAFO-AFO CALF/            	    44.60	   $44.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L4100	REPL LEATH CUFF KAFO PROX TH            	    58.02	   $58.02	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L4100	REPL LEATH CUFF KAFO PROX TH            	    58.02	   $58.02	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L4110	REPL LEATH CUFF KAFO-AFO CAL            	    57.29	   $57.29	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L4110	REPL LEATH CUFF KAFO-AFO CAL            	    57.29	   $57.29	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L4130	REPLACE PRETIBIAL SHELL                 	   325.36	  $325.36	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L4130	REPLACE PRETIBIAL SHELL                 	   325.36	  $325.36	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L4205	ORTHO DVC REPAIR PER 15 MIN             	    16.47	   $16.47	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L4205	ORTHO DVC REPAIR PER 15 MIN             	    16.47	   $16.47	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L4210	ORTH DEV REPAIR/REPL MINOR P            	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
1	L4210	ORTH DEV REPAIR/REPL MINOR P            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L4350	ANKLE CONTROL ORTHO PRE OTS             	    71.78	   $71.78	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L4350	ANKLE CONTROL ORTHO PRE OTS             	    71.78	   $71.78	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L4360	PNEUMAT WALKING BOOT PRE CST            	   168.00	  $168.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L4360	PNEUMAT WALKING BOOT PRE CST            	   168.00	  $168.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L4361	PNEUMA/VAC WALK BOOT PRE OTS            	   227.88	  $227.88	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L4361	PNEUMA/VAC WALK BOOT PRE OTS            	   227.88	  $227.88	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L4370	PNEUM FULL LEG SPLNT PRE OTS            	   106.40	  $106.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L4370	PNEUM FULL LEG SPLNT PRE OTS            	   106.40	  $106.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L4386	NON-PNEUM WALK BOOT PRE CST             	    99.66	   $99.66	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L4386	NON-PNEUM WALK BOOT PRE CST             	    99.66	   $99.66	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L4387	NON-PNEUM WALK BOOT PRE OTS             	   116.74	  $116.74	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L4387	NON-PNEUM WALK BOOT PRE OTS             	   116.74	  $116.74	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L4396	STATIC OR DYNAMI AFO PRE CST            	    99.32	   $99.32	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L4396	STATIC OR DYNAMI AFO PRE CST            	    99.32	   $99.32	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L4397	STATIC OR DYNAMI AFO PRE OTS            	   121.49	  $121.49	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L4397	STATIC OR DYNAMI AFO PRE OTS            	   121.49	  $121.49	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L4398	FOOT DROP SPLINT PRE OTS                	    45.72	   $45.72	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L4398	FOOT DROP SPLINT PRE OTS                	    45.72	   $45.72	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L4631	AFO, WALK BOOT TYPE, CUS FAB            	  1329.32	 $1329.32	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L4631	AFO, WALK BOOT TYPE, CUS FAB            	  1329.32	 $1329.32	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5000	SHO INSERT W ARCH TOE FILLER            	   195.45	  $195.45	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L5000	SHO INSERT W ARCH TOE FILLER            	   195.45	  $195.45	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L5010	MOLD SOCKET ANK HGT W/ TOE F            	   558.45	  $558.45	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5010	MOLD SOCKET ANK HGT W/ TOE F            	   558.45	  $558.45	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5020	TIBIAL TUBERCLE HGT W/ TOE F            	  1236.57	 $1236.57	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L5020	TIBIAL TUBERCLE HGT W/ TOE F            	  1236.57	 $1236.57	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L5050	ANK SYMES MOLD SCKT SACH FT             	   955.80	  $955.80	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5050	ANK SYMES MOLD SCKT SACH FT             	   955.80	  $955.80	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5060	SYMES MET FR LEATH SOCKET AR            	  1616.81	 $1616.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L5060	SYMES MET FR LEATH SOCKET AR            	  1616.81	 $1616.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L5100	MOLDED SOCKET SHIN SACH FOOT            	  1022.37	 $1022.37	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5100	MOLDED SOCKET SHIN SACH FOOT            	  1022.37	 $1022.37	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5105	PLAST SOCKET JTS/THGH LACER             	  1664.94	 $1664.94	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5150	MOLD SCKT EXT KNEE SHIN SACH            	  1428.59	 $1428.59	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L5150	MOLD SCKT EXT KNEE SHIN SACH            	  1428.59	 $1428.59	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L5160	MOLD SOCKET BENT KNEE SHIN S            	  1368.19	 $1368.19	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5160	MOLD SOCKET BENT KNEE SHIN S            	  1368.19	 $1368.19	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5200	KNE SING AXIS FRIC SHIN SACH            	  1405.01	 $1405.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L5200	KNE SING AXIS FRIC SHIN SACH            	  1405.01	 $1405.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5210	NO KNEE/ANKLE JOINTS W/ FT B            	  1587.11	 $1587.11	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5220	NO KNEE JOINT WITH ARTIC ALI            	  1904.69	 $1904.69	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5230	FEM FOCAL DEFIC CONSTANT FRI            	  2411.38	 $2411.38	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5250	HIP CANAD SING AXI CONS FRIC            	  2083.60	 $2083.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5270	TILT TABLE LOCKING HIP SING             	  3943.93	 $3943.93	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5280	HEMIPELVECT CANAD SING AXIS             	  2293.96	 $2293.96	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5301	BK MOLD SOCKET SACH FT ENDO             	  1955.71	 $1955.71	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5312	KNEE DISART, SACH FT, ENDO              	  2908.66	 $2908.66	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5321	AK OPEN END SACH                        	  2811.55	 $2811.55	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5331	HIP DISART CANADIAN SACH FT             	  3736.33	 $3736.33	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5341	HEMIPELVECTOMY CANADIAN SACH            	  4323.32	 $4323.32	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5400	POSTOP DRESS & 1 CAST CHG BK            	   668.05	  $668.05	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5410	POSTOP DSG BK EA ADD CAST CH            	   202.18	  $202.18	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5420	POSTOP DSG & 1 CAST CHG AK/D            	   753.10	  $753.10	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5430	POSTOP DSG AK EA ADD CAST CH            	   208.92	  $208.92	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5450	POSTOP APP NON-WGT BEAR DSG             	   132.66	  $132.66	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5460	POSTOP APP NON-WGT BEAR DSG             	   164.63	  $164.63	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5500	INIT BK PTB PLASTER DIRECT              	   580.66	  $580.66	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5505	INIT AK ISCHAL PLSTR DIRECT             	   701.90	  $701.90	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5510	PREP BK PTB PLASTER MOLDED              	   785.76	  $785.76	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5520	PERP BK PTB THERMOPLS DIRECT            	   829.01	  $829.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5530	PREP BK PTB THERMOPLS MOLDED            	  1105.22	 $1105.22	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5535	PREP BK PTB OPEN END SOCKET             	  1210.22	 $1210.22	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5540	PREP BK PTB LAMINATED SOCKET            	  1065.00	 $1065.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5560	PREP AK ISCHIAL PLAST MOLDED            	  1050.23	 $1050.23	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5570	PREP AK ISCHIAL DIRECT FORM             	  1167.52	 $1167.52	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5580	PREP AK ISCHIAL THERMO MOLD             	  1254.54	 $1254.54	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5585	PREP AK ISCHIAL OPEN END                	  1255.80	 $1255.80	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5590	PREP AK ISCHIAL LAMINATED               	  1492.80	 $1492.80	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5595	HIP DISARTIC SACH THERMOPLS             	  3219.48	 $3219.48	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5600	HIP DISART SACH LAMINAT MOLD            	  3430.00	 $3430.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5610	ABOVE KNEE HYDRACADENCE                 	  1572.18	 $1572.18	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5611	AK 4 BAR LINK W/FRIC SWING              	  1271.46	 $1271.46	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5613	AK 4 BAR LING W/HYDRAUL SWIG            	   862.40	  $862.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5614	4-BAR LINK ABOVE KNEE W/SWNG            	  1062.81	 $1062.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5616	AK UNIV MULTIPLEX SYS FRICT             	   631.81	  $631.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5617	AK/BK SELF-ALIGNING UNIT EA             	   244.46	  $244.46	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5618	TEST SOCKET SYMES                       	   108.27	  $108.27	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5620	TEST SOCKET BELOW KNEE                  	   108.27	  $108.27	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5622	TEST SOCKET KNEE DISARTICULA            	   149.81	  $149.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5624	TEST SOCKET ABOVE KNEE                  	   149.81	  $149.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5626	TEST SOCKET HIP DISARTICULAT            	   174.10	  $174.10	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5628	TEST SOCKET HEMIPELVECTOMY              	   174.10	  $174.10	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5629	BELOW KNEE ACRYLIC SOCKET               	    98.56	   $98.56	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5630	SYME TYP EXPANDABL WALL SCKT            	   170.79	  $170.79	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5631	AK/KNEE DISARTIC ACRYLIC SOC            	   192.50	  $192.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5632	SYMES TYPE PTB BRIM DESIGN S            	    80.69	   $80.69	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5634	SYMES TYPE POSTER OPENING SO            	   227.81	  $227.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L5634	SYMES TYPE POSTER OPENING SO            	   227.81	  $227.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L5636	SYMES TYPE MEDIAL OPENING SO            	   113.17	  $113.17	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5636	SYMES TYPE MEDIAL OPENING SO            	   113.17	  $113.17	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5637	BELOW KNEE TOTAL CONTACT                	   246.15	  $246.15	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5638	BELOW KNEE LEATHER SOCKET               	   327.50	  $327.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5639	BELOW KNEE WOOD SOCKET                  	   959.10	  $959.10	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5640	KNEE DISARTICULAT LEATHER SO            	   134.48	  $134.48	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5642	ABOVE KNEE LEATHER SOCKET               	   134.48	  $134.48	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5643	HIP FLEX INNER SOCKET EXT FR            	   690.03	  $690.03	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5644	ABOVE KNEE WOOD SOCKET                  	   134.48	  $134.48	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5645	BK FLEX INNER SOCKET EXT FRA            	   427.29	  $427.29	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5646	BELOW KNEE CUSHION SOCKET               	   207.11	  $207.11	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5647	BELOW KNEE SUCTION SOCKET               	   539.64	  $539.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5648	ABOVE KNEE CUSHION SOCKET               	   220.79	  $220.79	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5649	ISCH CONTAINMT/NARROW M-L SO            	   829.38	  $829.38	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5650	TOT CONTACT AK/KNEE DISART S            	   203.88	  $203.88	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5651	AK FLEX INNER SOCKET EXT FRA            	   470.98	  $470.98	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5652	SUCTION SUSP AK/KNEE DISART             	    81.20	   $81.20	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5653	KNEE DISART EXPAND WALL SOCK            	   402.64	  $402.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5654	SOCKET INSERT SYMES                     	   159.58	  $159.58	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5655	SOCKET INSERT BELOW KNEE                	   129.77	  $129.77	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5656	SOCKET INSERT KNEE ARTICULAT            	   137.12	  $137.12	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5658	SOCKET INSERT ABOVE KNEE                	   137.12	  $137.12	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5661	MULTI-DUROMETER SYMES                   	   344.89	  $344.89	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L5661	MULTI-DUROMETER SYMES                   	   344.89	  $344.89	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L5665	MULTI-DUROMETER BELOW KNEE              	   392.19	  $392.19	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5665	MULTI-DUROMETER BELOW KNEE              	   392.19	  $392.19	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5666	BELOW KNEE CUFF SUSPENSION              	    45.14	   $45.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L5666	BELOW KNEE CUFF SUSPENSION              	    45.14	   $45.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5668	BK MOLDED DISTAL CUSHION                	    58.80	   $58.80	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5670	BK MOLDED SUPRACONDYLAR SUSP            	   117.05	  $117.05	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5671	BK/AK LOCKING MECHANISM                 	   425.50	  $425.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5672	BK REMOVABLE MEDIAL BRIM SUS            	   135.28	  $135.28	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5673	SOCKET INSERT W LOCK MECH               	   502.73	  $502.73	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5676	BK KNEE JOINTS SINGLE AXIS P            	   203.01	  $203.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5677	BK KNEE JOINTS POLYCENTRIC P            	   369.53	  $369.53	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5678	BK JOINT COVERS PAIR                    	    23.76	   $23.76	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5679	SOCKET INSERT W/O LOCK MECH             	   418.94	  $418.94	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5680	BK THIGH LACER NON-MOLDED               	   134.76	  $134.76	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5681	INTL CUSTM CONG/LATYP INSERT            	   828.47	  $828.47	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5682	BK THIGH LACER GLUT/ISCHIA M            	   248.88	  $248.88	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5683	INITIAL CUSTOM SOCKET INSERT            	   828.47	  $828.47	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5684	BK FORK STRAP                           	    32.98	   $32.98	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5685	BELOW KNEE SUS/SEAL SLEEVE              	    80.66	   $80.66	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L5685	BELOW KNEE SUS/SEAL SLEEVE              	    48.96	   $48.96	      ---	       --	009	0	0	0.00	    $0.00	N	
1	L5686	BK BACK CHECK                           	    19.85	   $19.85	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5688	BK WAIST BELT WEBBING                   	    43.44	   $43.44	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5690	BK WAIST BELT PADDED AND LIN            	    75.60	   $75.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5692	AK PELVIC CONTROL BELT LIGHT            	    88.65	   $88.65	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5694	AK PELVIC CONTROL BELT PAD/L            	   105.52	  $105.52	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5695	AK SLEEVE SUSP NEOPRENE/EQUA            	    94.50	   $94.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5696	AK/KNEE DISARTIC PELVIC JOIN            	   105.52	  $105.52	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5697	AK/KNEE DISARTIC PELVIC BAND            	    46.45	   $46.45	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5698	AK/KNEE DISARTIC SILESIAN BA            	    49.14	   $49.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L5698	AK/KNEE DISARTIC SILESIAN BA            	    49.14	   $49.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5699	SHOULDER HARNESS                        	   144.67	  $144.67	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5700	REPLACE SOCKET BELOW KNEE               	  1625.05	 $1625.05	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5701	REPLACE SOCKET ABOVE KNEE               	  2017.64	 $2017.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5702	REPLACE SOCKET HIP                      	  2578.12	 $2578.12	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5703	SYMES ANKLE W/O (SACH) FOOT             	  1544.40	 $1544.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L5703	SYMES ANKLE W/O (SACH) FOOT             	  1544.40	 $1544.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5704	CUSTOM SHAPE COVER BK                   	   271.40	  $271.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5705	CUSTOM SHAPE COVER AK                   	   445.55	  $445.55	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5706	CUSTOM SHAPE CVR KNEE DISART            	   441.59	  $441.59	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5707	CUSTOM SHAPE CVR HIP DISART             	   627.74	  $627.74	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5710	KNE-SHIN EXO SNG AXI MNL LOC            	   221.64	  $221.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5711	KNEE-SHIN EXO MNL LOCK ULTRA            	   359.38	  $359.38	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5712	KNEE-SHIN EXO FRICT SWG & ST            	   289.00	  $289.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5714	KNEE-SHIN EXO VARIABLE FRICT            	   170.66	  $170.66	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5716	KNEE-SHIN EXO MECH STANCE PH            	   520.11	  $520.11	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5718	KNEE-SHIN EXO FRCT SWG & STA            	   560.56	  $560.56	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5722	KNEE-SHIN PNEUM SWG FRCT EXO            	   696.14	  $696.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5724	KNEE-SHIN EXO FLUID SWING PH            	   726.20	  $726.20	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5726	KNEE-SHIN EXT JNTS FLD SWG E            	  1265.35	 $1265.35	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5728	KNEE-SHIN FLUID SWG & STANCE            	  1125.26	 $1125.26	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5780	KNEE-SHIN PNEUM/HYDRA PNEUM             	   345.48	  $345.48	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5781	LOWER LIMB PROS VACUUM PUMP             	  2520.06	 $2520.06	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5782	HD LOW LIMB PROS VACUUM PUMP            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5785	EXOSKELETAL BK ULTRALT MATER            	   317.63	  $317.63	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L5785	EXOSKELETAL BK ULTRALT MATER            	   317.63	  $317.63	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5790	EXOSKELETAL AK ULTRA-LIGHT M            	   417.97	  $417.97	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5795	EXOSKEL HIP ULTRA-LIGHT MATE            	   534.19	  $534.19	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5810	ENDOSKEL KNEE-SHIN MNL LOCK             	   384.51	  $384.51	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5811	ENDO KNEE-SHIN MNL LCK ULTRA            	   623.88	  $623.88	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5812	ENDO KNEE-SHIN FRCT SWG & ST            	   393.19	  $393.19	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5814	ENDO KNEE-SHIN HYDRAL SWG PH            	  1622.66	 $1622.66	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5816	ENDO KNEE-SHIN POLYC MCH STA            	   689.08	  $689.08	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5818	ENDO KNEE-SHIN FRCT SWG & ST            	   728.70	  $728.70	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5822	ENDO KNEE-SHIN PNEUM SWG FRC            	   683.69	  $683.69	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5824	ENDO KNEE-SHIN FLUID SWING P            	  1243.27	 $1243.27	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5826	MINIATURE KNEE JOINT                    	  1398.96	 $1398.96	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5828	ENDO KNEE-SHIN FLUID SWG/STA            	  1687.63	 $1687.63	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5830	ENDO KNEE-SHIN PNEUM/SWG PHA            	  1623.21	 $1623.21	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5840	MULTI-AXIAL KNEE/SHIN SYSTEM            	  1343.30	 $1343.30	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5845	KNEE-SHIN SYS STANCE FLEXION            	  1128.89	 $1128.89	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5848	KNEE-SHIN SYS HYDRAUL STANCE            	   677.28	  $677.28	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5850	ENDO AK/HIP KNEE EXTENS ASSI            	    73.68	   $73.68	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5855	MECH HIP EXTENSION ASSIST               	   183.27	  $183.27	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5856	ELEC KNEE-SHIN SWING/STANCE             	 15119.69	$15119.69	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5857	ELEC KNEE-SHIN SWING ONLY               	  5365.04	 $5365.04	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5858	STANCE PHASE ONLY                       	 11705.58	$11705.58	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5859	KNEE-SHIN PRO FLEX/EXT CONT             	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	Y	
1	L5910	ENDO BELOW KNEE ALIGNABLE SY            	   161.19	  $161.19	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L5910	ENDO BELOW KNEE ALIGNABLE SY            	   161.19	  $161.19	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5920	ENDO AK/HIP ALIGNABLE SYSTEM            	   236.13	  $236.13	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5925	ABOVE KNEE MANUAL LOCK                  	   194.09	  $194.09	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5926	ENDOSKEL POSIT ROTAT UNIT               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	L5930	HIGH ACTIVITY KNEE FRAME                	  1470.62	 $1470.62	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5940	ENDO BK ULTRA-LIGHT MATERIAL            	   310.89	  $310.89	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5950	ENDO AK ULTRA-LIGHT MATERIAL            	   453.71	  $453.71	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5960	ENDO HIP ULTRA-LIGHT MATERIA            	   562.20	  $562.20	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5961	ENDO POLY HIP, PNEU/HYD/ROT             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5962	BELOW KNEE FLEX COVER SYSTEM            	   348.79	  $348.79	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5964	ABOVE KNEE FLEX COVER SYSTEM            	   502.11	  $502.11	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5966	HIP FLEXIBLE COVER SYSTEM               	   650.97	  $650.97	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5968	MULTIAXIAL ANKLE W DORSIFLEX            	  1623.84	 $1623.84	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5970	FOOT EXTERNAL KEEL SACH FOOT            	    76.53	   $76.53	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L5970	FOOT EXTERNAL KEEL SACH FOOT            	    76.53	   $76.53	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L5971	SACH FOOT, REPLACEMENT                  	   163.92	  $163.92	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5971	SACH FOOT, REPLACEMENT                  	   163.92	  $163.92	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5972	FLEXIBLE KEEL FOOT                      	   209.13	  $209.13	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L5972	FLEXIBLE KEEL FOOT                      	   209.13	  $209.13	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L5973	ANK-FOOT SYS DORS-PLANT FLEX            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	L5973	ANK-FOOT SYS DORS-PLANT FLEX            	 12453.00	$12453.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5974	FOOT SINGLE AXIS ANKLE/FOOT             	   143.80	  $143.80	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L5974	FOOT SINGLE AXIS ANKLE/FOOT             	   143.80	  $143.80	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L5975	COMBO ANKLE/FOOT PROSTHESIS             	   207.16	  $207.16	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5975	COMBO ANKLE/FOOT PROSTHESIS             	   207.16	  $207.16	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5976	ENERGY STORING FOOT                     	   332.32	  $332.32	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L5976	ENERGY STORING FOOT                     	   332.32	  $332.32	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L5978	FT PROSTH MULTIAXIAL ANKL/FT            	   178.44	  $178.44	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5978	FT PROSTH MULTIAXIAL ANKL/FT            	   178.44	  $178.44	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5979	MULTI-AXIAL ANKLE/FT PROSTH             	  1341.49	 $1341.49	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L5979	MULTI-AXIAL ANKLE/FT PROSTH             	  1341.49	 $1341.49	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L5980	FLEX FOOT SYSTEM                        	  1878.25	 $1878.25	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5980	FLEX FOOT SYSTEM                        	  1878.25	 $1878.25	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5981	FLEX-WALK SYS LOW EXT PROSTH            	  1457.82	 $1457.82	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L5981	FLEX-WALK SYS LOW EXT PROSTH            	  1457.82	 $1457.82	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L5982	EXOSKELETAL AXIAL ROTATION U            	   384.33	  $384.33	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5982	EXOSKELETAL AXIAL ROTATION U            	   384.33	  $384.33	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5984	ENDOSKELETAL AXIAL ROTATION             	   338.05	  $338.05	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L5984	ENDOSKELETAL AXIAL ROTATION             	   338.05	  $338.05	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L5985	LWR EXT DYNAMIC PROSTH PYLON            	   123.37	  $123.37	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5985	LWR EXT DYNAMIC PROSTH PYLON            	   123.37	  $123.37	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5986	MULTI-AXIAL ROTATION UNIT               	   376.03	  $376.03	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L5986	MULTI-AXIAL ROTATION UNIT               	   376.03	  $376.03	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L5987	SHANK FT W VERT LOAD PYLON              	  3143.06	 $3143.06	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5987	SHANK FT W VERT LOAD PYLON              	  3143.06	 $3143.06	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5988	VERTICAL SHOCK REDUCING PYLO            	   892.69	  $892.69	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L5988	VERTICAL SHOCK REDUCING PYLO            	   892.69	  $892.69	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L5990	USER ADJUSTABLE HEEL HEIGHT             	  1142.65	 $1142.65	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L5990	USER ADJUSTABLE HEEL HEIGHT             	  1142.65	 $1142.65	      ---	       --	009	0	0	0.00	    $0.00	N	
1	L5991	LOW PROS EXT OSSEO CONNECTOR            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	L6000	PART HAND THUMB REM                     	   856.69	  $856.69	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6010	PART HAND LITTLE/RING                   	   950.10	  $950.10	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6020	PART HAND NO FINGERS                    	   920.07	  $920.07	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6026	PART HAND MYO EXCLU TERM DEV            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6050	WRST MLD SCK FLX HNG TRI PAD            	   805.99	  $805.99	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6055	WRST MOLD SOCK W/EXP INTERFA            	  1488.03	 $1488.03	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6100	ELB MOLD SOCK FLEX HINGE PAD            	   815.10	  $815.10	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6110	ELBOW MOLD SOCK SUSPENSION T            	   853.14	  $853.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6120	ELBOW MOLD DOUB SPLT SOC STE            	   987.19	  $987.19	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6130	ELBOW STUMP ACTIVATED LOCK H            	  1236.13	 $1236.13	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6200	ELBOW MOLD OUTSID LOCK HINGE            	  1141.93	 $1141.93	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6205	ELBOW MOLDED W/ EXPAND INTER            	  2060.63	 $2060.63	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6250	ELBOW INTER LOC ELBOW FORARM            	  1173.23	 $1173.23	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6300	SHLDER DISART INT LOCK ELBOW            	  1468.22	 $1468.22	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6310	SHOULDER PASSIVE RESTOR COMP            	  1894.54	 $1894.54	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6320	SHOULDER PASSIVE RESTOR CAP             	  1215.57	 $1215.57	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6350	THORACIC INTERN LOCK ELBOW              	  2362.08	 $2362.08	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6360	THORACIC PASSIVE RESTOR COMP            	  2540.85	 $2540.85	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6370	THORACIC PASSIVE RESTOR CAP             	  1332.14	 $1332.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6380	POSTOP DSG CAST CHG WRST/ELB            	   593.60	  $593.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6382	POSTOP DSG CAST CHG ELB DIS/            	   660.10	  $660.10	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6384	POSTOP DSG CAST CHG SHLDER/T            	  1101.63	 $1101.63	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6386	POSTOP EA CAST CHG & REALIGN            	   222.95	  $222.95	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6388	POSTOP APPLICAT RIGID DSG ON            	   232.49	  $232.49	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6400	BELOW ELBOW PROSTH TISS SHAP            	  1442.96	 $1442.96	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6450	ELB DISART PROSTH TISS SHAP             	  2209.58	 $2209.58	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6500	ABOVE ELBOW PROSTH TISS SHAP            	  2062.10	 $2062.10	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6550	SHLDR DISAR PROSTH TISS SHAP            	  2990.12	 $2990.12	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6570	SCAP THORAC PROSTH TISS SHAP            	  3336.60	 $3336.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6580	WRIST/ELBOW BOWDEN CABLE MOL            	   823.38	  $823.38	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6582	WRIST/ELBOW BOWDEN CBL DIR F            	   649.95	  $649.95	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6584	ELBOW FAIR LEAD CABLE MOLDED            	  1163.31	 $1163.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6586	ELBOW FAIR LEAD CABLE DIR FO            	  1016.14	 $1016.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6588	SHDR FAIR LEAD CABLE MOLDED             	  1730.58	 $1730.58	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6590	SHDR FAIR LEAD CABLE DIRECT             	  1514.98	 $1514.98	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6600	POLYCENTRIC HINGE PAIR                  	    67.89	   $67.89	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6605	SINGLE PIVOT HINGE PAIR                 	    75.29	   $75.29	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6610	FLEXIBLE METAL HINGE PAIR               	    64.44	   $64.44	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6611	ADDITIONAL SWITCH, EXT POWER            	   270.47	  $270.47	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6615	DISCONNECT LOCKING WRIST UNI            	    71.22	   $71.22	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6616	DISCONNECT INSERT LOCKING WR            	    28.00	   $28.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6620	FLEXION/EXTENSION WRIST UNIT            	   149.29	  $149.29	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6621	FLEX/EXT WRIST W/WO FRICTION            	  1440.62	 $1440.62	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6623	SPRING-ASS ROT WRST W/ LATCH            	   247.89	  $247.89	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6624	FLEX/EXT/ROTATION WRIST UNIT            	  2474.01	 $2474.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6625	ROTATION WRST W/ CABLE LOCK             	   272.66	  $272.66	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6628	QUICK DISCONN HOOK ADAPTER O            	   280.56	  $280.56	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6629	LAMINATION COLLAR W/ COUPLIN            	    79.33	   $79.33	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6630	STAINLESS STEEL ANY WRIST               	    76.95	   $76.95	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6632	LATEX SUSPENSION SLEEVE EACH            	    36.96	   $36.96	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6635	LIFT ASSIST FOR ELBOW                   	   115.08	  $115.08	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6637	NUDGE CONTROL ELBOW LOCK                	   203.70	  $203.70	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6638	ELEC LOCK ON MANUAL PW ELBOW            	  1575.05	 $1575.05	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6640	SHOULDER ABDUCTION JOINT PAI            	   109.69	  $109.69	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6641	EXCURSION AMPLIFIER PULLEY T            	   103.34	  $103.34	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6642	EXCURSION AMPLIFIER LEVER TY            	   129.68	  $129.68	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6645	SHOULDER FLEXION-ABDUCTION J            	   149.05	  $149.05	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6646	MULTIPO LOCKING SHOULDER JNT            	  1986.49	 $1986.49	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6647	SHOULDER LOCK ACTUATOR                  	   327.03	  $327.03	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6648	EXT PWRD SHLDER LOCK/UNLOCK             	  2048.78	 $2048.78	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6650	SHOULDER UNIVERSAL JOINT                	   145.71	  $145.71	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6655	STANDARD CONTROL CABLE EXTRA            	    32.03	   $32.03	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6660	HEAVY DUTY CONTROL CABLE                	    78.52	   $78.52	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6665	TEFLON OR EQUAL CABLE LINING            	    21.89	   $21.89	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6670	HOOK TO HAND CABLE ADAPTER              	    26.84	   $26.84	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6672	HARNESS CHEST/SHLDER SADDLE             	   104.77	  $104.77	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6675	HARNESS FIGURE OF 8 SING CON            	    62.51	   $62.51	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6676	HARNESS FIGURE OF 8 DUAL CON            	    77.72	   $77.72	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6677	UE TRIPLE CONTROL HARNESS               	   186.83	  $186.83	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6680	TEST SOCK WRIST DISART/BEL E            	   179.71	  $179.71	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6682	TEST SOCK ELBW DISART/ABOVE             	   179.71	  $179.71	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6684	TEST SOCKET SHLDR DISART/THO            	   179.71	  $179.71	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6686	SUCTION SOCKET                          	   364.79	  $364.79	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6687	FRAME TYP SOCKET BEL ELBOW/W            	   265.30	  $265.30	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6688	FRAME TYP SOCK ABOVE ELB/DIS            	   291.55	  $291.55	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6689	FRAME TYP SOCKET SHOULDER DI            	   350.18	  $350.18	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6690	FRAME TYP SOCK INTERSCAP-THO            	   380.01	  $380.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6691	REMOVABLE INSERT EACH                   	   209.13	  $209.13	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6692	SILICON GEL INSERT W/WO LOCK            	   413.00	  $413.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6693	LOCKINGELBOW FOREARM CNTRBAL            	  1297.85	 $1297.85	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6694	ELBOW SOCKET INS USE W/LOCK             	   502.73	  $502.73	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6695	ELBOW SOCKET INS USE W/O LCK            	   418.94	  $418.94	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6696	CUS ELBO SKT IN FOR CON/ATYP            	   828.47	  $828.47	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6697	CUS ELBO SKT IN NOT CON/ATYP            	   828.47	  $828.47	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6698	ADD UP-EX PROSTHES LOCK MECH            	   425.50	  $425.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6703	TERM DEV, PASSIVE HAND MITT             	   240.50	  $240.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6704	TERM DEV, SPORT/REC/WORK ATT            	   522.51	  $522.51	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6706	TERM DEV MECH HOOK VOL OPEN             	   288.79	  $288.79	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6707	TERM DEV MECH HOOK VOL CLOSE            	  1102.72	 $1102.72	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6708	TERM DEV MECH HAND VOL OPEN             	   746.30	  $746.30	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6709	TERM DEV MECH HAND VOL CLOSE            	  1080.94	 $1080.94	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6711	PED TERM DEV, HOOK, VOL OPEN            	   476.26	  $476.26	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6712	PED TERM DEV, HOOK, VOL CLOS            	   876.88	  $876.88	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6713	PED TERM DEV, HAND, VOL OPEN            	  1106.72	 $1106.72	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6714	PED TERM DEV, HAND, VOL CLOS            	   937.39	  $937.39	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6715	TERM DEVICE, MULTI ART DIGIT            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6721	HOOK/HAND, HVY DTY, VOL OPEN            	  1666.10	 $1666.10	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6722	HOOK/HAND, HVY DTY, VOL CLOS            	  1436.30	 $1436.30	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6805	TERM DEV MODIFIER WRIST UNIT            	   157.33	  $157.33	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6810	TERM DEV PRECISION PINCH DEV            	    96.51	   $96.51	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6880	ELEC HAND IND ART DIGITS                	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6881	TERM DEV AUTO GRASP FEATURE             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6882	MICROPROCESSOR CONTROL UPLMB            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6883	REPLC SOCKT BELOW E/W DISA              	  1102.87	 $1102.87	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6884	REPLC SOCKT ABOVE ELBOW DISA            	  1909.77	 $1909.77	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6885	REPLC SOCKT SHLDR DIS/INTERC            	  2724.70	 $2724.70	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6890	PREFAB GLOVE FOR TERM DEVICE            	    92.39	   $92.39	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6895	CUSTOM GLOVE FOR TERM DEVICE            	   215.08	  $215.08	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6900	HAND RESTORAT THUMB/1 FINGER            	   654.89	  $654.89	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6905	HAND RESTORATION MULTIPLE FI            	   624.89	  $624.89	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6910	HAND RESTORATION NO FINGERS             	   648.48	  $648.48	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6915	HAND RESTORATION REPLACMNT G            	   417.30	  $417.30	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6920	WRIST DISARTICUL SWITCH CTRL            	  3360.79	 $3360.79	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6925	WRIST DISART MYOELECTRONIC C            	  3830.58	 $3830.58	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6930	BELOW ELBOW SWITCH CONTROL              	  3675.00	 $3675.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6935	BELOW ELBOW MYOELECTRONIC CT            	  4188.31	 $4188.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6940	ELBOW DISARTICULATION SWITCH            	  3950.33	 $3950.33	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6945	ELBOW DISART MYOELECTRONIC C            	  4546.50	 $4546.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6950	ABOVE ELBOW SWITCH CONTROL              	  4404.17	 $4404.17	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6955	ABOVE ELBOW MYOELECTRONIC CT            	  5262.83	 $5262.83	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6960	SHLDR DISARTIC SWITCH CONTRO            	  5740.00	 $5740.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6965	SHLDR DISARTIC MYOELECTRONIC            	  6667.50	 $6667.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6970	INTERSCAPULAR-THOR SWITCH CT            	  7070.00	 $7070.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L6975	INTERSCAP-THOR MYOELECTRONIC            	  8050.00	 $8050.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L7007	ADULT ELECTRIC HAND                     	  2302.63	 $2302.63	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L7008	PEDIATRIC ELECTRIC HAND                 	  3870.97	 $3870.97	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L7009	ADULT ELECTRIC HOOK                     	  2349.42	 $2349.42	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L7040	PREHENSILE ACTUATOR                     	  1281.88	 $1281.88	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L7045	PEDIATRIC ELECTRIC HOOK                 	   675.62	  $675.62	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L7170	ELECTRONIC ELBOW HOSMER SWIT            	  2572.50	 $2572.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L7180	ELECTRONIC ELBOW SEQUENTIAL             	 16310.00	$16310.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L7181	ELECTRONIC ELBO SIMULTANEOUS            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L7185	ELECTRON ELBOW ADOLESCENT SW            	  2695.00	 $2695.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L7186	ELECTRON ELBOW CHILD SWITCH             	  3797.50	 $3797.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L7190	ELBOW ADOLESCENT MYOELECTRON            	  3543.75	 $3543.75	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L7191	ELBOW CHILD MYOELECTRONIC CT            	  4706.24	 $4706.24	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L7259	ELECTRONIC WRIST ROTATOR ANY            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L7360	SIX VOLT BAT OTTO BOCK/EQ EA            	   111.21	  $111.21	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L7362	BATTERY CHRGR SIX VOLT OTTO             	   116.81	  $116.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L7364	TWELVE VOLT BATTERY UTAH/EQU            	   214.03	  $214.03	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L7366	BATTERY CHRGR 12 VOLT UTAH/E            	   280.00	  $280.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L7367	REPLACEMNT LITHIUM IONBATTER            	   245.21	  $245.21	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L7368	LITHIUM ION BATTERY CHARGER             	   317.87	  $317.87	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L7400	ADD UE PROST BE/WD, ULTLITE             	   193.03	  $193.03	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L7401	ADD UE PROST A/E ULTLITE MAT            	   216.10	  $216.10	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L7402	ADD UE PROST S/D ULTLITE MAT            	   233.38	  $233.38	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L7403	ADD UE PROST B/E ACRYLIC                	   231.94	  $231.94	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L7404	ADD UE PROST A/E ACRYLIC                	   350.06	  $350.06	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L7405	ADD UE PROST S/D ACRYLIC                	   457.84	  $457.84	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L7510	PROSTHETIC DEVICE REPAIR REP            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L7520	REPAIR PROSTHESIS PER 15 MIN            	    16.47	   $16.47	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L7700	PROS SOC INSERT GASKET/SEAL             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8000	MASTECTOMY BRA                          	    30.71	   $30.71	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8001	BREAST PROSTHESIS BRA & FORM            	    78.99	   $78.99	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8002	BRST PRSTH BRA & BILAT FORM             	   103.90	  $103.90	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8015	EXT BREASTPROSTHESIS GARMENT            	    37.75	   $37.75	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8020	MASTECTOMY FORM                         	    91.47	   $91.47	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8030	BREAST PROSTHES W/O ADHESIVE            	   245.02	  $245.02	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8031	BREAST PROSTHESIS W ADHESIVE            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8032	REUSABLE NIPPLE PROSTHESIS              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8033	NIPPLE PROSTHESIS CUSTOM, EA            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8035	CUSTOM BREAST PROSTHESIS                	  2196.13	 $2196.13	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8300	TRUSS SINGLE W/ STANDARD PAD            	    72.16	   $72.16	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8310	TRUSS DOUBLE W/ STANDARD PAD            	   113.93	  $113.93	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8320	TRUSS ADDITION TO STD PAD WA            	    26.96	   $26.96	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8330	TRUSS ADD TO STD PAD SCROTAL            	    26.07	   $26.07	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8400	SHEATH BELOW KNEE                       	    11.88	   $11.88	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8410	SHEATH ABOVE KNEE                       	    11.88	   $11.88	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8415	SHEATH UPPER LIMB                       	    10.94	   $10.94	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8417	PROS SHEATH/SOCK W GEL CUSHN            	    36.31	   $36.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L8417	PROS SHEATH/SOCK W GEL CUSHN            	    36.31	   $36.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8420	PROSTHETIC SOCK MULTI PLY BK            	    11.79	   $11.79	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8430	PROSTHETIC SOCK MULTI PLY AK            	    11.79	   $11.79	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8435	PROS SOCK MULTI PLY UPPER LM            	    11.99	   $11.99	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8440	SHRINKER BELOW KNEE                     	    25.68	   $25.68	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8460	SHRINKER ABOVE KNEE                     	    57.02	   $57.02	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8465	SHRINKER UPPER LIMB                     	    19.08	   $19.08	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8470	PROS SOCK SINGLE PLY BK                 	     4.48	    $4.48	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	L8470	PROS SOCK SINGLE PLY BK                 	     4.48	    $4.48	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8480	PROS SOCK SINGLE PLY AK                 	     5.22	    $5.22	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8485	PROS SOCK SINGLE PLY UPPER L            	     9.22	    $9.22	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8500	ARTIFICIAL LARYNX                       	   339.06	  $339.06	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8505	ARTIFICIAL LARYNX, ACCESSORY            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8507	TRACH-ESOPH VOICE PROS PT IN            	    26.38	   $26.38	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8509	TRACH-ESOPH VOICE PROS MD IN            	    68.78	   $68.78	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8510	VOICE AMPLIFIER                         	   159.15	  $159.15	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8603	COLLAGEN IMP URINARY 2.5 ML             	   281.33	  $281.33	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8604	DEXTRANOMER/HYALURONIC ACID             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8605	INJ BULKING AGENT ANAL CANAL            	   523.18	  $523.18	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8606	SYNTHETIC IMPLNT URINARY 1ML            	   146.09	  $146.09	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8607	INJ VOCAL CORD BULKING AGENT            	    31.98	   $31.98	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8608	ARG II EXT COM/SUP/ACC MISC             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8614	COCHLEAR DEVICE                         	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8615	COCH IMPLANT HEADSET REPLACE            	   284.06	  $284.06	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8616	COCH IMPLANT MICROPHONE REPL            	    66.16	   $66.16	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8617	COCH IMPLANT TRANS COIL REPL            	    57.78	   $57.78	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8618	COCH IMPLANT TRAN CABLE REPL            	    16.51	   $16.51	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8619	COCH IMP EXT PROC/CONTR RPLC            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8621	REPL ZINC AIR BATTERY                   	     0.42	    $0.42	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8622	REPL ALKALINE BATTERY                   	     0.22	    $0.22	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8623	LITH ION BATT CID,NON-EARLVL            	    40.74	   $40.74	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8624	LITH ION BATT CID, EAR LEVEL            	   101.57	  $101.57	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8625	CHARGER COCH IMPL/AOI BATTRY            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8627	CID EXT SPEECH PROCESS REPL             	  5189.60	 $5189.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8628	CID EXT CONTROLLER REPL                 	   920.17	  $920.17	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8629	CID TRANSMIT COIL AND CABLE             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8678	EXT SPLY IMPLT NEUROSTIM                	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8680	IMPLT NEUROSTIM ELCTR EACH              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8681	PT PRGRM FOR IMPLT NEUROSTIM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8682	IMPLT NEUROSTIM RADIOFQ REC             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8683	RADIOFQ TRSMTR FOR IMPLT NEU            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8685	IMPLT NROSTM PLS GEN SNG REC            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8686	IMPLT NROSTM PLS GEN SNG NON            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8687	IMPLT NROSTM PLS GEN DUA REC            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8688	IMPLT NROSTM PLS GEN DUA NON            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8689	EXTERNAL RECHARG SYS INTERN             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8690	AUD OSSEO DEV, INT/EXT COMP             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	L8691	AOI SND PROC REPL EXCL ACTUA            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8692	NON-OSSEOINTEGRATED SND PROC            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8693	AUD OSSEO DEV, ABUTMENT                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8694	AOI TRANSDUCER/ACTUATOR REPL            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8695	EXTERNAL RECHARG SYS EXTERN             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8696	EXT ANTENNA PHREN NERVE STIM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L8699	PROSTHETIC IMPLANT NOS                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	L9900	O&P SUPPLY/ACCESSORY/SERVICE            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	M0201	PNE FLU HEPB COV HOME ADMIN             	    35.50	   $35.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	M0201	PNE FLU HEPB COV HOME ADMIN             	    35.50	   $35.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	M0224	PEMIVIBART INFUSION                     	   450.00	  $450.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	P9010	WHOLE BLOOD FOR TRANSFUSION             	   254.85	  $254.85	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	P9011	BLOOD SPLIT UNIT                        	   149.20	  $149.20	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	P9012	CRYOPRECIPITATE EACH UNIT               	    41.24	   $41.24	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	P9016	RBC LEUKOCYTES REDUCED                  	   185.15	  $185.15	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	P9017	PLASMA 1 DONOR FRZ W/IN 8 HR            	    67.03	   $67.03	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	P9019	PLATELETS, EACH UNIT                    	    69.50	   $69.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	P9020	PLAELET RICH PLASMA UNIT                	   363.50	  $363.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	P9021	RED BLOOD CELLS UNIT                    	   129.66	  $129.66	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	P9022	WASHED RED BLOOD CELLS UNIT             	   277.03	  $277.03	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	P9023	FROZEN PLASMA, POOLED, SD               	     5.31	    $5.31	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	P9025	PLASMA CRYO REDU PATH EACH              	     0.00	    $0.00	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	P9026	CRYO FIB COMP PATH REDU EACH            	     0.00	    $0.00	      ---	       --	030	0	0	0.00	    $0.00	Y	
1	P9027	RBC O2 CO2 REDUCED                      	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	P9031	PLATELETS LEUKOCYTES REDUCED            	   107.51	  $107.51	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	P9032	PLATELETS, IRRADIATED                   	   121.72	  $121.72	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	P9033	PLATELETS LEUKOREDUCED IRRAD            	   139.94	  $139.94	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	P9034	PLATELETS, PHERESIS                     	   441.03	  $441.03	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	P9035	PLATELET PHERES LEUKOREDUCED            	   499.53	  $499.53	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	P9036	PLATELET PHERESIS IRRADIATED            	   417.71	  $417.71	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	P9037	PLATE PHERES LEUKOREDU IRRAD            	   624.66	  $624.66	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	P9038	RBC IRRADIATED                          	   195.18	  $195.18	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	P9039	RBC DEGLYCEROLIZED                      	   347.23	  $347.23	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	P9040	RBC LEUKOREDUCED IRRADIATED             	   240.27	  $240.27	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	P9041	ALBUMIN (HUMAN),5%, 50ML                	    10.62	   $10.62	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	P9043	PLASMA PROTEIN FRACT,5%,50ML            	    22.52	   $22.52	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	P9044	CRYOPRECIPITATEREDUCEDPLASMA            	    83.69	   $83.69	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	P9045	ALBUMIN (HUMAN), 5%, 250 ML             	    53.08	   $53.08	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	P9046	ALBUMIN (HUMAN), 25%, 20 ML             	    21.23	   $21.23	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	P9047	ALBUMIN (HUMAN), 25%, 50ML              	    53.08	   $53.08	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	P9048	PLASMAPROTEIN FRACT,5%,250ML            	    57.36	   $57.36	      ---	       --	030	0	0	0.00	    $0.00	Y	
1	P9050	GRANULOCYTES, PHERESIS UNIT             	  1387.55	 $1387.55	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	P9051	BLOOD, L/R, CMV-NEG                     	   147.90	  $147.90	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	P9052	PLATELETS, HLA-M, L/R, UNIT             	   645.94	  $645.94	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	P9053	PLT, PHER, L/R CMV-NEG, IRR             	   686.54	  $686.54	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	P9054	BLOOD, L/R, FROZ/DEGLY/WASH             	   218.81	  $218.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	P9055	PLT, APH/PHER, L/R, CMV-NEG             	   488.74	  $488.74	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	P9056	BLOOD, L/R, IRRADIATED                  	   147.13	  $147.13	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	P9057	RBC, FRZ/DEG/WSH, L/R, IRRAD            	   373.99	  $373.99	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	P9058	RBC, L/R, CMV-NEG, IRRAD                	   263.49	  $263.49	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	P9059	PLASMA, FRZ BETWEEN 8-24HOUR            	    77.93	   $77.93	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	P9060	FR FRZ PLASMA DONOR RETESTED            	    52.64	   $52.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	P9073	PLATELETS PHERESIS PATH REDU            	   624.66	  $624.66	      ---	       --	009	0	0	0.00	    $0.00	Y	
M	P9100	PATHOGEN TEST FOR PLATELETS             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	Q0092	SET UP PORT XRAY EQUIPMENT              	    14.27	   $14.27	      ---	       --	009	0	0	0.00	    $0.00	N	
M	Q0111	WET MOUNTS/ W PREPARATIONS              	     3.66	    $3.66	      ---	       --	009	0	0	0.20	    $0.00	N	
1	Q0111	WET MOUNTS/ W PREPARATIONS              	     4.72	    $4.72	      ---	       --	009	0	0	0.20	    $0.00	N	
1	Q0112	POTASSIUM HYDROXIDE PREPS               	     4.72	    $4.72	      ---	       --	009	0	0	0.20	    $0.00	N	
M	Q0112	POTASSIUM HYDROXIDE PREPS               	     4.65	    $4.65	      ---	       --	009	0	0	0.20	    $0.00	N	
M	Q0113	PINWORM EXAMINATIONS                    	     3.80	    $3.80	      ---	       --	009	0	0	0.20	    $0.00	N	
1	Q0113	PINWORM EXAMINATIONS                    	     4.72	    $4.72	      ---	       --	009	0	0	0.20	    $0.00	N	
I	Q0138	FERUMOXYTOL, NON-ESRD                   	     0.33	    $0.33	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	Q0139	FERUMOXYTOL, ESRD USE                   	     0.33	    $0.33	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q0144	AZITHROMYCIN DIHYDRATE, ORAL            	     1.75	    $1.75	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q0166	GRANISETRON HCL 1 MG ORAL               	     1.51	    $1.51	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	Q0224	INJ, PEMIVIBART, 4500 MG                	  6583.50	 $6583.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q0477	PWR MODULE PT CABLE LVAD RPL            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q0478	POWER ADAPTER, COMBO VAD                	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q0479	POWER MODULE COMBO VAD, REP             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q0480	DRIVER PNEUMATIC VAD, REP               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q0481	MICROPRCSR CU ELEC VAD, REP             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q0482	MICROPRCSR CU COMBO VAD, REP            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q0483	MONITOR ELEC VAD, REP                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q0484	MONITOR ELEC OR COMB VAD REP            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q0485	MONITOR CABLE ELEC VAD, REP             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q0486	MON CABLE ELEC/PNEUM VAD REP            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q0487	LEADS ANY TYPE VAD, REP ONLY            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q0488	PWR PACK BASE ELEC VAD, REP             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q0489	PWR PCK BASE COMBO VAD, REP             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q0490	EMR PWR SOURCE ELEC VAD, REP            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q0491	EMR PWR SOURCE COMBO VAD REP            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q0492	EMR PWR CBL ELEC VAD, REP               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q0493	EMR PWR CBL COMBO VAD, REP              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q0494	EMR HD PMP ELEC/COMBO, REP              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q0495	CHARGER ELEC/COMBO VAD, REP             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q0496	BATTERY ELEC/COMBO VAD, REP             	  1062.02	 $1062.02	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q0497	BAT CLPS ELEC/COMB VAD, REP             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q0498	HOLSTER ELEC/COMBO VAD, REP             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q0499	BELT/VEST ELEC/COMBO VAD REP            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q0500	FILTERS ELEC/COMBO VAD, REP             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q0501	SHWR COV ELEC/COMBO VAD, REP            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q0502	MOBILITY CART PNEUM VAD, REP            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q0503	BATTERY PNEUM VAD REPLACEMNT            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q0504	PWR ADPT PNEUM VAD, REP VEH             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q0506	LITH-ION BATT ELEC/PNEUM VAD            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q0507	MISC SUP/ACC EXT VAD                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q0508	MIS SUP/ACC IMP VAD                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q0509	MIS SUP/AC IMP VAD NOPAY MED            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	Q2041	AXICABTAGENE CILOLEUCEL CAR+            	 83806.79	$83806.79	      ---	       --	009	0	0	0.00	    $0.00	N	
I	Q2042	TISAGENLECLEUCEL CAR-POS T              	 96461.85	$96461.85	      ---	       --	009	0	0	0.00	    $0.00	N	
I	Q2043	SIPULEUCEL-T AUTO CD54+                 	 57017.10	$57017.10	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	Q2049	IMPORTED LIPODOX INJ                    	   506.46	  $506.46	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	Q2050	DOXORUBICIN INJ 10MG                    	   150.41	  $150.41	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	Q2053	BREXUCABTAGENE CAR POS T                	 97879.83	$97879.83	      ---	       --	009	0	0	0.00	    $0.00	N	
I	Q2054	LISOCABTAGENE MARA CAR POS T            	 86073.71	$86073.71	      ---	       --	009	0	0	0.00	    $0.00	N	
I	Q2055	IDECABTAGENE VICLEUCEL CAR              	 87937.08	$87937.08	      ---	       --	009	0	0	0.00	    $0.00	N	
I	Q2056	CILTACABTAGENE CAR-POS T                	 92194.88	$92194.88	      ---	       --	009	0	0	0.00	    $0.00	N	
I	Q2057	AFAMITRESGENE AUTOLEUCEL                	 90875.00	$90875.00	      ---	       --	009	0	0	0.00	    $0.00	N	
I	Q2058	OBECBTGE AUTOL UP TO 400 MIL            	 87500.00	$87500.00	      ---	       --	009	0	0	0.00	    $0.00	N	
L	Q3001	BRACHYTHERAPY RADIOELEMENTS             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	Q3014	TELEHEALTH FACILITY FEE                 	    22.94	   $22.94	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	Q4081	EPOETIN ALFA, 100 UNITS ESRD            	     5.17	    $5.17	      ---	       --	030	0	0	0.00	    $0.00	Y	
1	Q4082	DRUG/BIO NOC PART B DRUG CAP            	     0.00	    $0.00	      ---	       --	030	0	0	0.00	    $0.00	Y	
1	Q4100	SKIN SUBSTITUTE, NOS                    	     0.00	    $0.00	      ---	       --	009	1	0	0.00	    $0.00	Y	
P	Q4100	SKIN SUBSTITUTE, NOS                    	     0.00	    $0.00	      ---	       --	009	1	0	0.00	    $0.00	Y	
P	Q4101	APLIGRAF                                	    30.36	   $30.36	      ---	   $30.36	009	1	0	0.00	    $0.00	Y	
1	Q4101	APLIGRAF                                	    30.36	   $30.36	      ---	   $30.36	009	1	0	0.00	    $0.00	Y	
1	Q4102	OASIS WOUND MATRIX                      	     9.80	    $9.80	      ---	    $9.80	009	1	0	0.00	    $0.00	Y	
P	Q4102	OASIS WOUND MATRIX                      	     9.80	    $9.80	      ---	    $9.80	009	1	0	0.00	    $0.00	Y	
P	Q4103	OASIS BURN MATRIX                       	     4.35	    $4.35	      ---	    $4.35	009	1	0	0.00	    $0.00	Y	
1	Q4103	OASIS BURN MATRIX                       	     4.35	    $4.35	      ---	    $4.35	009	1	0	0.00	    $0.00	Y	
1	Q4104	INTEGRA BMWD                            	    11.87	   $11.87	      ---	   $11.87	009	1	0	0.00	    $0.00	Y	
P	Q4104	INTEGRA BMWD                            	    11.87	   $11.87	      ---	   $11.87	009	1	0	0.00	    $0.00	Y	
P	Q4105	INTEGRA DRT OR OMNIGRAFT                	    11.87	   $11.87	      ---	   $11.87	009	1	0	0.00	    $0.00	Y	
1	Q4105	INTEGRA DRT OR OMNIGRAFT                	    11.87	   $11.87	      ---	   $11.87	009	1	0	0.00	    $0.00	Y	
1	Q4106	DERMAGRAFT                              	    16.25	   $16.25	      ---	   $16.25	009	1	0	0.00	    $0.00	Y	
P	Q4106	DERMAGRAFT                              	    16.25	   $16.25	      ---	   $16.25	009	1	0	0.00	    $0.00	Y	
P	Q4107	GRAFTJACKET                             	    95.72	   $95.72	      ---	   $95.72	009	1	0	0.00	    $0.00	Y	
1	Q4107	GRAFTJACKET                             	    95.72	   $95.72	      ---	   $95.72	009	1	0	0.00	    $0.00	Y	
1	Q4108	INTEGRA MATRIX                          	    18.85	   $18.85	      ---	   $18.85	009	1	0	0.00	    $0.00	Y	
P	Q4108	INTEGRA MATRIX                          	    18.85	   $18.85	      ---	   $18.85	009	1	0	0.00	    $0.00	Y	
P	Q4110	PRIMATRIX                               	    39.06	   $39.06	      ---	   $39.06	009	1	0	0.00	    $0.00	Y	
1	Q4110	PRIMATRIX                               	    39.06	   $39.06	      ---	   $39.06	009	1	0	0.00	    $0.00	Y	
1	Q4111	GAMMAGRAFT                              	     6.99	    $6.99	      ---	    $6.99	009	1	0	0.00	    $0.00	Y	
P	Q4111	GAMMAGRAFT                              	     6.99	    $6.99	      ---	    $6.99	009	1	0	0.00	    $0.00	Y	
P	Q4112	CYMETRA INJECTABLE                      	   311.36	  $311.36	      ---	  $311.36	009	1	0	0.00	    $0.00	Y	
1	Q4112	CYMETRA INJECTABLE                      	   311.36	  $311.36	      ---	  $311.36	009	1	0	0.00	    $0.00	Y	
1	Q4113	GRAFTJACKET XPRESS                      	   311.36	  $311.36	      ---	  $311.36	009	1	0	0.00	    $0.00	Y	
P	Q4113	GRAFTJACKET XPRESS                      	   311.36	  $311.36	      ---	  $311.36	009	1	0	0.00	    $0.00	Y	
P	Q4114	INTEGRA FLOWABLE WOUND MATRI            	   897.11	  $897.11	      ---	  $897.11	009	1	0	0.00	    $0.00	Y	
1	Q4114	INTEGRA FLOWABLE WOUND MATRI            	   897.11	  $897.11	      ---	  $897.11	009	1	0	0.00	    $0.00	Y	
1	Q4116	ALLODERM                                	    25.78	   $25.78	      ---	   $25.78	009	1	0	0.00	    $0.00	Y	
P	Q4116	ALLODERM                                	    25.78	   $25.78	      ---	   $25.78	009	1	0	0.00	    $0.00	Y	
P	Q4117	HYALOMATRIX                             	     8.71	    $8.71	      ---	    $8.71	009	1	0	0.00	    $0.00	Y	
1	Q4117	HYALOMATRIX                             	     8.71	    $8.71	      ---	    $8.71	009	1	0	0.00	    $0.00	Y	
1	Q4118	MATRISTEM MICROMATRIX                   	     1.86	    $1.86	      ---	    $1.86	009	1	0	0.00	    $0.00	Y	
P	Q4118	MATRISTEM MICROMATRIX                   	     1.86	    $1.86	      ---	    $1.86	009	1	0	0.00	    $0.00	Y	
P	Q4121	THERASKIN                               	    41.96	   $41.96	      ---	   $41.96	009	1	0	0.00	    $0.00	Y	
1	Q4121	THERASKIN                               	    41.96	   $41.96	      ---	   $41.96	009	1	0	0.00	    $0.00	Y	
1	Q4122	DERMACELL, AWM, POROUS SQ CM            	     0.00	    $0.00	      ---	       --	009	1	0	0.00	    $0.00	Y	
P	Q4122	DERMACELL, AWM, POROUS SQ CM            	     0.00	    $0.00	      ---	       --	009	1	0	0.00	    $0.00	Y	
P	Q4123	ALLOSKIN                                	    23.40	   $23.40	      ---	   $23.40	009	1	0	0.00	    $0.00	Y	
1	Q4123	ALLOSKIN                                	    23.40	   $23.40	      ---	   $23.40	009	1	0	0.00	    $0.00	Y	
1	Q4124	OASIS TRI-LAYER WOUND MATRIX            	     9.11	    $9.11	      ---	    $9.11	009	1	0	0.00	    $0.00	Y	
P	Q4124	OASIS TRI-LAYER WOUND MATRIX            	     9.11	    $9.11	      ---	    $9.11	009	1	0	0.00	    $0.00	Y	
P	Q4125	ARTHROFLEX                              	     0.00	    $0.00	      ---	       --	009	1	0	0.00	    $0.00	Y	
1	Q4125	ARTHROFLEX                              	     0.00	    $0.00	      ---	       --	009	1	0	0.00	    $0.00	Y	
1	Q4126	MEMODERM/DERMA/TRANZ/INTEGUP            	    59.54	   $59.54	      ---	   $59.54	009	1	0	0.00	    $0.00	Y	
P	Q4126	MEMODERM/DERMA/TRANZ/INTEGUP            	    59.54	   $59.54	      ---	   $59.54	009	1	0	0.00	    $0.00	Y	
P	Q4127	TALYMED                                 	    68.49	   $68.49	      ---	   $68.49	009	1	0	0.00	    $0.00	Y	
1	Q4127	TALYMED                                 	    68.49	   $68.49	      ---	   $68.49	009	1	0	0.00	    $0.00	Y	
1	Q4128	FLEXHD/ALLOPATCHHD/SQ CM                	    30.59	   $30.59	      ---	   $30.59	009	1	0	0.00	    $0.00	Y	
P	Q4128	FLEXHD/ALLOPATCHHD/SQ CM                	    30.59	   $30.59	      ---	   $30.59	009	1	0	0.00	    $0.00	Y	
P	Q4130	STRATTICE TM                            	     0.00	    $0.00	      ---	       --	009	1	0	0.00	    $0.00	Y	
1	Q4130	STRATTICE TM                            	     0.00	    $0.00	      ---	       --	009	1	0	0.00	    $0.00	Y	
1	Q4131	EPIFIX OR EPICORD                       	   165.00	  $165.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4131	EPIFIX OR EPICORD                       	   165.00	  $165.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4132	GRAFIX CORE, GRAFIXPL CORE              	   131.42	  $131.42	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4132	GRAFIX CORE, GRAFIXPL CORE              	   131.42	  $131.42	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4133	GRAFIX STRAVIX PRIME PL SQCM            	   134.06	  $134.06	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4133	GRAFIX STRAVIX PRIME PL SQCM            	   134.06	  $134.06	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4134	HMATRIX                                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4134	HMATRIX                                 	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	N	
1	Q4135	MEDISKIN                                	     0.00	    $0.00	      ---	       --	007	0	0	0.00	    $0.00	N	
P	Q4135	MEDISKIN                                	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4136	EZDERM                                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4136	EZDERM                                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4151	AMNIOBAND, GUARDIAN 1 SQ CM             	   120.84	  $120.84	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4151	AMNIOBAND, GUARDIAN 1 SQ CM             	   120.84	  $120.84	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4154	BIOVANCE 1 SQUARE CM                    	   144.36	  $144.36	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4154	BIOVANCE 1 SQUARE CM                    	   144.36	  $144.36	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4158	KERECIS OMEGA3, PER SQ CM               	    75.46	   $75.46	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4158	KERECIS OMEGA3, PER SQ CM               	    75.46	   $75.46	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4159	AFFINITY1 SQUARE CM                     	   175.45	  $175.45	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4159	AFFINITY1 SQUARE CM                     	   175.45	  $175.45	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4160	NUSHIELD 1 SQUARE CM                    	    93.93	   $93.93	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4160	NUSHIELD 1 SQUARE CM                    	    93.93	   $93.93	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4166	CYTAL, PER SQUARE CENTIMETER            	    18.55	   $18.55	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4166	CYTAL, PER SQUARE CENTIMETER            	    18.55	   $18.55	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4167	TRUSKIN, PER SQ CENTIMETER              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4167	TRUSKIN, PER SQ CENTIMETER              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4168	AMNIOBAND, 1 MG                         	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4168	AMNIOBAND, 1 MG                         	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4169	ARTACENT WOUND, PER SQ CM               	   176.06	  $176.06	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4169	ARTACENT WOUND, PER SQ CM               	   176.06	  $176.06	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4170	CYGNUS, PER SQ CM                       	    46.16	   $46.16	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4170	CYGNUS, PER SQ CM                       	    46.16	   $46.16	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4171	INTERFYL, 1 MG                          	    11.74	   $11.74	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4171	INTERFYL, 1 MG                          	    11.74	   $11.74	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4172	PURAPLY OR PURAPLY AM                   	    96.08	   $96.08	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4172	PURAPLY OR PURAPLY AM                   	    96.08	   $96.08	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4173	PALINGEN OR PALINGEN XPLUS              	   383.25	  $383.25	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4173	PALINGEN OR PALINGEN XPLUS              	   383.25	  $383.25	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4174	PALINGEN OR PROMATRX                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4174	PALINGEN OR PROMATRX                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4175	MIRODERM                                	    63.38	   $63.38	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4175	MIRODERM                                	    63.38	   $63.38	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4176	NEOPATCH OR THERION, 1 SQ CM            	   129.62	  $129.62	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4176	NEOPATCH OR THERION, 1 SQ CM            	   129.62	  $129.62	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4177	FLOWERAMNIOFLO, 0.1 CC                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4177	FLOWERAMNIOFLO, 0.1 CC                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4178	FLOWERAMNIOPATCH, PER SQ CM             	    86.52	   $86.52	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4178	FLOWERAMNIOPATCH, PER SQ CM             	    86.52	   $86.52	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4179	FLOWERDERM, PER SQ CM                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4179	FLOWERDERM, PER SQ CM                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4180	REVITA, PER SQ CM                       	   166.13	  $166.13	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4180	REVITA, PER SQ CM                       	   166.13	  $166.13	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4181	AMNIO WOUND, PER SQUARE CM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4181	AMNIO WOUND, PER SQUARE CM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4182	TRANSCYTE, PER SQ CENTIMETER            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4182	TRANSCYTE, PER SQ CENTIMETER            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4183	SURGIGRAFT, 1 SQ CM                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4183	SURGIGRAFT, 1 SQ CM                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4184	CELLESTA OR DUO PER SQ CM               	   624.34	  $624.34	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4184	CELLESTA OR DUO PER SQ CM               	   624.34	  $624.34	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4185	CELLESTA FLOWAB AMNION 0.5CC            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4185	CELLESTA FLOWAB AMNION 0.5CC            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4186	EPIFIX 1 SQ CM                          	   151.60	  $151.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4186	EPIFIX 1 SQ CM                          	   151.60	  $151.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4187	EPICORD 1 SQ CM                         	   223.73	  $223.73	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4187	EPICORD 1 SQ CM                         	   223.73	  $223.73	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4188	AMNIOARMOR 1 SQ CM                      	   346.64	  $346.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4188	AMNIOARMOR 1 SQ CM                      	   346.64	  $346.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4189	ARTACENT AC, 1 MG                       	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4189	ARTACENT AC, 1 MG                       	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4190	ARTACENT AC 1 SQ CM                     	   235.69	  $235.69	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4190	ARTACENT AC 1 SQ CM                     	   235.69	  $235.69	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4191	RESTORIGIN 1 SQ CM                      	  1016.31	 $1016.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4191	RESTORIGIN 1 SQ CM                      	  1016.31	 $1016.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4192	RESTORIGIN, 1 CC                        	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4192	RESTORIGIN, 1 CC                        	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4193	COLL-E-DERM 1 SQ CM                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4193	COLL-E-DERM 1 SQ CM                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4194	NOVACHOR 1 SQ CM                        	   858.92	  $858.92	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4194	NOVACHOR 1 SQ CM                        	   858.92	  $858.92	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4195	PURAPLY 1 SQ CM                         	    71.23	   $71.23	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4195	PURAPLY 1 SQ CM                         	    71.23	   $71.23	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4196	PURAPLY AM 1 SQ CM                      	   103.77	  $103.77	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4196	PURAPLY AM 1 SQ CM                      	   103.77	  $103.77	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4197	PURAPLY XT 1 SQ CM                      	    72.64	   $72.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4197	PURAPLY XT 1 SQ CM                      	    72.64	   $72.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4198	GENESIS AMNIO MEMBRANE 1SQCM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4198	GENESIS AMNIO MEMBRANE 1SQCM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4199	CYGNUS MATRIX, PER SQ CM                	   317.84	  $317.84	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4199	CYGNUS MATRIX, PER SQ CM                	   317.84	  $317.84	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4200	SKIN TE 1 SQ CM                         	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4200	SKIN TE 1 SQ CM                         	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4201	MATRION 1 SQ CM                         	    85.03	   $85.03	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4201	MATRION 1 SQ CM                         	    85.03	   $85.03	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4202	KEROXX (2.5G/CC), 1CC                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4202	KEROXX (2.5G/CC), 1CC                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4203	DERMA-GIDE, 1 SQ CM                     	   206.74	  $206.74	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4203	DERMA-GIDE, 1 SQ CM                     	   206.74	  $206.74	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4204	XWRAP 1 SQ CM                           	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4204	XWRAP 1 SQ CM                           	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4205	MEMBRANE GRAFT OR WRAP SQ CM            	  1159.61	 $1159.61	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4205	MEMBRANE GRAFT OR WRAP SQ CM            	  1159.61	 $1159.61	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4206	FLUID FLOW OR FLUID GF 1 CC             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4206	FLUID FLOW OR FLUID GF 1 CC             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4208	NOVAFIX PER SQ CM                       	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4208	NOVAFIX PER SQ CM                       	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4209	SURGRAFT PER SQ CM                      	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4209	SURGRAFT PER SQ CM                      	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4211	AMNION BIO OR AXOBIO SQ CM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4211	AMNION BIO OR AXOBIO SQ CM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4212	ALLOGEN, PER CC                         	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4212	ALLOGEN, PER CC                         	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4213	ASCENT, 0.5 MG                          	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4213	ASCENT, 0.5 MG                          	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4214	CELLESTA CORD PER SQ CM                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4214	CELLESTA CORD PER SQ CM                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4215	AXOLOTL AMBIENT, CRYO 0.1 MG            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4215	AXOLOTL AMBIENT, CRYO 0.1 MG            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4216	ARTACENT CORD PER SQ CM                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4216	ARTACENT CORD PER SQ CM                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4217	WOUNDFIX BIOWOUND PLUS XPLUS            	   370.86	  $370.86	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4217	WOUNDFIX BIOWOUND PLUS XPLUS            	   370.86	  $370.86	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4218	SURGICORD PER SQ CM                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4218	SURGICORD PER SQ CM                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4219	SURGIGRAFT DUAL PER SQ CM               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4219	SURGIGRAFT DUAL PER SQ CM               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4220	BELLACELL HD, SUREDERM SQ CM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4220	BELLACELL HD, SUREDERM SQ CM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4221	AMNIOWRAP2 PER SQ CM                    	  1696.00	 $1696.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4221	AMNIOWRAP2 PER SQ CM                    	  1696.00	 $1696.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4222	PROGENAMATRIX, PER SQ CM                	    91.08	   $91.08	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4222	PROGENAMATRIX, PER SQ CM                	    91.08	   $91.08	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4224	HHF10-P PER SQ CM                       	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4224	HHF10-P PER SQ CM                       	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4225	AMNIO OR DERMA TL, PER SQ CM            	  1459.55	 $1459.55	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4225	AMNIO OR DERMA TL, PER SQ CM            	  1459.55	 $1459.55	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4226	MYOWN HARV PREP PROC SQ CM              	   386.49	  $386.49	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4226	MYOWN HARV PREP PROC SQ CM              	   386.49	  $386.49	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4227	AMNIOCORE PER SQ CM                     	    96.19	   $96.19	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4227	AMNIOCORE PER SQ CM                     	    96.19	   $96.19	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4229	COGENEX AMNIO MEMB PER SQ CM            	   106.02	  $106.02	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4229	COGENEX AMNIO MEMB PER SQ CM            	   106.02	  $106.02	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4230	COGENEX FLOW AMNION 0.5 CC              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4230	COGENEX FLOW AMNION 0.5 CC              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4232	CORPLEX, PER SQ CM                      	    69.62	   $69.62	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4232	CORPLEX, PER SQ CM                      	    69.62	   $69.62	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4233	SURFACTOR /NUDYN PER 0.5 CC             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4233	SURFACTOR /NUDYN PER 0.5 CC             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4234	XCELLERATE, PER SQ CM                   	   255.14	  $255.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4234	XCELLERATE, PER SQ CM                   	   255.14	  $255.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4235	AMNIOREPAIR OR ALTIPLY SQ CM            	    95.15	   $95.15	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4235	AMNIOREPAIR OR ALTIPLY SQ CM            	    95.15	   $95.15	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4236	CAREPATCH PER SQ CM                     	   613.60	  $613.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4236	CAREPATCH PER SQ CM                     	   613.60	  $613.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4237	CRYO-CORD, PER SQ CM                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4237	CRYO-CORD, PER SQ CM                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4238	DERM-MAXX, PER SQ CM                    	  1557.99	 $1557.99	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4238	DERM-MAXX, PER SQ CM                    	  1557.99	 $1557.99	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4239	AMNIO-MAXX OR LITE PER SQ CM            	    68.68	   $68.68	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4239	AMNIO-MAXX OR LITE PER SQ CM            	    68.68	   $68.68	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4240	CORECYTE TOPICAL ONLY 0.5 CC            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4240	CORECYTE TOPICAL ONLY 0.5 CC            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4241	POLYCYTE, TOPICAL ONLY 0.5CC            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4241	POLYCYTE, TOPICAL ONLY 0.5CC            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4242	AMNIOCYTE PLUS, PER 0.5 CC              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4242	AMNIOCYTE PLUS, PER 0.5 CC              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4245	AMNIOTEXT, PER CC                       	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4245	AMNIOTEXT, PER CC                       	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4246	CORETEXT OR PROTEXT, PER CC             	  2968.00	 $2968.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4246	CORETEXT OR PROTEXT, PER CC             	  2968.00	 $2968.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4247	AMNIOTEXT PATCH, PER SQ CM              	   530.00	  $530.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4247	AMNIOTEXT PATCH, PER SQ CM              	   530.00	  $530.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4248	DERMACYTE AMN MEM ALLO SQ CM            	   119.42	  $119.42	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4248	DERMACYTE AMN MEM ALLO SQ CM            	   119.42	  $119.42	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4249	AMNIPLY, PER SQ CM                      	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4249	AMNIPLY, PER SQ CM                      	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4250	AMNIOAMP-MP PER SQ CM                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4250	AMNIOAMP-MP PER SQ CM                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4251	VIM, PER SQUARE CENTIMETER              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4251	VIM, PER SQUARE CENTIMETER              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4252	VENDAJE, PER SQUARE CENTIMET            	    76.97	   $76.97	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4252	VENDAJE, PER SQUARE CENTIMET            	    76.97	   $76.97	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4253	ZENITH AMNIOTIC MEMBRANE PSC            	   119.43	  $119.43	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4253	ZENITH AMNIOTIC MEMBRANE PSC            	   119.43	  $119.43	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4254	NOVAFIX DL PER SQ CM                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4254	NOVAFIX DL PER SQ CM                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4255	REGUARD, TOPICAL USE PER SQ             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4255	REGUARD, TOPICAL USE PER SQ             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4256	MLG COMPLET, PER SQ CM                  	   972.83	  $972.83	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4256	MLG COMPLET, PER SQ CM                  	   972.83	  $972.83	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4257	RELESE, PER SQ CM                       	   487.72	  $487.72	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4257	RELESE, PER SQ CM                       	   487.72	  $487.72	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4258	ENVERSE, PER SQ CM                      	    61.23	   $61.23	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4258	ENVERSE, PER SQ CM                      	    61.23	   $61.23	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4259	CELERA PER SQ CM                        	  1280.74	 $1280.74	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4259	CELERA PER SQ CM                        	  1280.74	 $1280.74	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4260	SIGNATURE APATCH, PER SQ CM             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4260	SIGNATURE APATCH, PER SQ CM             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4261	TAG, PER SQUARE CENTIMETER              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4261	TAG, PER SQUARE CENTIMETER              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4262	DUAL LAYER IMPAX, PER SQ CM             	   302.52	  $302.52	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4262	DUAL LAYER IMPAX, PER SQ CM             	   302.52	  $302.52	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4263	SURGRAFT TL, PER SQ CM                  	  1054.31	 $1054.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4263	SURGRAFT TL, PER SQ CM                  	  1054.31	 $1054.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4264	COCOON MEMBRANE, PER SQ CM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4264	COCOON MEMBRANE, PER SQ CM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4265	NEOSTIM TL PER SQ CM                    	  2114.70	 $2114.70	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4265	NEOSTIM TL PER SQ CM                    	  2114.70	 $2114.70	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4266	NEOSTIM PER SQ CM                       	   888.92	  $888.92	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4266	NEOSTIM PER SQ CM                       	   888.92	  $888.92	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4267	NEOSTIM DL PER SQ CM                    	   371.31	  $371.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4267	NEOSTIM DL PER SQ CM                    	   371.31	  $371.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4268	SURGRAFT FT PER SQ CM                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4268	SURGRAFT FT PER SQ CM                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4269	SURGRAFT XT PER SQ CM                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4269	SURGRAFT XT PER SQ CM                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4270	COMPLETE SL PER SQ CM                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4270	COMPLETE SL PER SQ CM                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4271	COMPLETE FT PER SQ CM                   	  1541.61	 $1541.61	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4271	COMPLETE FT PER SQ CM                   	  1541.61	 $1541.61	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4272	ESANO A, PER SQ CM                      	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4272	ESANO A, PER SQ CM                      	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4273	ESANO AAA, PER SQ CM                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4273	ESANO AAA, PER SQ CM                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4274	ESANO AC, PER SQ CM                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4274	ESANO AC, PER SQ CM                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4275	ESANO ACA, PER SQ CM                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4275	ESANO ACA, PER SQ CM                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4276	ORION, PER SQ CM                        	   483.79	  $483.79	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4276	ORION, PER SQ CM                        	   483.79	  $483.79	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4278	EPIEFFECT, PER SQ CM                    	   306.07	  $306.07	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4278	EPIEFFECT, PER SQ CM                    	   306.07	  $306.07	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4279	VENDAJE AC, PER SQ CM                   	  2385.00	 $2385.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4279	VENDAJE AC, PER SQ CM                   	  2385.00	 $2385.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4280	XCELL AMNIO MATRIX PER SQ CM            	  2060.40	 $2060.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4280	XCELL AMNIO MATRIX PER SQ CM            	  2060.40	 $2060.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4281	BARRERA SLOR DL PER SQ CM               	   888.11	  $888.11	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4281	BARRERA SLOR DL PER SQ CM               	   888.11	  $888.11	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4282	CYGNUS DUAL PER SQ CM                   	   486.78	  $486.78	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4282	CYGNUS DUAL PER SQ CM                   	   486.78	  $486.78	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4283	BIOVANCE TRI OR 3L, SQ CM               	   660.38	  $660.38	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4283	BIOVANCE TRI OR 3L, SQ CM               	   660.38	  $660.38	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4284	DERMABIND SL, PER SQ CM                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4284	DERMABIND SL, PER SQ CM                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4285	NUDYN DL OR DL MESH PR SQ CM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4285	NUDYN DL OR DL MESH PR SQ CM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4286	NUDYN SL OR SLW, PER SQ CM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4286	NUDYN SL OR SLW, PER SQ CM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4287	DERMABIND DL, PER SQ CM                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4287	DERMABIND DL, PER SQ CM                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4288	DERMABIND CH, PER SQ CM                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4288	DERMABIND CH, PER SQ CM                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4289	REVOSHIELD+ AMNIO, PER SQ CM            	  1859.50	 $1859.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4289	REVOSHIELD+ AMNIO, PER SQ CM            	  1859.50	 $1859.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4290	MEMBRANE WRAP HYDR PER SQ CM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4290	MEMBRANE WRAP HYDR PER SQ CM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4291	LAMELLAS XT, PER SQ CM                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4291	LAMELLAS XT, PER SQ CM                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4292	LAMELLAS, PER SQ CM                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4292	LAMELLAS, PER SQ CM                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4293	ACESSO DL, PER SQ CM                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4293	ACESSO DL, PER SQ CM                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4294	AMNIO QUAD-CORE, PER SQ CM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4294	AMNIO QUAD-CORE, PER SQ CM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4295	AMNIO TRI-CORE, PER SQ CM               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4295	AMNIO TRI-CORE, PER SQ CM               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4296	REBOUND MATRIX, PER SQ CM               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4296	REBOUND MATRIX, PER SQ CM               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4297	EMERGE MATRIX, PER SQ CM                	  1788.16	 $1788.16	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4297	EMERGE MATRIX, PER SQ CM                	  1788.16	 $1788.16	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4298	AMNICORE PRO, PER SQ CM                 	  2172.41	 $2172.41	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4298	AMNICORE PRO, PER SQ CM                 	  2172.41	 $2172.41	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4299	AMNICORE PRO+, PER SQ CM                	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4299	AMNICORE PRO+, PER SQ CM                	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4300	ACESSO TL, PER SQ CM                    	  2114.70	 $2114.70	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4300	ACESSO TL, PER SQ CM                    	  2114.70	 $2114.70	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4301	ACTIVATE MATRIX, PER SQ CM              	  1934.93	 $1934.93	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4301	ACTIVATE MATRIX, PER SQ CM              	  1934.93	 $1934.93	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4302	COMPLETE ACA, PER SQ CM                 	  2008.70	 $2008.70	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4302	COMPLETE ACA, PER SQ CM                 	  2008.70	 $2008.70	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4303	COMPLETE AA, PER SQ CM                  	  3412.79	 $3412.79	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4303	COMPLETE AA, PER SQ CM                  	  3412.79	 $3412.79	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4304	GRAFIX PLUS, PER SQ CM                  	   919.99	  $919.99	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4304	GRAFIX PLUS, PER SQ CM                  	   919.99	  $919.99	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4305	AMER AM AC TRI-LAY PER SQ CM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4305	AMER AM AC TRI-LAY PER SQ CM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4306	AMERIC AMNION AC PER SQ CM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4306	AMERIC AMNION AC PER SQ CM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4307	AMERICAN AMNION, PER SQ CM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4307	AMERICAN AMNION, PER SQ CM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4308	SANOPELLIS, PER SQ CM                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4308	SANOPELLIS, PER SQ CM                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4309	VIA MATRIX, PER SQ CM                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4309	VIA MATRIX, PER SQ CM                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4310	PROCENTA, PER 100 MG                    	  2154.98	 $2154.98	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4310	PROCENTA, PER 100 MG                    	  2154.98	 $2154.98	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4311	ACESSO, PER SQ CM                       	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4311	ACESSO, PER SQ CM                       	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4312	ACESSO AC, PER SQ CM                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4312	ACESSO AC, PER SQ CM                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4313	DERMABIND FM, PER SQ CM                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4313	DERMABIND FM, PER SQ CM                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4314	REEVA, PER SQ CM                        	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4314	REEVA, PER SQ CM                        	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4315	REGENELINK AMNIOTIC MEM ALLO            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4315	REGENELINK AMNIOTIC MEM ALLO            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4316	AMCHOPLAST, PER SQ CM                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4316	AMCHOPLAST, PER SQ CM                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4317	VITOGRAFT, PER SQ CM                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4317	VITOGRAFT, PER SQ CM                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4318	E-GRAFT, PER SQ CM                      	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4318	E-GRAFT, PER SQ CM                      	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4319	SANOGRAFT, PER SQ CM                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4319	SANOGRAFT, PER SQ CM                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4320	PELLOGRAFT, PER SQ CM                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4320	PELLOGRAFT, PER SQ CM                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4321	RENOGRAFT, PER SQ CM                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4321	RENOGRAFT, PER SQ CM                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4322	CAREGRAFT, PER SQ CM                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4322	CAREGRAFT, PER SQ CM                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4323	ALLOPLY, PER SQ CM                      	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4323	ALLOPLY, PER SQ CM                      	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4324	AMNIOTX, PER SQ CM                      	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4324	AMNIOTX, PER SQ CM                      	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4325	ACAPATCH, PER SQ CM                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4325	ACAPATCH, PER SQ CM                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4326	WOUNDPLUS, PER SQ CM                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4326	WOUNDPLUS, PER SQ CM                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4327	DUOAMNION, PER SQ CM                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4327	DUOAMNION, PER SQ CM                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4328	MOST, PER SQ CM                         	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4328	MOST, PER SQ CM                         	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4329	SINGLAY, PER SQ CM                      	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4329	SINGLAY, PER SQ CM                      	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4330	TOTAL, PER SQ CM                        	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4330	TOTAL, PER SQ CM                        	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4331	AXOLOTL GRAFT, PER SQ CM                	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4331	AXOLOTL GRAFT, PER SQ CM                	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4332	AXOLOTL DUALGRAFT, PER SQ CM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4332	AXOLOTL DUALGRAFT, PER SQ CM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4333	ARDEOGRAFT, PER SQ CM                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4333	ARDEOGRAFT, PER SQ CM                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4334	AMNIOPLAST 1, PER SQ CM                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4334	AMNIOPLAST 1, PER SQ CM                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4335	AMNIOPLAST 2, PER SQ CM                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4335	AMNIOPLAST 2, PER SQ CM                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4336	ARTECENT C, PER SQ CM                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4336	ARTECENT C, PER SQ CM                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4337	ARTECENT TRIDENT, PER SQ CM             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4337	ARTECENT TRIDENT, PER SQ CM             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4338	ARTACENT VELOS, PER SQ CM               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4338	ARTACENT VELOS, PER SQ CM               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4339	ARTACENT VERICLEN, PER SQ CM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4339	ARTACENT VERICLEN, PER SQ CM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4340	SIMPLIGRAFT, PER SQ CM                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4340	SIMPLIGRAFT, PER SQ CM                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4341	SIMPLIMAX, PER SQ CM                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4341	SIMPLIMAX, PER SQ CM                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4342	THERAMEND, PER SQ CM                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4342	THERAMEND, PER SQ CM                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4343	DERMACYTE AC MATRX PER SQ CM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4343	DERMACYTE AC MATRX PER SQ CM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4344	TRI MEMBRANE WRAP, PER SQ CM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4344	TRI MEMBRANE WRAP, PER SQ CM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4345	MATRIX HD ALLOGRFT PER SQ CM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4345	MATRIX HD ALLOGRFT PER SQ CM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4346	SHELTER DM MATRIX PER SQ CM             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4346	SHELTER DM MATRIX PER SQ CM             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4347	RAMPART DL MATRIX PER SQ CM             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4347	RAMPART DL MATRIX PER SQ CM             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4348	SENTRY SL MATRIX PER SQ CM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4348	SENTRY SL MATRIX PER SQ CM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4349	MANTLE DL MATRIX PER SQ CM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4349	MANTLE DL MATRIX PER SQ CM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4350	PALISADE DM MATRIX PER SQ CM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4350	PALISADE DM MATRIX PER SQ CM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4351	ENCLOSE TL MATRIX, PER SQ CM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4351	ENCLOSE TL MATRIX, PER SQ CM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4352	OVERLAY SL MATRIX, PER SQ CM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4352	OVERLAY SL MATRIX, PER SQ CM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4353	XCEED TL MATRIX PER SQ CM               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4353	XCEED TL MATRIX PER SQ CM               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4354	PALINGEN DUAL-LAYER SQ CM               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4354	PALINGEN DUAL-LAYER SQ CM               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4355	ABIO XPL ABIO XPL HY P SQ CM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4355	ABIO XPL ABIO XPL HY P SQ CM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4356	ABIO MEM ABIO HYD PER SQ CM             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4356	ABIO MEM ABIO HYD PER SQ CM             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4357	XWRAP PLUS, PER SQ CM                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4357	XWRAP PLUS, PER SQ CM                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4358	XWRAP DUAL, PER SQ CM                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4358	XWRAP DUAL, PER SQ CM                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4359	CHORIPLY, PER SQ CM                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4359	CHORIPLY, PER SQ CM                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4360	AMCHOPLAST FD PER SQ CM                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4360	AMCHOPLAST FD PER SQ CM                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4361	EPIXPRESS, PER SQ CM                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4361	EPIXPRESS, PER SQ CM                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4362	CYGNUS DISK, PER SQ CM                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4362	CYGNUS DISK, PER SQ CM                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4363	AM BUR MEM HYDRO PER SQ CM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4363	AM BUR MEM HYDRO PER SQ CM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4364	AM BUR XP MEM XPL HY P SQ CM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4364	AM BUR XP MEM XPL HY P SQ CM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4365	AMNIO BUR DL MEM PER SQ CM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4365	AMNIO BUR DL MEM PER SQ CM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4366	DL AMNIO BUR X-MEM PER SQ CM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4366	DL AMNIO BUR X-MEM PER SQ CM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4367	AMNIOCORE SL, PER SQ CM                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4367	AMNIOCORE SL, PER SQ CM                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4368	AMCHOTHICK PER SQ CM                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4368	AMCHOTHICK PER SQ CM                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4369	AMNIOPLAST 3 PER SQ CM                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4369	AMNIOPLAST 3 PER SQ CM                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4370	AEROGUARD PER SQ CM                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4370	AEROGUARD PER SQ CM                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4371	NEOGUARD PER SQ CM                      	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4371	NEOGUARD PER SQ CM                      	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4372	AMCHOPLAST EXCL PER SQ CM               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4372	AMCHOPLAST EXCL PER SQ CM               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4373	MEMBRANE WRP LT PER SQ CM               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4373	MEMBRANE WRP LT PER SQ CM               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4375	DUOGRAFT AC PER SQ CM                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4375	DUOGRAFT AC PER SQ CM                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4376	DUOGRAFT AA PER SQ CM                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4376	DUOGRAFT AA PER SQ CM                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4377	TRIGRAFT FT PER SQ CM                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4377	TRIGRAFT FT PER SQ CM                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4378	RENEW FT MATRIX PER SQ CM               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4378	RENEW FT MATRIX PER SQ CM               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4379	AMNIODEFEND FT PER SQ CM                	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4379	AMNIODEFEND FT PER SQ CM                	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4380	ADVOGRAFT ONE PER SQ CM                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4380	ADVOGRAFT ONE PER SQ CM                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	Q4382	ADVOGRAFT DUAL PER SQ CM                	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q4382	ADVOGRAFT DUAL PER SQ CM                	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Q5001	HOSPICE OR HOME HLTH IN HOME            	     0.01	    $0.01	      ---	       --	009	0	0	0.00	    $0.00	N	
I	Q5098	INJ USTEKINUMAB-SRLF, 1 MG              	     0.00	    $0.00	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	Q5099	INJ USTEKINUMAB-STBA, 1 MG              	    36.18	   $36.18	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	Q5100	INJ USTEKINUMAB-KFCE, 1 MG              	    30.23	   $30.23	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	Q5101	INJECTION, ZARXIO                       	     4.79	    $4.79	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	Q5103	INJECTION, INFLECTRA                    	    15.91	   $15.91	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	Q5104	INJECTION, RENFLEXIS                    	    27.85	   $27.85	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	Q5105	INJ RETACRIT ESRD ON DIALYSI            	     5.17	    $5.17	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	Q5106	INJ RETACRIT NON-ESRD USE               	    11.53	   $11.53	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	Q5107	INJ MVASI 10 MG                         	    29.82	   $29.82	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	Q5108	INJECTION, FULPHILA                     	   117.36	  $117.36	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	Q5109	INJECTION, IXIFI, 10 MG                 	     0.00	    $0.00	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	Q5110	NIVESTYM                                	     4.75	    $4.75	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	Q5111	INJECTION, UDENYCA 0.5 MG               	   168.06	  $168.06	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	Q5112	INJ ONTRUZANT 10 MG                     	    28.74	   $28.74	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	Q5113	INJ HERZUMA 10 MG                       	    73.91	   $73.91	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	Q5114	INJ OGIVRI 10 MG                        	    46.82	   $46.82	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	Q5115	INJ TRUXIMA 10 MG                       	    34.76	   $34.76	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	Q5116	INJ., TRAZIMERA, 10 MG                  	    24.93	   $24.93	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	Q5117	INJ., KANJINTI, 10 MG                   	    27.91	   $27.91	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	Q5118	INJ., ZIRABEV, 10 MG                    	    26.94	   $26.94	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	Q5119	INJ RUXIENCE, 10 MG                     	    24.94	   $24.94	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	Q5120	INJ PEGFILGRASTIM-BMEZ 0.5MG            	    29.17	   $29.17	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	Q5121	INJ. AVSOLA, 10 MG                      	    19.75	   $19.75	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	Q5122	INJ, NYVEPRIA                           	   138.71	  $138.71	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	Q5123	INJ. RIABNI, 10 MG                      	    33.09	   $33.09	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	Q5124	INJ. BYOOVIZ, 0.1 MG                    	    85.57	   $85.57	      ---	       --	009	0	0	0.00	    $0.00	N	
I	Q5125	INJ, RELEUKO 1 MCG                      	     4.89	    $4.89	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	Q5126	INJ ALYMSYS 10 MG                       	    46.05	   $46.05	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	Q5127	INJ, STIMUFEND, 0.5 MG                  	   255.71	  $255.71	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	Q5128	INJ, CIMERLI, 0.1 MG                    	   146.76	  $146.76	      ---	       --	009	0	0	0.00	    $0.00	N	
I	Q5129	INJ, VEGZELMA, 10 MG                    	    48.08	   $48.08	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	Q5130	INJ, FYLNETRA, 0.5 MG                   	   168.61	  $168.61	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	Q5133	INJ, TOFIDENCE, 1 MG                    	     5.97	    $5.97	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	Q5134	INJ, TYRUKO, 1 MG                       	     0.00	    $0.00	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	Q5135	INJ, TYENNE, 1 MG                       	     8.53	    $8.53	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	Q5136	INJ. DENOSUMAB-BBDZ, 1 MG               	     0.00	    $0.00	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	Q5137	INJ, WEZLANA, SUB CU, 1 MG              	    66.33	   $66.33	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	Q5138	INJ, WEZLANA, IV, 1 MG                  	    10.90	   $10.90	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	Q5140	INJ ADALIMUMAB-FKJP, 1 MG               	    21.04	   $21.04	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	Q5141	INJ ADALIMUMAB-AATY, 1 MG               	    31.85	   $31.85	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	Q5142	INJ ADALIMUMAB-RYVK, 1 MG               	    28.97	   $28.97	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	Q5143	INJ ADALIMUMAB-ADBM, 1 MG               	    34.29	   $34.29	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	Q5144	INJ, IDACIO, 1 MG                       	    26.94	   $26.94	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	Q5145	INJ, ABRILADA, 1 MG                     	     0.00	    $0.00	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	Q5146	INJ, HERCESSI, 10 MG                    	    88.20	   $88.20	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	Q5147	INJ, AFLIBERCEPT-AYYH, 1 MG             	   795.86	  $795.86	      ---	       --	009	0	0	0.00	    $0.00	N	
I	Q5149	INJ, AFLIBERCEPT-ABZV, 1 MG             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	Q5150	INJ, AFLIBERCEPT-MRBB, 1 MG             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	Q5151	INJ, ECULIZUMAB-AAGH, 2 MG              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	Q5152	INJ, ECULIZUMAB-AEEB, 2 MG              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	Q5153	INJ, AFLIBERCEPT-YSZY, 1 MG             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
N	Q9001	CHAPLAIN ASSESSMENT                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	Q9002	CHAPLAIN COUNSEL INDIVIDU               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	Q9003	CHAPLAIN COUNSEL GROUP                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	Q9004	VA WHOLE HEALTH PARTNER SERV            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	Q9950	INJ SULF HEXA LIPID MICROSPH            	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	Q9951	LOCM >= 400 MG/ML IODINE,1ML            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	Q9953	INJ FE-BASED MR CONTRAST,1ML            	    24.33	   $24.33	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	Q9954	ORAL MR CONTRAST, 100 ML                	     7.18	    $7.18	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	Q9956	INJ OCTAFLUOROPROPANE MIC,ML            	    30.52	   $30.52	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	Q9956	INJ OCTAFLUOROPROPANE MIC,ML            	    34.90	   $34.90	      ---	       --	030	0	0	0.00	    $0.00	N	
I	Q9957	INJ PERFLUTREN LIP MICROS,ML            	    50.24	   $50.24	      ---	       --	030	0	0	0.00	    $0.00	N	
L	Q9957	INJ PERFLUTREN LIP MICROS,ML            	    48.27	   $48.27	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	Q9958	HOCM <=149 MG/ML IODINE, 1ML            	     0.08	    $0.08	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	Q9959	HOCM 150-199MG/ML IODINE,1ML            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	Q9960	HOCM 200-249MG/ML IODINE,1ML            	     0.22	    $0.22	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	Q9961	HOCM 250-299MG/ML IODINE,1ML            	     0.15	    $0.15	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	Q9962	HOCM 300-349MG/ML IODINE,1ML            	     0.15	    $0.15	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	Q9963	HOCM 350-399MG/ML IODINE,1ML            	     0.21	    $0.21	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	Q9964	HOCM>= 400MG/ML IODINE, 1ML             	     0.16	    $0.16	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	Q9965	LOCM 100-199MG/ML IODINE,1ML            	     1.49	    $1.49	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	Q9966	LOCM 200-299MG/ML IODINE,1ML            	     0.48	    $0.48	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	Q9967	LOCM 300-399MG/ML IODINE,1ML            	     0.17	    $0.17	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	Q9968	VISUALIZATION ADJUNCT                   	    18.64	   $18.64	      ---	       --	030	0	0	0.00	    $0.00	N	
L	Q9969	NON-HEU TC-99M ADD-ON/DOSE              	     0.00	    $0.00	      ---	       --	005	0	0	0.00	    $0.00	Y	
L	Q9982	FLUTEMETAMOL F18 DIAGNOSTIC             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	Q9983	FLORBETABEN F18 DIAGNOSTIC              	  2800.00	 $2800.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	Q9991	BUPRENORPH XR 100 MG OR LESS            	  1929.69	 $1929.69	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	Q9992	BUPRENORPHINE XR OVER 100 MG            	  1929.69	 $1929.69	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	Q9996	USTEKINUMAB- TTWE SUB CU INJ            	    50.86	   $50.86	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	Q9997	USTEKINUMAB-TTWE IV INJ 1 MG            	     8.46	    $8.46	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	Q9998	INJ USTEKINUMAB-AEKN, 1 MG              	    50.86	   $50.86	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	Q9999	INJ USTEKINUMAB-AAUZ 1 MG               	    35.59	   $35.59	      ---	       --	030	0	0	0.00	    $0.00	Y	
L	R0070	TRANSPORT PORTABLE X-RAY                	   174.06	  $174.06	      ---	       --	009	0	0	0.00	    $0.00	N	
L	R0075	TRANSPORT PORT X-RAY MULTIPL            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	S0013	ESKETAMINE, NASAL SPRAY                 	    14.39	   $14.39	      ---	       --	009	0	0	0.00	    $0.00	N	
I	S0074	INJECTION, CEFOTETAN DISODIU            	    16.57	   $16.57	      ---	       --	030	0	0	0.00	    $0.00	N	
I	S0078	INJECTION, FOSPHENYTOIN SODI            	    95.21	   $95.21	      ---	       --	030	0	0	0.00	    $0.00	N	
I	S0080	INJECTION, PENTAMIDINE ISETH            	   130.58	  $130.58	      ---	       --	030	0	0	0.00	    $0.00	Y	
1	S0109	METHADONE ORAL 5MG                      	     0.11	    $0.11	      ---	       --	009	0	0	0.00	    $0.00	N	
1	S0117	TRETINOIN TOPICAL 5 G                   	    20.79	   $20.79	      ---	       --	009	0	0	0.00	    $0.00	N	
1	S0119	ONDANSETRON 4 MG                        	     0.17	    $0.17	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	S0132	INJ GANIRELIX ACETAT 250 MCG            	    71.61	   $71.61	      ---	       --	030	0	0	0.00	    $0.00	N	
1	S0140	SAQUINAVIR, 200 MG                      	     4.13	    $4.13	      ---	       --	009	0	0	0.00	    $0.00	Y	
I	S0145	PEG INTERFERON ALFA-2A/180              	  1117.88	 $1117.88	      ---	       --	030	0	0	0.00	    $0.00	Y	
I	S0148	PEG INTERFERON ALFA-2B/10               	   154.89	  $154.89	      ---	       --	030	0	0	0.00	    $0.00	Y	
1	S0189	TESTOSTERONE PELLET 75 MG               	   108.18	  $108.18	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	S0190	MIFEPRISTONE, ORAL, 200 MG              	    47.79	   $47.79	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	S0191	MISOPROSTOL, ORAL, 200 MCG              	     0.65	    $0.65	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	S0197	PRENATAL VITAMINS 30 DAY                	     1.38	    $1.38	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	S0199	MED ABORTION INC ALL EX DRUG            	    14.41	  $536.48	      ---	       --	035	0	0	0.00	    $0.00	Y	
N	S0257	END OF LIFE COUNSELING                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
N	S0265	GENETIC COUNSEL 15 MINS                 	    15.00	   $15.00	      ---	       --	009	0	0	0.00	    $0.00	N	
U	S0390	ROUT FOOT CARE PER VISIT                	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	S0500	DISPOS CONT LENS                        	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	N	
N	S0500	DISPOS CONT LENS                        	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	N	
N	S0512	DAILY CONT LENS                         	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	N	
1	S0512	DAILY CONT LENS                         	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	N	
1	S0514	COLOR CONT LENS                         	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	N	
N	S0514	COLOR CONT LENS                         	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	N	
N	S0516	SAFETY FRAMES                           	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	N	
1	S0516	SAFETY FRAMES                           	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	N	
1	S1040	CRANIAL REMOLDING ORTHOSIS              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	S1091	STENT NON-CORONARY PROPEL               	  1350.00	 $1350.00	      ---	       --	009	0	0	0.00	    $0.00	N	
O	S2065	SIMULT PANC KIDN TRANS                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	S2065	SIMULT PANC KIDN TRANS                  	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	S2066	BREAST GAP FLAP RECONST                 	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	S2066	BREAST GAP FLAP RECONST                 	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
O	S2067	BREAST "STACKED" DIEP/GAP               	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	S2067	BREAST "STACKED" DIEP/GAP               	     0.00	    $0.00	      ---	       --	004	0	0	0.00	    $0.00	Y	
K	S2068	BREAST DIEP OR SIEA FLAP                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	S2068	BREAST DIEP OR SIEA FLAP                	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
K	S2079	LAP ESOPHAGOMYOTOMY                     	    21.52	  $801.19	      ---	 $1010.36	004	1	0	0.00	    $0.00	Y	
K	S2117	ARTHROEREISIS, SUBTALAR                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
O	S2117	ARTHROEREISIS, SUBTALAR                 	     0.00	    $0.00	      ---	       --	004	1	0	0.00	    $0.00	Y	
P	S2117	ARTHROEREISIS, SUBTALAR                 	     0.00	    $0.00	      ---	       --	015	1	0	0.00	    $0.00	Y	
O	S2118	TOTAL HIP RESURFACING                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	S2118	TOTAL HIP RESURFACING                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	S2230	IMPLANT SEMI-IMP HEAR                   	    10.57	  $393.52	      ---	  $496.26	004	1	0	0.00	    $0.00	Y	
O	S2230	IMPLANT SEMI-IMP HEAR                   	     2.11	   $78.56	      ---	   $99.06	004	1	0	0.00	    $0.00	Y	
O	S2235	IMPLANT AUDITORY BRAIN IMP              	     2.78	  $103.50	      ---	  $130.52	004	1	0	0.00	    $0.00	Y	
K	S2235	IMPLANT AUDITORY BRAIN IMP              	    13.92	  $518.24	      ---	  $653.54	004	1	0	0.00	    $0.00	Y	
M	S3620	NEWBORN METABOLIC SCREENING             	   211.00	  $211.00	      ---	       --	009	0	0	0.80	    $0.00	N	
1	S4024	AIR POLYMER FOAM PER STUDY              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	S4989	CONTRACEPT IUD                          	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	S4993	CONTRACEPTIVE PILLS FOR BC              	    12.00	   $12.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	S5000	PRESCRIPTION DRUG, GENERIC              	     0.01	    $0.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	S5001	PRESCRIPTION DRUG,BRAND NAME            	     0.01	    $0.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
U	S5100	ADULT DAYCARE SERVICES 15MIN            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
U	S5102	ADULT DAY CARE PER DIEM                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	S5102	ADULT DAY CARE PER DIEM                 	    76.27	   $76.27	      ---	       --	009	0	0	0.00	    $0.00	N	
1	S5110	FAMILY HOMECARE TRAINING 15M            	    11.36	   $11.36	      ---	       --	009	0	0	0.00	    $0.00	N	
N	S5110	HOMECARE TRAIN, FM 15 MIN               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
Q	S5110	HOMECARE TRAIN, FM 15 MIN               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
Q	S5111	HOMECARE TRAIN, FM PER SESS             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
N	S5111	HOMECARE TRAIN, FM PER SESS             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	S5111	FAMILY HOMECARE TRAIN/SESSIO            	    35.77	   $35.77	      ---	       --	009	0	0	0.00	    $0.00	N	
U	S5125	ATTENDANT CARE SERVICE /15M             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
U	S5126	ATTENDANT CARE SERVICE /DIEM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
U	S5130	HOMAKER SERVICE NOS PER 15M             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
G	S5130	HOMAKER SERVICE NOS PER 15M             	     3.72	    $3.72	      ---	       --	009	0	0	0.00	    $0.00	N	
U	S5131	HOMEMAKER SERVICE NOS /DIEM             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
U	S5135	ADULT COMPANIONCARE PER 15M             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
U	S5136	ADULT COMPANIONCARE PER DIEM            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	S5136	ADULT COMPANIONCARE PER DIEM            	     0.01	    $0.01	      ---	       --	009	0	0	0.00	    $0.00	N	
U	S5150	UNSKILLED RESPITE CARE /15M             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	S5160	EMER RESPONSE SYS INSTAL&TST            	     0.01	    $0.01	      ---	       --	009	0	0	0.00	    $0.00	N	
1	S5161	EMER RSPNS SYS SERV PERMONTH            	     0.01	    $0.01	      ---	       --	009	0	0	0.00	    $0.00	N	
U	S5161	EMER RSPNS SYS SERV PERMONTH            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
U	S5162	EMER RSPNS SYSTEM PURCHASE              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
U	S5165	HOME MODIFICATIONS PER SERV             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	S5165	HOME MODIFICATIONS PER SERV             	  1500.00	 $1500.00	      ---	       --	009	0	0	0.00	    $0.00	N	
G	S5165	HOME MODIFICATIONS PER SERV             	  1000.00	 $1000.00	      ---	       --	009	0	0	0.00	    $0.00	N	
G	S5170	HOMEDELIVERED PREPARED MEAL             	   150.00	  $150.00	      ---	       --	009	0	0	0.00	    $0.00	N	
U	S5170	HOMEDELIVERED PREPARED MEAL             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	S5190	WELLNESS ASSESSMENT BY NONPH            	   100.00	  $100.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	S5199	PERSONAL CARE ITEM NOS EACH             	    14.99	   $14.99	      ---	       --	009	0	0	0.00	    $0.00	Y	
U	S5199	PERSONAL CARE ITEM NOS EACH             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
I	S5550	INSULIN RAPID 5 U                       	     5.15	    $5.15	      ---	       --	030	0	0	0.00	    $0.00	N	
I	S5551	INSULIN MOST RAPID 5 U                  	     5.25	    $5.25	      ---	       --	030	0	0	0.00	    $0.00	N	
I	S5552	INSULIN INTERMED 5 U                    	     4.78	    $4.78	      ---	       --	030	0	0	0.00	    $0.00	N	
I	S5553	INSULIN LONG ACTING 5 U                 	     5.30	    $5.30	      ---	       --	030	0	0	0.00	    $0.00	N	
I	S5566	INSULIN CARTRIDGE 300 U                 	    50.50	   $50.50	      ---	       --	030	0	0	0.00	    $0.00	N	
I	S5571	INSULIN DISPOS PEN 3 ML                 	    66.76	   $66.76	      ---	       --	030	0	0	0.00	    $0.00	N	
1	S8035	MAGNETIC SOURCE IMAGING                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
L	S8037	MRCP                                    	   147.18	  $562.23	      ---	       --	005	0	0	0.30	    $0.00	Y	
1	S8130	INTERFERENTIAL STIM 2 CHAN              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	S8131	INTERFERENTIAL STIM 4 CHAN              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	S8265	HABERMAN FEEDER                         	    18.52	   $18.52	      ---	       --	009	0	0	0.00	    $0.00	Y	
U	S8990	PT OR MANIP FOR MAINT                   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
U	S9110	TELEMONITORING/HOME PER MNTH            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	S9122	HOME HEALTH AIDE OR CERTIFIE            	    18.90	   $18.90	      ---	       --	009	0	0	0.00	    $0.00	N	
1	S9123	NURSING CARE IN HOME RN                 	    47.91	   $47.91	      ---	       --	009	0	0	0.00	    $0.00	N	
T	S9123	NURSING CARE IN HOME RN                 	    47.91	   $47.91	      ---	       --	009	0	0	0.00	    $0.00	Y	
T	S9124	NURSING CARE, IN THE HOME; B            	    36.63	   $36.63	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	S9124	NURSING CARE, IN THE HOME; B            	    36.63	   $36.63	      ---	       --	009	0	0	0.00	    $0.00	N	
U	S9125	RESPITE CARE, IN THE HOME, P            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
U	S9127	SOCIAL WORK VISIT, IN THE HO            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
U	S9131	PT IN THE HOME PER DIEM                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	S9335	HT HEMODIALYSIS DIEM                    	    84.50	   $84.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	S9339	HIT PERITON DIALYSIS DIEM               	    60.37	   $60.37	      ---	       --	009	0	0	0.00	    $0.00	Y	
U	S9433	MEDICAL FOOD ORAL 100% NUTR             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
U	S9470	NUTRITIONAL COUNSELING, DIET            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
G	S9470	NUTRITIONAL COUNSELING, DIET            	    33.48	   $33.48	      ---	       --	009	0	0	0.00	    $0.00	N	
E	S9470	NUTRITIONAL COUNSELING, DIET            	    12.08	   $12.08	      ---	       --	009	0	0	0.00	    $0.00	Y	
U	S9977	MEALS PER DIEM                          	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
Y	T1001	NURSING ASSESSMENT/EVALUATN             	    69.30	   $69.30	      ---	       --	009	0	0	0.00	    $0.00	N	
E	T1001	NURSING ASSESSMENT/EVALUATN             	    27.52	   $27.52	      ---	       --	009	0	0	0.00	    $0.00	N	
E	T1002	RN SERVICES UP TO 15 MINUTES            	    12.08	   $12.08	      ---	       --	009	0	0	0.00	    $0.00	Y	
T	T1002	RN SERVICES UP TO 15 MINUTES            	    16.74	   $16.74	      ---	       --	009	0	0	0.00	    $0.00	Y	
T	T1003	LPN/LVN SERVICES UP TO 15MIN            	    12.13	   $12.13	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	T1003	LPN/LVN SERVICES UP TO 15MIN            	     6.18	    $6.18	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	T1004	NSG AIDE SERVICE UP TO 15MIN            	     5.31	    $5.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
U	T1005	RESPITE CARE SERVICE 15 MIN             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	T1005	RESPITE CARE SERVICE 15 MIN             	     2.63	    $2.63	      ---	       --	009	0	0	0.00	    $0.00	N	
Y	T1006	FAMILY/COUPLE COUNSELING                	    86.64	   $86.64	      ---	       --	009	0	0	0.00	    $0.00	N	
Y	T1007	TREATMENT PLAN DEVELOPMENT              	   163.08	  $163.08	      ---	       --	009	0	0	0.00	    $0.00	N	
Y	T1013	SIGN LANG/ORAL INTERPRETER              	     4.84	    $4.84	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	T1013	SIGN LANG/ORAL INTERPRETER              	     4.84	    $4.84	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	T1013	SIGN LANG/ORAL INTERPRETER              	    14.75	   $14.75	      ---	       --	009	0	0	0.00	    $0.00	N	
U	T1013	SIGN LANG/ORAL INTERPRETER              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	T1014	TELEHEALTH TRANSMIT, PER MIN            	     0.24	    $0.24	      ---	       --	009	0	0	0.00	    $0.00	Y	
F	T1015	CLINIC SERVICE                          	    71.50	   $71.50	      ---	       --	009	0	0	0.00	    $0.00	N	
1	T1016	CASE MANAGEMENT                         	    13.41	   $13.41	      ---	       --	009	0	0	0.00	    $0.00	N	
T	T1016	CASE MANAGEMENT                         	    13.41	   $13.41	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	T1016	CASE MANAGEMENT                         	    21.34	   $21.34	      ---	       --	009	0	0	0.00	    $0.00	Y	
Y	T1017	TARGETED CASE MANAGEMENT                	    50.00	   $50.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	T1017	TARGETED CASE MANAGEMENT                	    50.00	   $50.00	      ---	       --	009	0	0	0.00	    $0.00	N	
E	T1017	TARGETED CASE MANAGEMENT                	     6.19	    $6.19	      ---	       --	009	0	0	0.00	    $0.00	N	
1	T1019	PERSONAL CARE SER PER 15 MIN            	     3.62	    $3.62	      ---	       --	009	0	0	0.00	    $0.00	N	
U	T1019	PERSONAL CARE SER PER 15 MIN            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
U	T1020	PERSONAL CARE SER PER DIEM              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	T1023	PROGRAM INTAKE ASSESSMENT               	    64.83	   $64.83	      ---	       --	009	0	0	0.00	    $0.00	N	
E	T1023	PROGRAM INTAKE ASSESSMENT               	    12.34	   $12.34	      ---	       --	009	0	0	0.00	    $0.00	Y	
T	T1026	PED COMPR CARE PKG, PER HOUR            	    44.12	   $44.12	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	T1027	FAMILY TRAINING & COUNSELING            	    20.11	   $20.11	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	T1027	FAMILY TRAINING & COUNSELING            	    19.31	   $19.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	T1027	FAMILY TRAINING & COUNSELING            	    20.11	   $20.11	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	T1028	HOME ENVIRONMENT ASSESSMENT             	    26.66	   $26.66	      ---	       --	009	0	0	0.00	    $0.00	Y	
T	T1029	DWELLING LEAD INVESTIGATION             	   270.00	  $270.00	      ---	       --	009	0	0	0.00	    $0.00	N	
N	T1032	SV DOULA BRTH WRK PER 15 MIN            	    15.00	   $15.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	T1032	SV DOULA BRTH WRK PER 15 MIN            	    40.53	   $40.53	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	T1033	SV DOULA BRTH WRK PER DIEM              	   250.85	  $250.85	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	T1033	SV DOULA BRTH WRK PER DIEM              	   250.85	  $250.85	      ---	       --	009	0	0	0.00	    $0.00	Y	
U	T1505	ELEC MED COMP DEV, NOC                  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
U	T1999	NOC RETAIL ITEMS ANDSUPPLIES            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	T2001	N-ET; PATIENT ATTEND/ESCORT             	     5.52	    $5.52	      ---	       --	009	0	0	0.00	    $0.00	N	
E	T2003	N-ET; ENCOUNTER/TRIP                    	     9.27	    $9.27	      ---	       --	009	0	0	0.00	    $0.00	N	
G	T2003	N-ET; ENCOUNTER/TRIP                    	   100.00	  $100.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	T2005	N-ET; STRETCHER VAN                     	    26.29	   $26.29	      ---	       --	009	0	0	0.00	    $0.00	N	
1	T2007	NON-EMER TRANSPORT WAIT TIME            	    11.30	   $11.30	      ---	       --	009	0	0	0.00	    $0.00	N	
1	T2013	HABIL ED WAIVER PER HOUR                	    22.00	   $22.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	T2017	HABIL RES WAIVER 15 MIN                 	     8.94	    $8.94	      ---	       --	009	0	0	0.00	    $0.00	N	
1	T2022	CASE MANAGEMENT, PER MONTH              	   229.17	  $229.17	      ---	       --	009	0	0	0.00	    $0.00	N	
U	T2022	CASE MANAGEMENT, PER MONTH              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
G	T2022	CASE MANAGEMENT, PER MONTH              	   229.17	  $229.17	      ---	       --	009	0	0	0.00	    $0.00	N	
U	T2024	SERV ASMNT/CARE PLAN WAIVER             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	T2024	SERV ASMNT/CARE PLAN WAIVER             	   200.00	  $200.00	      ---	       --	009	0	0	0.00	    $0.00	N	
Y	T2024	SERV ASMNT/CARE PLAN WAIVER             	   199.00	  $199.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	T2025	WAIVER SERVICE, NOS                     	    35.77	   $35.77	      ---	       --	009	0	0	0.00	    $0.00	N	
U	T2025	WAIVER SERVICE, NOS                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
G	T2025	WAIVER SERVICE, NOS                     	   170.28	  $170.28	      ---	       --	009	0	0	0.00	    $0.00	N	
G	T2026	SPECIAL CHILDCARE WAIVER/D              	   338.00	  $338.00	      ---	       --	009	0	0	0.00	    $0.00	N	
G	T2028	SPECIAL SUPPLY, NOS WAIVER              	  1000.00	 $1000.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	T2028	SPECIAL SUPPLY, NOS WAIVER              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
G	T2029	SPECIAL MED EQUIP, NOSWAIVER            	  1000.00	 $1000.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	T2031	ASSIST LIVING WAIVER/DIEM               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	T2033	RES, NOS WAIVER PER DIEM                	    91.28	   $91.28	      ---	       --	009	0	0	0.00	    $0.00	N	
1	T2035	UTILITY SERVICES WAIVER                 	     0.01	    $0.01	      ---	       --	009	0	0	0.00	    $0.00	N	
1	T2038	COMM TRANS WAIVER/SERVICE               	  2500.00	 $2500.00	      ---	       --	009	0	0	0.00	    $0.00	N	
U	T2038	COMM TRANS WAIVER/SERVICE               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	T2039	VEHICLE MOD WAIVER/SERVICE              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
U	T2040	FINANCIAL MGT WAIVER/15MIN              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	T2045	HOSPICE GENERAL CARE                    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
N	T2047	HAB PREVO WAIVER PER 15                 	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	T2101	BREAST MILK PROC/STORE/DIST             	     3.00	    $3.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	T5001	POSITION SEAT SPEC ORTH NEED            	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
M	U0001	2019-NCOV DIAGNOSTIC P                  	    35.91	   $35.91	      ---	       --	009	0	0	0.00	    $0.00	N	
M	U0002	COVID-19 LAB TEST NON-CDC               	    51.31	   $51.31	      ---	       --	009	0	0	0.00	    $0.00	N	
1	V2020	VISION SVCS FRAMES PURCHASES            	    21.31	   $21.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2020	VISION SVCS FRAMES PURCHASES            	    21.31	   $21.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2025	EYEGLASSES DELUX FRAMES                 	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
1	V2025	EYEGLASSES DELUX FRAMES                 	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
1	V2100	LENS SPHER SINGLE PLANO 4.00            	    18.30	   $18.30	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2100	LENS SPHER SINGLE PLANO 4.00            	     8.29	    $8.29	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2100	LENS SPHER SINGLE PLANO 4.00            	    18.30	   $18.30	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2101	SINGLE VISN SPHERE 4.12-7.00            	    21.69	   $21.69	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2101	SINGLE VISN SPHERE 4.12-7.00            	     9.53	    $9.53	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2101	SINGLE VISN SPHERE 4.12-7.00            	    21.69	   $21.69	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2102	SINGL VISN SPHERE 7.12-20.00            	    25.75	   $25.75	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2102	SINGL VISN SPHERE 7.12-20.00            	    12.85	   $12.85	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2102	SINGL VISN SPHERE 7.12-20.00            	    25.75	   $25.75	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2103	SPHEROCYLINDR 4.00D/12-2.00D            	    18.48	   $18.48	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2103	SPHEROCYLINDR 4.00D/12-2.00D            	     8.29	    $8.29	      ---	       --	009	0	0	0.00	    $0.00	N	
1	V2103	SPHEROCYLINDR 4.00D/12-2.00D            	    18.48	   $18.48	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2104	SPHEROCYLINDR 4.00D/2.12-4D             	    18.62	   $18.62	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2104	SPHEROCYLINDR 4.00D/2.12-4D             	     8.29	    $8.29	      ---	       --	009	0	0	0.00	    $0.00	N	
N	V2104	SPHEROCYLINDR 4.00D/2.12-4D             	    18.62	   $18.62	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2105	SPHEROCYLINDER 4.00D/4.25-6D            	    29.39	   $29.39	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2105	SPHEROCYLINDER 4.00D/4.25-6D            	     8.29	    $8.29	      ---	       --	009	0	0	0.00	    $0.00	N	
1	V2105	SPHEROCYLINDER 4.00D/4.25-6D            	    29.39	   $29.39	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2106	SPHEROCYLINDER 4.00D/>6.00D             	    31.14	   $31.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2106	SPHEROCYLINDER 4.00D/>6.00D             	     8.29	    $8.29	      ---	       --	009	0	0	0.00	    $0.00	N	
N	V2106	SPHEROCYLINDER 4.00D/>6.00D             	    31.14	   $31.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2107	SPHEROCYLINDER 4.25D/12-2D              	    21.89	   $21.89	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2107	SPHEROCYLINDER 4.25D/12-2D              	     9.53	    $9.53	      ---	       --	009	0	0	0.00	    $0.00	N	
1	V2107	SPHEROCYLINDER 4.25D/12-2D              	    21.89	   $21.89	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2108	SPHEROCYLINDER 4.25D/2.12-4D            	    22.18	   $22.18	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2108	SPHEROCYLINDER 4.25D/2.12-4D            	     9.53	    $9.53	      ---	       --	009	0	0	0.00	    $0.00	N	
N	V2108	SPHEROCYLINDER 4.25D/2.12-4D            	    22.18	   $22.18	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2109	SPHEROCYLINDER 4.25D/4.25-6D            	    33.01	   $33.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2109	SPHEROCYLINDER 4.25D/4.25-6D            	     9.53	    $9.53	      ---	       --	009	0	0	0.00	    $0.00	N	
1	V2109	SPHEROCYLINDER 4.25D/4.25-6D            	    33.01	   $33.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2110	SPHEROCYLINDER 4.25D/OVER 6D            	    37.34	   $37.34	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2110	SPHEROCYLINDER 4.25D/OVER 6D            	     9.53	    $9.53	      ---	       --	009	0	0	0.00	    $0.00	N	
N	V2110	SPHEROCYLINDER 4.25D/OVER 6D            	    37.34	   $37.34	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2111	SPHEROCYLINDR 7.25D/.25-2.25            	    25.74	   $25.74	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2111	SPHEROCYLINDR 7.25D/.25-2.25            	    12.85	   $12.85	      ---	       --	009	0	0	0.00	    $0.00	N	
1	V2111	SPHEROCYLINDR 7.25D/.25-2.25            	    25.74	   $25.74	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2112	SPHEROCYLINDR 7.25D/2.25-4D             	    25.74	   $25.74	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2112	SPHEROCYLINDR 7.25D/2.25-4D             	    12.85	   $12.85	      ---	       --	009	0	0	0.00	    $0.00	N	
N	V2112	SPHEROCYLINDR 7.25D/2.25-4D             	    25.74	   $25.74	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2113	SPHEROCYLINDR 7.25D/4.25-6D             	    37.40	   $37.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2113	SPHEROCYLINDR 7.25D/4.25-6D             	    12.85	   $12.85	      ---	       --	009	0	0	0.00	    $0.00	N	
1	V2113	SPHEROCYLINDR 7.25D/4.25-6D             	    37.40	   $37.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2114	SPHEROCYLINDER OVER 12.00D              	    29.90	   $29.90	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2114	SPHEROCYLINDER OVER 12.00D              	    12.85	   $12.85	      ---	       --	009	0	0	0.00	    $0.00	N	
N	V2114	SPHEROCYLINDER OVER 12.00D              	    29.90	   $29.90	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2115	LENS LENTICULAR BIFOCAL                 	    77.05	   $77.05	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2115	LENS LENTICULAR MYODISC SINGLE VISION   	    29.41	   $29.41	      ---	       --	009	0	0	0.00	    $0.00	N	
1	V2115	LENS LENTICULAR BIFOCAL                 	    77.05	   $77.05	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2121	LENTICULAR LENS, SINGLE                 	    64.77	   $64.77	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2121	LENTICULAR LENS, SINGLE                 	    29.41	   $29.41	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2121	LENTICULAR LENS, SINGLE                 	    64.77	   $64.77	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2199	LENS SINGLE VISION NOT OTH C            	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
1	V2199	LENS SINGLE VISION NOT OTH C            	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
1	V2200	LENS SPHER BIFOC PLANO 4.00D            	    29.39	   $29.39	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2200	LENS SPHER BIFOC PLANO 4.00D            	    12.93	   $12.93	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2200	LENS SPHER BIFOC PLANO 4.00D            	    29.39	   $29.39	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2201	LENS SPHERE BIFOCAL 4.12-7.0            	    36.38	   $36.38	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2201	LENS SPHERE BIFOCAL 4.12-7.0            	    15.23	   $15.23	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2201	LENS SPHERE BIFOCAL 4.12-7.0            	    36.38	   $36.38	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2202	LENS SPHERE BIFOCAL 7.12-20.            	    42.60	   $42.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2202	LENS SPHERE BIFOCAL 7.12-20.            	    19.44	   $19.44	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2202	LENS SPHERE BIFOCAL 7.12-20.            	    42.60	   $42.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2203	LENS SPHCYL BIFOCAL 4.00D/.1            	    29.76	   $29.76	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2203	LENS SPHCYL BIFOCAL 4.00D/.1            	    12.93	   $12.93	      ---	       --	009	0	0	0.00	    $0.00	N	
1	V2203	LENS SPHCYL BIFOCAL 4.00D/.1            	    29.76	   $29.76	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2204	LENS SPHCY BIFOCAL 4.00D/2.1            	    29.77	   $29.77	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2204	LENS SPHCY BIFOCAL 4.00D/2.1            	    12.93	   $12.93	      ---	       --	009	0	0	0.00	    $0.00	N	
N	V2204	LENS SPHCY BIFOCAL 4.00D/2.1            	    29.77	   $29.77	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2205	LENS SPHCY BIFOCAL 4.00D/4.2            	    43.91	   $43.91	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2205	LENS SPHCY BIFOCAL 4.00D/4.2            	    12.93	   $12.93	      ---	       --	009	0	0	0.00	    $0.00	N	
1	V2205	LENS SPHCY BIFOCAL 4.00D/4.2            	    43.91	   $43.91	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2206	LENS SPHCY BIFOCAL 4.00D/OVE            	    44.17	   $44.17	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2206	LENS SPHCY BIFOCAL 4.00D/OVE            	    12.93	   $12.93	      ---	       --	009	0	0	0.00	    $0.00	N	
N	V2206	LENS SPHCY BIFOCAL 4.00D/OVE            	    44.17	   $44.17	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2207	LENS SPHCY BIFOCAL 4.25-7D/.            	    36.41	   $36.41	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2207	LENS SPHCY BIFOCAL 4.25-7D/.            	    15.23	   $15.23	      ---	       --	009	0	0	0.00	    $0.00	N	
1	V2207	LENS SPHCY BIFOCAL 4.25-7D/.            	    36.41	   $36.41	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2208	LENS SPHCY BIFOCAL 4.25-7/2.            	    38.48	   $38.48	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2208	LENS SPHCY BIFOCAL 4.25-7/2.            	    15.23	   $15.23	      ---	       --	009	0	0	0.00	    $0.00	N	
N	V2208	LENS SPHCY BIFOCAL 4.25-7/2.            	    38.48	   $38.48	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2209	LENS SPHCY BIFOCAL 4.25-7/4.            	    49.81	   $49.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2209	LENS SPHCY BIFOCAL 4.25-7/4.            	    15.23	   $15.23	      ---	       --	009	0	0	0.00	    $0.00	N	
1	V2209	LENS SPHCY BIFOCAL 4.25-7/4.            	    49.81	   $49.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2210	LENS SPHCY BIFOCAL 4.25-7/OV            	    51.64	   $51.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2210	LENS SPHCY BIFOCAL 4.25-7/OV            	    15.23	   $15.23	      ---	       --	009	0	0	0.00	    $0.00	N	
N	V2210	LENS SPHCY BIFOCAL 4.25-7/OV            	    51.64	   $51.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2211	LENS SPHCY BIFO 7.25-12/.25-            	    42.31	   $42.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2211	LENS SPHCY BIFO 7.25-12/.25-            	    19.44	   $19.44	      ---	       --	009	0	0	0.00	    $0.00	N	
1	V2211	LENS SPHCY BIFO 7.25-12/.25-            	    42.31	   $42.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2212	LENS SPHCYL BIFO 7.25-12/2.2            	    42.60	   $42.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2212	LENS SPHCYL BIFO 7.25-12/2.2            	    19.44	   $19.44	      ---	       --	009	0	0	0.00	    $0.00	N	
N	V2212	LENS SPHCYL BIFO 7.25-12/2.2            	    42.60	   $42.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2213	LENS SPHCYL BIFO 7.25-12/4.2            	    52.37	   $52.37	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2213	LENS SPHCYL BIFO 7.25-12/4.2            	    19.44	   $19.44	      ---	       --	009	0	0	0.00	    $0.00	N	
1	V2213	LENS SPHCYL BIFO 7.25-12/4.2            	    52.37	   $52.37	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2214	LENS SPHCYL BIFOCAL OVER 12.            	    44.87	   $44.87	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2214	LENS SPHCYL BIFOCAL OVER 12.            	    19.44	   $19.44	      ---	       --	009	0	0	0.00	    $0.00	N	
N	V2214	LENS SPHCYL BIFOCAL OVER 12.            	    44.87	   $44.87	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2215	LENS LENTICULAR BIFOCAL                 	    95.89	   $95.89	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2215	LENS LENTICULAR MYODISC BIFOCAL         	    45.99	   $45.99	      ---	       --	009	0	0	0.00	    $0.00	N	
1	V2215	LENS LENTICULAR BIFOCAL                 	    95.89	   $95.89	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2220	LENS BIFOCAL ADD OVER 3.25D             	    14.31	   $14.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2220	LENS BIFOCAL ADD OVER 3.25D             	    10.57	   $10.57	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2220	LENS BIFOCAL ADD OVER 3.25D             	    14.31	   $14.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2221	LENTICULAR LENS, BIFOCAL                	    75.56	   $75.56	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2221	LENTICULAR LENS, BIFOCAL                	    45.99	   $45.99	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2221	LENTICULAR LENS, BIFOCAL                	    75.56	   $75.56	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2299	LENS BIFOCAL SPECIALITY                 	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
N	V2299	LENS BIFOCAL SPECIALITY                 	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
N	V2300	LENS SPHERE TRIFOCAL 4.00D              	    42.35	   $42.35	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2300	LENS SPHERE TRIFOCAL 4.00D              	    42.35	   $42.35	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2300	LENS SPHERE TRIFOCAL 4.00D              	    19.61	   $19.61	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2301	LENS SPHERE TRIFOCAL 4.12-7.            	    22.07	   $22.07	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2301	LENS SPHERE TRIFOCAL 4.12-7.            	    46.42	   $46.42	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2301	LENS SPHERE TRIFOCAL 4.12-7.            	    46.42	   $46.42	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2302	LENS SPHERE TRIFOCAL 7.12-20            	    54.33	   $54.33	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2302	LENS SPHERE TRIFOCAL 7.12-20            	    54.33	   $54.33	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2302	LENS SPHERE TRIFOCAL 7.12-20            	    32.18	   $32.18	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2303	LENS SPHCY TRIFOCAL 4.0/.12-            	    19.61	   $19.61	      ---	       --	009	0	0	0.00	    $0.00	N	
1	V2303	LENS SPHCY TRIFOCAL 4.0/.12-            	    42.59	   $42.59	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2303	LENS SPHCY TRIFOCAL 4.0/.12-            	    42.59	   $42.59	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2304	LENS SPHCY TRIFOCAL 4.0/2.25            	    50.21	   $50.21	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2304	LENS SPHCY TRIFOCAL 4.0/2.25            	    50.21	   $50.21	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2304	LENS SPHCY TRIFOCAL 4.0/2.25            	    19.61	   $19.61	      ---	       --	009	0	0	0.00	    $0.00	N	
3	V2305	LENS SPHCY TRIFOCAL 4.0/4.25            	    19.61	   $19.61	      ---	       --	009	0	0	0.00	    $0.00	N	
1	V2305	LENS SPHCY TRIFOCAL 4.0/4.25            	    55.10	   $55.10	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2305	LENS SPHCY TRIFOCAL 4.0/4.25            	    55.10	   $55.10	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2306	LENS SPHCYL TRIFOCAL 4.00/>6            	    55.36	   $55.36	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2306	LENS SPHCYL TRIFOCAL 4.00/>6            	    55.36	   $55.36	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2306	LENS SPHCYL TRIFOCAL 4.00/>6            	    19.61	   $19.61	      ---	       --	009	0	0	0.00	    $0.00	N	
3	V2307	LENS SPHCY TRIFOCAL 4.25-7/.            	    22.07	   $22.07	      ---	       --	009	0	0	0.00	    $0.00	N	
1	V2307	LENS SPHCY TRIFOCAL 4.25-7/.            	    47.60	   $47.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2307	LENS SPHCY TRIFOCAL 4.25-7/.            	    47.60	   $47.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2308	LENS SPHC TRIFOCAL 4.25-7/2.            	    47.60	   $47.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2308	LENS SPHC TRIFOCAL 4.25-7/2.            	    47.60	   $47.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2308	LENS SPHC TRIFOCAL 4.25-7/2.            	    22.07	   $22.07	      ---	       --	009	0	0	0.00	    $0.00	N	
3	V2309	LENS SPHC TRIFOCAL 4.25-7/4.            	    22.07	   $22.07	      ---	       --	009	0	0	0.00	    $0.00	N	
1	V2309	LENS SPHC TRIFOCAL 4.25-7/4.            	    61.83	   $61.83	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2309	LENS SPHC TRIFOCAL 4.25-7/4.            	    61.83	   $61.83	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2310	LENS SPHC TRIFOCAL 4.25-7/>6            	    62.09	   $62.09	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2310	LENS SPHC TRIFOCAL 4.25-7/>6            	    62.09	   $62.09	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2310	LENS SPHC TRIFOCAL 4.25-7/>6            	    22.07	   $22.07	      ---	       --	009	0	0	0.00	    $0.00	N	
3	V2311	LENS SPHC TRIFO 7.25-12/.25-            	    32.18	   $32.18	      ---	       --	009	0	0	0.00	    $0.00	N	
1	V2311	LENS SPHC TRIFO 7.25-12/.25-            	    54.33	   $54.33	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2311	LENS SPHC TRIFO 7.25-12/.25-            	    54.33	   $54.33	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2312	LENS SPHC TRIFO 7.25-12/2.25            	    54.59	   $54.59	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2312	LENS SPHC TRIFO 7.25-12/2.25            	    54.59	   $54.59	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2312	LENS SPHC TRIFO 7.25-12/2.25            	    32.18	   $32.18	      ---	       --	009	0	0	0.00	    $0.00	N	
3	V2313	LENS SPHC TRIFO 7.25-12/4.25            	    32.18	   $32.18	      ---	       --	009	0	0	0.00	    $0.00	N	
1	V2313	LENS SPHC TRIFO 7.25-12/4.25            	    62.09	   $62.09	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2313	LENS SPHC TRIFO 7.25-12/4.25            	    62.09	   $62.09	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2314	LENS SPHCYL TRIFOCAL OVER 12            	    54.33	   $54.33	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2314	LENS SPHCYL TRIFOCAL OVER 12            	    54.33	   $54.33	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2314	LENS SPHCYL TRIFOCAL OVER 12            	    32.18	   $32.18	      ---	       --	009	0	0	0.00	    $0.00	N	
1	V2320	LENS TRIFOCAL ADD OVER 3.25D            	    14.31	   $14.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2320	LENS TRIFOCAL ADD OVER 3.25D            	    14.31	   $14.31	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2321	LENTICULAR LENS, TRIFOCAL               	    93.54	   $93.54	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2321	LENTICULAR LENS, TRIFOCAL               	    93.54	   $93.54	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2399	LENS TRIFOCAL SPECIALITY                	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
N	V2399	LENS TRIFOCAL SPECIALITY                	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
N	V2410	LENS VARIAB ASPHERICITY SING            	    57.05	   $57.05	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2410	LENS VARIAB ASPHERICITY SING            	    57.05	   $57.05	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2430	LENS VARIABLE ASPHERICITY BI            	    97.71	   $97.71	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2430	LENS VARIABLE ASPHERICITY BI            	    97.71	   $97.71	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2499	VARIABLE ASPHERICITY LENS               	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
1	V2499	VARIABLE ASPHERICITY LENS               	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
1	V2500	CONTACT LENS PMMA SPHERICAL             	    65.94	   $65.94	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2500	CONTACT LENS PMMA SPHERICAL             	    65.94	   $65.94	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2501	CNTCT LENS PMMA-TORIC/PRISM             	   103.69	  $103.69	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2501	CNTCT LENS PMMA-TORIC/PRISM             	   103.69	  $103.69	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2510	CNTCT GAS PERMEABLE SPHERICL            	    88.64	   $88.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2510	CNTCT GAS PERMEABLE SPHERICL            	    88.64	   $88.64	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2511	CNTCT TORIC PRISM BALLAST               	   143.27	  $143.27	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2511	CNTCT TORIC PRISM BALLAST               	   143.27	  $143.27	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2513	CONTACT LENS EXTENDED WEAR              	   152.59	  $152.59	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2513	CONTACT LENS EXTENDED WEAR              	   152.59	  $152.59	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2520	CONTACT LENS HYDROPHILIC                	    78.21	   $78.21	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2520	CONTACT LENS HYDROPHILIC                	    78.21	   $78.21	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2521	CNTCT LENS HYDROPHILIC TORIC            	   136.15	  $136.15	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2521	CNTCT LENS HYDROPHILIC TORIC            	   136.15	  $136.15	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2523	CNTCT LENS HYDROPHIL EXTEND             	   112.92	  $112.92	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2523	CNTCT LENS HYDROPHIL EXTEND             	   112.92	  $112.92	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2531	CONTACT LENS GAS PERMEABLE              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2531	CONTACT LENS GAS PERMEABLE              	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2599	CONTACT LENS/ES OTHER TYPE              	    56.77	   $56.77	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2599	CONTACT LENS/ES OTHER TYPE              	    56.77	   $56.77	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2600	HAND HELD LOW VISION AIDS               	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
N	V2600	HAND HELD LOW VISION AIDS               	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
N	V2610	SINGLE LENS SPECTACLE MOUNT             	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
1	V2610	SINGLE LENS SPECTACLE MOUNT             	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
1	V2615	TELESCOP/OTHR COMPOUND LENS             	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
N	V2615	TELESCOP/OTHR COMPOUND LENS             	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
N	V2623	PLASTIC EYE PROSTH CUSTOM               	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
1	V2623	PLASTIC EYE PROSTH CUSTOM               	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
1	V2624	POLISHING ARTIFICAL EYE                 	    31.96	   $31.96	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2624	POLISHING ARTIFICAL EYE                 	    31.96	   $31.96	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2625	ENLARGEMNT OF EYE PROSTHESIS            	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
1	V2625	ENLARGEMNT OF EYE PROSTHESIS            	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
1	V2626	REDUCTION OF EYE PROSTHESIS             	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
N	V2626	REDUCTION OF EYE PROSTHESIS             	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
N	V2627	SCLERAL COVER SHELL                     	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
1	V2627	SCLERAL COVER SHELL                     	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
1	V2628	FABRICATION & FITTING                   	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
N	V2628	FABRICATION & FITTING                   	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
N	V2629	PROSTHETIC EYE OTHER TYPE               	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
1	V2629	PROSTHETIC EYE OTHER TYPE               	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
N	V2630	ANTER CHAMBER INTRAOCUL LENS            	     0.00	    $0.00	      ---	       --	007	1	0	0.00	    $0.00	Y	
N	V2631	IRIS SUPPORT INTRAOCLR LENS             	     0.00	    $0.00	      ---	       --	007	1	0	0.00	    $0.00	Y	
N	V2632	POST CHMBR INTRAOCULAR LENS             	     0.00	    $0.00	      ---	       --	007	1	0	0.00	    $0.00	Y	
N	V2702	DELUXE LENS FEATURE                     	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
1	V2702	DELUXE LENS FEATURE                     	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
1	V2710	GLASS/PLASTIC SLAB OFF PRISM            	    40.00	   $40.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2710	GLASS/PLASTIC SLAB OFF PRISM            	    26.00	   $26.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2710	GLASS/PLASTIC SLAB OFF PRISM            	    40.00	   $40.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2715	PRISM LENS/ES                           	     8.17	    $8.17	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2715	PRISM LENS/ES                           	     4.22	    $4.22	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2715	PRISM LENS/ES                           	     8.17	    $8.17	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2718	FRESNELL PRISM PRESS-ON LENS            	    15.78	   $15.78	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2718	FRESNELL PRISM PRESS-ON LENS            	    11.05	   $11.05	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2718	FRESNELL PRISM PRESS-ON LENS            	    15.78	   $15.78	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2744	TINT PHOTOCHROMATIC LENS/ES             	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
3	V2744	TINT PHOTOCHROMATIC LENS/ES             	    17.19	   $17.19	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2744	TINT PHOTOCHROMATIC LENS/ES             	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
1	V2745	TINT, ANY COLOR/SOLID/GRAD              	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
3	V2745	TINT, ANY COLOR/SOLID/GRAD              	     3.54	    $3.54	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2745	TINT, ANY COLOR/SOLID/GRAD              	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
N	V2750	ANTI-REFLECTIVE COATING                 	    15.33	   $15.33	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2750	ANTI-REFLECTIVE COATING                 	    15.33	   $15.33	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2755	UV LENS/ES                              	     9.37	    $9.37	      ---	       --	009	0	0	0.00	    $0.00	Y	
3	V2755	UV LENS/ES                              	     3.54	    $3.54	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2755	UV LENS/ES                              	     9.37	    $9.37	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2760	SCRATCH RESISTANT COATING               	    13.70	   $13.70	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2760	SCRATCH RESISTANT COATING               	    13.70	   $13.70	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2761	MIRROR COATING                          	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
N	V2761	MIRROR COATING                          	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
N	V2762	POLARIZATION, ANY LENS                  	    37.54	   $37.54	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2762	POLARIZATION, ANY LENS                  	    37.54	   $37.54	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2770	OCCLUDER LENS/ES                        	     7.68	    $7.68	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2770	OCCLUDER LENS/ES                        	     7.68	    $7.68	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2781	PROGRESSIVE LENS PER LENS               	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
1	V2781	PROGRESSIVE LENS PER LENS               	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
1	V2782	LENS, 1.54-1.65 P/1.60-1.79G            	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
N	V2782	LENS, 1.54-1.65 P/1.60-1.79G            	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
N	V2783	LENS, >= 1.66 P/>=1.80 G                	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
1	V2783	LENS, >= 1.66 P/>=1.80 G                	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
1	V2784	LENS POLYCARB OR EQUAL                  	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
3	V2784	LENS POLYCARB OR EQUAL                  	     4.00	    $4.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	V2784	LENS POLYCARB OR EQUAL                  	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
1	V2785	CORNEAL TISSUE PROCESSING               	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V2799	MISC VISION ITEM OR SERVICE             	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
N	V2799	MISC VISION ITEM OR SERVICE             	     0.00	    $0.00	      ---	       --	008	0	0	0.00	    $0.00	Y	
1	V5008	HEARING SCREENING                       	    18.07	   $18.07	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V5010	ASSESSMENT FOR HEARING AID              	    52.70	   $52.70	      ---	       --	009	0	0	0.00	    $0.00	Y	
E	V5011	HEARING AID FITTING/CHECKING            	    32.42	   $32.42	      ---	       --	009	0	0	0.00	    $0.00	N	
1	V5014	HEARING AID REPAIR/MODIFYING            	    25.00	   $25.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V5030	BODY-WORN HEARING AID AIR               	     0.01	    $0.01	      ---	       --	009	0	0	0.00	    $1.53	Y	
1	V5040	BODY-WORN HEARING AID BONE              	     0.01	    $0.01	      ---	       --	009	0	0	0.00	    $1.53	Y	
1	V5050	HEARING AID MONAURAL IN EAR             	     0.01	    $0.01	      ---	       --	009	0	0	0.00	    $1.53	Y	
1	V5060	BEHIND EAR HEARING AID                  	     0.01	    $0.01	      ---	       --	009	0	0	0.00	    $1.53	Y	
1	V5070	GLASSES AIR CONDUCTION                  	     0.01	    $0.01	      ---	       --	009	0	0	0.00	    $1.53	Y	
1	V5080	GLASSES BONE CONDUCTION                 	     0.01	    $0.01	      ---	       --	009	0	0	0.00	    $1.53	Y	
1	V5120	BODY-WORN BINAUR HEARING AID            	     0.01	    $0.01	      ---	       --	009	0	0	0.00	    $1.53	Y	
1	V5130	IN EAR BINAURAL HEARING AID             	     0.01	    $0.01	      ---	       --	009	0	0	0.00	    $1.53	Y	
1	V5140	BEHIND EAR BINAUR HEARING AI            	     0.01	    $0.01	      ---	       --	009	0	0	0.00	    $1.53	Y	
1	V5150	GLASSES BINAURAL HEARING AID            	     0.01	    $0.01	      ---	       --	009	0	0	0.00	    $1.53	Y	
1	V5171	HEARING AID MONAURAL ITE                	     0.01	    $0.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V5172	HEARING AID MONAURAL ITC                	     0.01	    $0.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V5181	HEARING AID MONAURAL BTE                	     0.01	    $0.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V5190	HEARING AID MONAURAL GLASSES            	     0.01	    $0.01	      ---	       --	009	0	0	0.00	    $1.53	Y	
1	V5211	HEARING AID BINAURAL ITE/ITE            	     0.01	    $0.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V5212	HEARING AID BINAURAL ITE/ITC            	     0.01	    $0.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V5213	HEARING AID BINAURAL ITE/BTE            	     0.01	    $0.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V5214	HEARING AID BINAURAL ITC/ITC            	     0.01	    $0.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V5215	HEARING AID BINAURAL ITC/BTE            	     0.01	    $0.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V5221	HEARING AID BINAURAL BTE/BTE            	     0.01	    $0.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V5230	HEARING AID BINAURAL GLASSES            	     0.01	    $0.01	      ---	       --	009	0	0	0.00	    $1.53	Y	
1	V5264	EAR MOLD/INSERT                         	    27.52	   $27.52	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V5265	EAR MOLD/INSERT, DISP                   	     0.01	    $0.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V5267	HEARING AID SUP/ACCESS/DEV              	     0.01	    $0.01	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	V5298	HEARING AID NOC                         	     0.01	    $0.01	      ---	       --	009	0	0	0.00	    $1.53	Y	
1	X3900	PHY THER SGL MODALITY ONE AREAINT 30 MI 	    17.04	   $17.04	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	X3900	PHY THER SGL MODALITY ONE AREAINT 30 MI 	    17.04	   $17.04	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	X3902	PHY THER SGL MODALITY ONE AREAEA ADD 15 	     3.63	    $3.63	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X3902	PHY THER SGL MODALITY ONE AREAEA ADD 15 	     3.63	    $3.63	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X3904	PHY THER SGL PROC ONE AREA INI 30 MIN   	    21.19	   $21.19	      ---	       --	009	0	0	0.00	    $0.00	Y	
P	X3904	PHY THER PROC ONE AREA INT 30 MIN       	    21.19	   $21.19	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X3906	PHY THER SGL PROC ONE AREA EA ADD 15 MIN	     6.86	    $6.86	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X3908	PHY THER TREAT INC MOD PROC INIT 30 MIN 	    21.19	   $21.19	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X3910	PHY THER TREAT INC MOD PROC EA ADD 15 MI	     6.86	    $6.86	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X3912	PHY THER HUBBARD TANK INIT 30 MIN       	    34.84	   $34.84	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X3914	PHY THER HUBBARD TANK EA ADD 15 MIN     	     6.86	    $6.86	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X3916	PHY THER HUBBARD TANK POOL EXER INI 30 M	    41.69	   $41.69	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X3918	PHY THER HUBB TANK POOL EXER EA ADD 15 M	     6.86	    $6.86	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X3920	PHY THER ANY TEST MEAS INI 30 MIN       	    34.84	   $34.84	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X3922	PHY THER ANY TEST MEAS EA ADD 15 MIN,PLU	    17.04	   $17.04	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X3924	PHYS THERAPY PRELIM EVAL REHAB SNF ICF  	    34.84	   $34.84	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X3926	PHY THER CASE CONFER A REPORT INT 30 MIN	    21.19	   $21.19	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X3928	PHY THER CASE CONSUL AND RPT            	    21.19	   $21.19	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X3930	CASE CONFERENCE AND REPORT EACH ADD 15  	     6.86	    $6.86	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X3932	PHY THER HME OR LONG TERM CARE FAC-ADD  	     6.57	    $6.57	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X3934	PHY THER MILAGE                         	     1.77	    $1.77	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X3936	PHY THER UNLISTED                       	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X4100	OCC THER EVAL INT 30 MIN,PLUS REPORT    	    34.84	   $34.84	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X4102	OCC THER EVAL EA ADD 15 MIN,PLUS REPORT 	    17.04	   $17.04	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X4104	OCC THER CSE CONF INI 30 MIN            	    21.19	   $21.19	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X4106	OCC THER CSE CONF EA ADD 15 MIN         	     6.86	    $6.86	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X4108	OCC THERAPY PRELIM EVAL REHAB SNF ICF   	    34.84	   $34.84	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X4110	OCC THER TREAT INI 30 MIN               	    21.19	   $21.19	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X4112	OCC THER TREAT EA ADD 15 MIN            	     6.86	    $6.86	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X4114	OCC THER HME OR LONGTERM FAC VISITADD   	     6.57	    $6.57	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X4116	OCC THER | MILEAGE                      	     1.77	    $1.77	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X4118	OCC THER | UNLISTED                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X4120	OCC THERAPY CASE CONSULTATION AND REPT  	    21.19	   $21.19	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X4300	SP THER LANGUAGE EVAL                   	    66.05	   $66.05	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X4301	SP THERSPEECH EVALUATION                	    66.05	   $66.05	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X4302	SPEECHLANGUAGE THER GROUP EA PAT OVER O 	    26.57	   $26.57	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X4303	SPEECHLANGUAGE THER INDIVID PER HR      	    45.24	   $45.24	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X4304	SPEECHLANGUAGE THERAPY INDIVIDUAL 1/2HR 	    22.63	   $22.63	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X4306	SPEECH THER OUT OF OFFICE CALL VIS 1ST P	     8.27	    $8.27	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X4308	SPCH THERAPY PRELIM EVAL REHAB SNF ICF  	    33.03	   $33.03	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X4310	SGD-REL BUNDLED SPCH THERAPY, PER VISIT 	    45.24	   $45.24	      ---	       --	009	0	0	0.00	    $0.00	N	
1	X4312	SGD-RECIPIENT ASSESSMENT                	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	X4320	UNLISTED SPEECH THERAPY SERVICES        	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X4500	SP HR HR DIAG AUDIOLOG EVALUATION       	    66.05	   $66.05	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X4501	SP HR HR PURE TONE AUDIOMETRY           	    35.79	   $35.79	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X4502	AUDIOL PRELIM EVALUATION REHAB SNF ICF  	    33.03	   $33.03	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X4504	SP HR O HR S AUDIOMETRY DURING SURGERY  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X4522	EVOKED RESP AUDIOMET TEST PHYSICIAN EVAL	   160.10	  $160.10	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X4526	HEARING THER INDIVID PER HOUR           	    45.40	   $45.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X4530	IMPED AUD (BILAT) PRT COMP AUD EVAL AUDI	    33.14	   $33.14	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X4532	ELECTROACOUSTIC ANALYSIS OF HEARING AID 	    23.32	   $23.32	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X4535	UNLISTED AUDIOLOGICAL SERVICES          	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X4540	TY (IMP TST) PRT COMP AUD EVAL AUDIOLOGI	    22.94	   $22.94	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X4542	ELECTROACOUSTIC ANALYSIS OF HEARING AID 	    42.81	   $42.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	X4544	SPEECH THERAPY HANDICAPPED PERSON OVER 7	    84.75	   $84.75	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	Z1032	INITIAL ANTEPARTUM OFFICE VISIT         	   154.04	  $126.31	      ---	       --	007	0	0	0.00	    $0.00	Y	
X	Z1032	INITIAL ANTEPARTUM OFFICE VISIT         	   197.98	  $197.98	      ---	       --	009	0	1	0.00	    $0.00	Y	
K	Z1032	INITIAL ANTEPARTUM OFFICE VISIT         	   154.04	  $126.31	      ---	       --	007	0	1	0.00	    $0.00	Y	
K	Z1034	ANTEPARTUM FOLLOW-UP OFFICE VISIT       	    60.48	   $60.48	      ---	       --	009	0	1	0.00	    $0.00	Y	
X	Z1034	ANTEPARTUM FOLLOW-UP OFFICE VISIT       	   162.11	  $162.11	      ---	       --	009	0	1	0.00	    $0.00	Y	
N	Z1034	ANTEPARTUM FOLLOW-UP OFFICE VISIT       	    60.48	   $60.48	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	Z1038	POSTPARTUM FOLLOW-UP OFFICE VISIT       	    60.48	   $60.48	      ---	       --	009	0	0	0.00	    $0.00	Y	
X	Z1038	POSTPARTUM FOLLOW-UP OFFICE VISIT       	   162.11	  $162.11	      ---	       --	009	0	1	0.00	    $0.00	Y	
K	Z1038	POSTPARTUM FOLLOW-UP OFFICE VISIT       	    60.48	   $60.48	      ---	       --	009	0	1	0.00	    $0.00	Y	
1	Z4300	CENTER COORDINATOR                      	    72.00	   $72.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z4301	ASSESSMENT, NURSE-PER HALF HOUR         	    16.80	   $16.80	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z4302	CASE CONF-ALLIED HEALTH-PER QT HR       	     8.40	    $8.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z4303	EPSDT: CCS PATIENT RPT-COMPLEX/PERIODIC 	    30.00	   $30.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	Z4303	PATIENT REPORT-COMPLEX/PERIODIC         	    30.00	   $30.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	Z4304	PATIENT REPORT-COMPLEX/COMPREHENSIVE    	    54.00	   $54.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z4304	EPSDT: CCS PATIENT RPT-COMPLEX/COMPREHEN	    54.00	   $54.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z4305	EPSDT SVS:CNTR COORD,PHYSICAN-PER CASE  	    72.00	   $72.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z4306	EPSDT: CASE CONF, PHYS/DENTIST-PER CASE 	    36.00	   $36.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z4307	EVAL/INTERVEN, SOC WK-PER HALF HOUR     	    16.80	   $16.80	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z4308	ASSESS/INTERVEN, DIETITIAN PER HALF HR  	    16.80	   $16.80	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z4309	ASSESS/INTERVEN, ALLD PROF-PER HALF HOUR	    16.80	   $16.80	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z4310	MEDICAL CASE CONF, NURSE-PER 1/4 HR     	     8.40	    $8.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z4311	MEDICAL CASE, SOCIAL WK-PER 1/4 HOUR    	     8.40	    $8.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z4312	MEDICAL CASE CONF, DIETITIAN-PER 1/4 HR 	     8.40	    $8.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z4313	GROUP COUNSELING, PHSY-PER PERSON       	    28.80	   $28.80	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	Z4313	GROUP COUNSELING, PHSY-PER PERSON       	    28.80	   $28.80	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z4314	GROUP COUNSELING, ALLD PROF-PER PERSON  	    13.37	   $13.37	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z4315	EPSDT: PHYS/PARENT CONF-PER 1/2 HR      	    36.00	   $36.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5406	ALLIED PROF. NECTELEP CONSULT  15 MIN   	     8.40	    $8.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5408	ALLIED PROF. NEC-PROG/CL CONSULT-HR     	    38.00	   $38.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5410	ALLIED PROFESSIONAL NEC -TRAVEL TIME HR 	    22.80	   $22.80	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5412	ALLIED PROF NEC -TRAVEL MILEAGE-ONEWAY  	     1.70	    $1.70	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5414	TRAVEL EXPENSES                         	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5416	TECHNICIAN SERVICES                     	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
N	Z5422	PROGRAM CONSULTATION/CLINIC (MED),HOUR  	   125.00	  $125.00	      ---	       --	009	0	0	0.00	    $0.00	N	
N	Z5424	TRAVEL MILEAGE/ MEDICAL (MILE)          	     2.00	    $2.00	      ---	       --	009	0	0	0.00	    $0.00	N	
N	Z5499	UNLISTED SERVICE & PROCEDURES           	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	Z5805	EPSDT SHARED NURSING(RN),INDVL NRS PROV 	    52.70	   $52.70	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5807	EPSDT SHARED NURSING(LVN)INDVL NRS PROV 	    40.29	   $40.29	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5814	EPSDT SVSMARRIAGE/FAMILY/CHILD COUNSEL  	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5816	EPSDT SERVICESSOCIAL WORKER             	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5820	EPSDT SERVICES CASE MANAGEMENT          	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5822	EPSDT SERVICES HEARING AID BATTERIES    	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5850	EPSDT SUPPL INDIVIDUAL AOD COUN-1/2 HOUR	    14.60	   $14.60	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5900	EPSDTAUDIO EVAL LESS THAN 2 YRS         	    71.50	   $71.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5902	EPSDTAUDIO EVAL 25 YRS                  	    65.00	   $65.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5904	EPSDTAUDIO EVAL 620 YRS                 	    58.50	   $58.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5906	EPSDTSUBSEQUENT AUDIO EVAL UNDER 2 YRS  	    39.00	   $39.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5908	EPSDTSUBSEQUENT AUDIO EVAL 25 YRS       	    36.40	   $36.40	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5910	EPSDTSUBSEQUENT AUDIO EVAL 620 YRS      	    32.50	   $32.50	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5912	EPSDTEVAL DIFFICULT TEST PT UNDER 7 YRS 	    84.75	   $84.75	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5914	EPSDTAUDITORY BRAINSTEM RESPONSE (ABR)  	   160.10	  $160.10	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5916	AUDIOMETRY/BEHAVIORAL OBSERVATIONAUDIO  	    36.05	   $36.05	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5918	EPSDTSPEECH THRESHOLD TEST              	    15.13	   $15.13	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5920	SPEECH DISCRIMINATION/WORD RECOGNI TEST 	    15.13	   $15.13	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5922	EPSDTACOUSTIC IMMITANCE TST, MONAURAL   	    32.96	   $32.96	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5924	EPSDT ACOUSTIC IMMITANCE TST, BINAURAL  	    48.56	   $48.56	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5928	EPSDTFUNCTIONAL GAIN TESTING            	    33.02	   $33.02	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5930	EPSDTREAL EAR MEASUREMENTS, MONAURAL    	    23.32	   $23.32	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5932	EPSDTREAL EAR MEASUREMENTS, BINAURAL    	    33.80	   $33.80	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5934	EPSDTEVOKED OTOACOUSTIC EMISSION, LTD   	    47.05	   $47.05	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5936	EVOKED OTOACOUSTIC EMISSION CMPHSV/DGNTC	    58.84	   $58.84	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5940	AURAL REHAB CONVEN HEARING AID 30 MIN   	    56.16	   $56.16	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5942	AURAL REHAB COCHLEAR IMPLANTATION 30 MIN	    56.16	   $56.16	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5944	AURAL REHAB ALTERN HEARING DEVICE 30 MIN	    56.16	   $56.16	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5946	EPSDT SUPPLEMENTAL SERVICEHEARING AID   	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5950	COUNSELING BY AUDIOLOGIST, PER HOUR     	   112.32	  $112.32	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5952	ASST PRECOCHLEAR EVAL BY 2ND AUDIOLOGIS 	    33.02	   $33.02	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5954	EVAL BY AUDIOLOGISTSPEECH PATHOLOGIST   	    21.32	   $21.32	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5956	SPEECH PERCEPTION TESTING PREOR POST    	    21.32	   $21.32	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5958	COCHLEAR IMPLANT BY AUDIOLOGIST, PER HR 	   112.32	  $112.32	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5964	COCHLEAR IMPLAN RECHECK/TROUBLE SHOOTING	    56.16	   $56.16	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5966	PT/CAREGIVER ORIENTATION, PER HOUR      	   112.32	  $112.32	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5968	POSTCOCHLEAR IMPLANT TESTING PER 30 MIN 	    33.02	   $33.02	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z5999	EPSDT SERVICES-UNLISTED/SUPPLEMENTAL SVS	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z6004	CTR OR HOSP DIALYSISXCL PROF CHG-INCL.LA	   141.31	  $141.31	      ---	       --	009	0	0	0.00	    $0.00	N	
1	Z6006	CTR OR HOSP DIALYSIS-XCL PROF CHG AND LA	   136.19	  $136.19	      ---	       --	009	0	0	0.00	    $0.00	N	
1	Z6020	CTR OR HOSP DIALYSIS XCL PROF CHG-INCL.L	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
K	Z6200	INITIAL NUTRIT ASSESSMENT/DEVELOP 30 MIN	    16.83	   $16.83	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	Z6202	SUB NUTRITION ASSESS/DEVELOP EA SUB 15MN	     8.41	    $8.41	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	Z6204	FOLLOW-UP ANTEPARTUM INDIVIDUAL EA 15MIN	     8.41	    $8.41	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	Z6206	FOLLOW-UP ANTEPARTUM PER PATIENT EA 15M 	     2.81	    $2.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	Z6208	POSTPARTUM NUTR ASSE/TREAT/INTER IND 15M	     8.41	    $8.41	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	Z6300	INIT PSYCHOSOCIAL ASSESS/DEVEL FIRST 30 	    16.83	   $16.83	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	Z6302	SUB PSYCHOSOCIAL ASSESS/DEVELOP EA 15MIN	     8.41	    $8.41	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	Z6304	FOLLOW-UP ANTEPARTUM PSYCHOSOCIAL EA 15M	     8.41	    $8.41	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	Z6306	FOLLOW-UP ANTEPARTUM PSYCHSOCIAL EA 15MI	     2.81	    $2.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	Z6308	POSTPARTUM PSYCHOSOCIAL ASSESS EA 15MIN 	     8.41	    $8.41	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	Z6400	NEW CLIENT ORIENTATION EA 15MIN         	     8.41	    $8.41	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	Z6402	INITIAL HEALTH ED ASSESS/DEVELOP 30 MIN 	    16.83	   $16.83	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	Z6404	3UB HEALTH EDUCATION ASSESS/DEVELOP 15MI	     8.41	    $8.41	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	Z6406	FOLLOW-UP ANTEPARTUM HEALTH/ED EA 15MIN 	     8.41	    $8.41	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	Z6408	FOLLOW-UP ANTEPARTUM HEALTH ED EA 15MIN 	     2.81	    $2.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	Z6410	PERINATAL EDUCATION INDIVIDUAL EA 15MIN 	     8.41	    $8.41	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	Z6412	PERINATAL EDUCATION GROUP PER PAT EA 15M	     2.81	    $2.81	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	Z6414	POSTPARTUM HEALTH ED ASSESS IND EA 15MIN	     8.41	    $8.41	      ---	       --	009	0	0	0.00	    $0.00	Y	
K	Z6500	INITIAL COMP FIRST 30 MIN/INC CASE COORD	   135.83	  $135.83	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z7500	USE OF HOSP,EXAM.OR TREAT.RM.           	    23.77	   $23.77	      ---	       --	009	0	0	0.00	    $0.00	N	
1	Z7502	USE OF EMERGENCY ROOM                   	    34.58	   $34.58	      ---	       --	009	0	0	0.00	    $0.00	N	
1	Z7504	USE OF CAST ROOM                        	    34.58	   $34.58	      ---	       --	009	0	0	0.00	    $0.00	N	
1	Z7506	USE OF OPER ROOM OR CYST ROOM-FIRST HOUR	   101.90	  $101.90	      ---	       --	009	0	0	0.00	    $0.00	N	
1	Z7508	USE OF OP OR CYSTO RM 1ST SUBSEQ HALF HR	    40.76	   $40.76	      ---	       --	009	0	0	0.00	    $0.00	N	
1	Z7510	USE OP OR CYSTO RM SEC SUBS HALF HOUR   	    40.76	   $40.76	      ---	       --	009	0	0	0.00	    $0.00	N	
1	Z7512	USE OF RECOVERY ROOM                    	    18.22	   $18.22	      ---	       --	009	0	0	0.00	    $0.00	N	
1	Z7514	PAY FOR RM AND BOARD AND GEN NURSING CAR	    40.76	   $40.76	      ---	       --	009	0	0	0.00	    $0.00	N	
1	Z7516	USE OF FACILITY - BIRTHING ROOM         	  1975.74	 $1975.74	      ---	       --	009	0	0	0.00	    $0.00	N	
1	Z7604	EX CORP SHOCK WAVE LITHRPSY OUTPAT FACIL	  2000.00	 $2000.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	Z7606	HYPERBARIC OXY CHMBR 1ST 15MIN ATMOS ABS	    19.73	   $19.73	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z7608	HYPERBARIC OXY CHMBR EACH SUB 15 MIN    	    19.73	   $19.73	      ---	       --	009	0	0	0.00	    $0.00	Y	
1	Z7610	MISC DRUGS AND MED SUPPLIES, ADMIN STAT 	     0.01	    $0.01	      ---	       --	009	0	0	0.00	    $0.00	N	
1	Z7612	UNLISTED SEVICES                        	     0.00	    $0.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	Z7614	HOPTEL SERVICES/ROOM/BOARD              	    32.53	   $32.53	      ---	       --	009	0	0	0.00	    $0.00	N	
1	Z9725	INITIAL INFANT HEAR-SCREEN-HOSP/INP     	    30.00	   $30.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	Z9726	INITIAL INFANT HEAR-SCREEN-OUTPATIENT   	    30.00	   $30.00	      ---	       --	009	0	0	0.00	    $0.00	N	
1	Z9727	INFANT HEARING RESCREEN-OUTPATIENT      	    30.00	   $30.00	      ---	       --	009	0	0	0.00	    $0.00	N	